Zimbabwe's prevention of mother to child transmission programme is one of the best on the continent. News of the increasing shortage of a key preventative medicine, Nevirapine, is worrying and a loud cry for an urgent solution to drug stock-outs, procurement bottlenecks, foreign currency scarcity, among other issues.
Research has proved that infants who receive a single dose of the antiviral drug Nevirapine soon after birth and whose mothers take one dose of the same drug during labour are less likely to acquire HIV at birth or during breastfeeding.
It is a known fact that if an HIV-exposed infant is given ART within the first 12 weeks of life, they are 75 percent less likely to die from an AIDS-related ailment.
According to WHO guidelines, which Zimbabwe follows, all infants who test positive for HIV should be immediately initiated on treatment and this should be linked to the mother's course of ARVs.
But, the recent gap in the supply of Nevirapine means that poor mothers who were given prescriptions, but could not afford the drug could have exposed their children to HIV during breastfeeding. Given such a success rate of Nevirapine, why is the health of women and children folded on the bottom shelves when it comes to foreign currency allocation?
We are simply leaving a window wide open to expose infants to HIV and risk having a whole new generation of HIV-positive youths, something Zimbabwe had made great strides to reduce.
Why should we first have a crisis for foreign currency to be released? This, however, should be no excuse for failure to prioritise health, which is also an important development indicator.
The shortages of Nevirapine are a clear indication that choices over allocation of funds to HIV-related treatment (ARVS) need public debate and scrutiny.
There is need to advocate equity in treatment access for HIV/AIDS, both in relation to drug access, beneficiary selection, health service access and treatment linked to prevention and care. We need to promote transparency in national decision-making on treatment access.
The goal should be to ensure 95 percent availability of essential drugs at clinics and district hospital level, whereas these have fallen to below 30 percent at some facilities.
Consumer access to drugs is affected by a range of factors within the procurement access -- drug supplies to health services, drug availability (supply and losses) at health services and access and use by consumers.
A survey of drug supplies conducted at community level by local NGO Community Working Group on Health in 2017 revealed that rural clinics and mission services -- which mainly service the majority poor -- had the lowest availability of vital drugs compared with district, provincial and central services over the last decade. Why does Government allow this to happen knowing well that the majority of people in this demographic cannot afford to buy medicines from private facilities?
A further problem is that the Health Services Fund, which should allocate 40 percent of its funds outside the hospital, has mirrored the issue at district level -- most spending in the hospital, and far less than the required 40 percent allocation at clinic or community level.
Foreign currency should be prioritised for ARV access (i.e. essential drugs be ranked with energy and fuel as a priority claimant on foreign currency) or ARVs would have to be purchased from private suppliers at high prices.
From past experiences, it is clear that foreign currency shortages undermine drug purchases as drug production in Zimbabwe is limited. The current procurement procedure also delays tenders, although this is not a major obstacle.
Increased stock-outs and shortages of vital drugs reduce confidence in the system coupled with the significant loss of drugs delivered due to theft and leakages.
Government spending on health has declined in real terms and is currently concentrated in hospitals, particularly at provincial and central level. There is disproportionately high expenditure on staff as compared to other recurrent inputs such as pharmaceuticals and maintenance, resulting in the general shortage of medical consumables. All these issues need urgent attention.
While it would appear that the private sector has been better able to buffer the effects of inflation and foreign currency shortages on supply, probably due to the pooled risk funding of medical aid and the higher income of the patients it covers, Government has a lot of work to do.
What is sad is this comes at a time Zimbabwe is trying to close all taps on new HIV infections. How do we close the taps when we have huge supply gaps of Nevirapine?