Paying for 'free' services

HARARE - Thousands of people living with HIV and Aids face the risk of losing their lives because of unnecessary user fees demanded by clinics for them to collect drugs which they are supposed to get for free.

The patients are defaulting on their drugs as a result of these user fees.

Many of them cannot afford them with a month’s supply of Tenofovir (a drug used to treat HIV in adults) costing an average of $5 a month.

As a result some patients are receiving expired antiretrovirals (ARVs) or those meant for children leaving them exposed to drug resistance.

The drugs, bought with a combination of donor funds and the Aids Levy are supposed to be distributed for free.

A two-month investigation by the Daily News at local clinics in Chitungwiza and Harare discovered a shocking situation.

Institutions distributing HIV drugs bought using donor funds and Aids Levy contributions are asking patients to pay an extra fee to get them.

These revelations come amid reports that the National Aids Council (Nac) spent $70 000 on a conference junket for seven of its officials to the United States recently. The importance of this trip and its justification remain unclear although the Nac board member Madeline Dube who was part of the junket said the trip was important because it offered insights into how Nac can fight the disease more effectively.

For long Nac has been accused of failing to properly manage Aids Levy funds and with the decrease in international funding the levy is increasingly becoming important.

Global Fund which funds 35 percent of resources used in the country’s HIV sector is reducing its support due to the international financial crisis which has hit Western countries.

UNAids advised countries, donors, and other partners to come up with new strategies of generating new resources and optimise Aids-related investments because the Global Fund was unable to fund Aids programmes as it used to.

Drugs used by the patients in conjunction with ARVs such as, Neverapine and Cotrimoxazole are in short supply as a result of the funding shortfall and patients are being asked to pay for them in controversial circumstances.

This is despite the fact that the drugs are procured using Aids Levy which Zimbabwean workers pay for as monthly contributions.

In accordance with the provisions of Section 14 Subsections 14 and 15 of the Finance Act Chapter 23:04, Aids Levy is charged on individuals, companies and trusts at a rate of three percent of the amount earned.

The money is collected by the Zimbabwe Revenue Authority (Zimra) and send directly to Nac.

Of the total funds collected under the Aids Levy, 50 percent goes towards the ARV therapy programme, 10 percent to prevention, six percent to monitoring evaluation and coordination to enabling environment, 23 percent and four percent to programme logistics support and assets accounts respectively.

Last year Nac got $25 million from Aids Levy and is projecting to get $30 million this year but it blames the closure of companies for failing to meet its target.

At least 476 000 people were on Antiretroviral Treatment (Art) as at the end of April 2012 according Nac statistics, with a total of 563 944 in need of Art.

“I used to collect my drugs at Parirenyatwa Hospital until recently I was transferred to Kuwadzana Polyclinic. The transfer was to my advantage since I stay in that area but it is now turning out to be a disadvantage because I have to pay a dollar for the drug collection which we used to get for free,” Julius Makomo of Kuwadzana Extension told the Daily News adding getting that dollar for someone who is not employed like him is a herculean task.

He is not alone in this predicament.

Kudzanai Mahwisa of Mabvuku said: “I was told to produce a dollar at Mabvuku Clinic last week. Prior to that we used to get the drugs for free at the same clinic. We are not told the reason behind paying for the drugs.”

According to Zimbabwe HIV Aids Activist Union president Bernard Nyathi this new measure of asking patients to pay extra costs has resulted in some of them skipping medication something which puts their lives in danger.

Anyone on Art should take medication on a daily basis.

Zimbabwe HIV and Aids Activist Union vice president Stanley Takaona said the fact that patients are being asked to pay for drugs is a sign of bad things to come.

“The country is running out of ARVs but authorities are not telling us the truth,” Takaona said.

An official who works at Kuwadzana Polyclinic who refused to be named confirmed that they are charging $1 per patient to collect ARVs.

“It is not like we are selling the drugs. The dollar we are charging is for administrative purposes. It is used for the purchasing of cards pens used by the clinic,” the official said.

Zimbabwe Network of People Living with HIV’s spokesperson Paidamoyo Magaya said the practice of asking patients to pay for drugs, though illegal, is widespread.

“They are being made to pay $2 for Cotrimoxazole which translates to $6 272 a week for the 1 112 of our members on Art and 2 024 on Cotrimoxazole,” said Magaya.

He said it is time to make the Aids levy work in preparation for the pullout of the donors.

“ZNNP+ gets $300 per province per quarter and $5 000 per quarter at national level for quarterly board meetings and network of positive women’s meetings.

“We need to be sustained such that in the event that Global Fund ends, the network will not die. What we are getting is a drop in the ocean yet we are the infected people,” she said.

The network provides drugs to people living with HIV and Aids.

People Living with HIV and Aids representative on the Nac board, Golden Guni agrees that the situation is becoming dire.

He recently told local media that patients on Art are now being switched from one combination of drugs  to another depending on which drug is available and the supply only last for up to two weeks.

Previously a three month supply was the recommended standard.

Aids and Arts Foundation regional coordinator Emmanuel Gasa said they are not sure of the existence of Aids Levy.

“Nothing tangible has been produced by the National Aids Council from Aids Levy. Our members continue to receive expired drugs. They continue being charged by hospitals when they want to collect their drugs which they should get for free,” he said.

The Zimbabwe Lawyers for Human Rights’ (ZLHR) HIV and Aids unit blames corruption for all this.

In its “Corruption Burns Access” national investigation, ZLHR found out that, “drug stock-outs have become commonplace, especially for those on secondline treatment who are at times given prescriptions to buy over the counter at their own expense.”

The report also concluded that the stock-outs are engineered by health personnel in an attempt to source bribes or promote their private enterprises by referring patients to buy from their own pharmacies.

“Fifty-seven percent of PLHIV who paid bribes needed access to drugs, 24 percent needed diagnostic services, and 19 percent paid a bribe for initial enrolment. Sixty-three percent of those who were asked to pay a bribe at one point were declined access to drugs or services.

This resulted in people defaulting or outsourcing for drugs or the required services,” the ZLHR report stated.

Nac officials acknowledged the shortage of ARVs but denied that they were being sold to patients.

“We have received an emergency order to purchase the drugs,” Nac chief executive officer Dr Tapuwa Magure told the Daily News.

“Financing National response to HIV using health insurance is one of the strategies and we will increase levels of domestic funding to the pandemic. Donor funding has been dwindling and we need to move fast in looking for alternative ways of increasing domestic funding,” he said adding that one such way would be to convince medical aid societies to provide drugs to their clients.

The chairperson of the Association of Healthcare Funders of Zimbabwe Enock Chitekedza said his organisation is already doing that.

“Despite the absence of empirical evidence it is important that we have an organised and sustainable approach towards HIV and Aids. As an organisation it has been our desire to procure ARVs on bulk in order to enjoy lower costs,” he said.

Another domestic way of funding HIV and Aids programmes which has been suggested by Aids organisations is the allocation by government some funds from the country’s diamond sales towards the procurement of ARVs.

Asked if the country is not faced with a stockout of ARV, Health and Child Welfare ministry’s permanent secretary Retired Brigadier General Gerald Gwinji was evasive.

“l think it’s a matter of logistics. We have enough money for that,” Gwinji said. - Garikai Chaunza

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