Is Tanzania’s HIV medicine shortage due to donor cutbacks?

Are the recent shortages of drugs used to manage HIV/AIDS linked to the withdrawal of development partners?

In a recent article published in the Daily News, Director of Pharmaceutical Services in the Ministry of Health, Community Development, Gender, Elderly and Children, Mr Daud Misasi, was quoted as saying that crucial drugs had ‘gone missing’ following the withdrawal of development partners who supported a programme to supply these medicines.

The missing drugs include Fluconazole and Acyclovir, which are used to treat candidiasis and herpes simplex respectively. These drugs are essential in the management of HIV, as they are administered to treat opportunistic infections before patients are put on Anti-Retroviral Therapy (ARVs).

We had these drugs donated by partners … but we are now experiencing shortages for lack of funding … so we’ve decided to source our own funding from next financial year — Daud Misasi, Director of Pharmaceutical Services

Following this claim, the Daily News visited health facilities in Katoro, Chato and Bukombe and found that the drugs were in short supply, leading to a price hike.

Mr Misasi added that the Tanzanian government would set aside funds in the 2018/19 Financial Year for buying drugs to treat critical opportunistic infections (OIs) for HIV-positive patients, most of which aren’t available in public health facilities.

Therefore the question is, how much of Tanzania’s medicine supply is supported by donor-funded programmes?

PesaCheck has researched this issue and finds the claim by Daudi Misasi that the withdrawal of donor funding was to blame for the shortage of crucial medicines in Tanzania to be PARTIALLY TRUE the following reasons:

Tanzania relies heavily on donor support in the management of HIV/AIDS, with as much as 97.5 percent of the funding coming from foreign donors. Therefore, any reduction in donor support would have to be matched with an increase in domestic funding.

To manage this, the country established a fund, the Tanzania AIDS Trust Fund, a multi-donor “ring-fenced” budget which was approved by Tanzania’s Parliament in 2015.

For the 2016–2017 fiscal year, the government of Tanzania doubled its prior year allocation to the fund to TZS 6 billion (approximately $2.7 million) against a demand of $285.7 million, majority of which is for commodities such as testing kits.

The Government of Tanzania’s share of health sector spending from its own resources has significantly declined from 13% in 2006/7 to approximately 6% in 2013/14, meaning that domestic funding for health programmes including HIV/AIDS management would be severely affected.

A 2014 study by Twaweza on stock-outs of essential medicine in Tanzania revealed that medicine shortages in the country are the result of not only resource constraints and technical problems, but a lack of long-term planning that led to ineffective policies, weak oversight, and a lack of meaningful accountability.

The study pointed out that reducing donor funding would not make the drugs run out completely. However, there could be possible disruption in the provision of ARVs in Tanzania at the moment following capping and reduction in donor funds.

The Global Fund accounted for about 38% of total HIV-related investment in Tanzania, which included 70% of ARV procurement.

The fund’s board awarded Tanzania a shortened HIV grant extension of $109 million to allow it to continue providing essential HIV services through to the end of 2017 following the expiry of a $277.5 million grant on 31 December 2016.

In January 2018, the Global Fund and health partners in Tanzania signed grant agreements to work toward ending the epidemics of HIV, tuberculosis and malaria. The new grants will also seek to increase coverage of HIV services in order to boost testing, treatment and management of the condition. The grants, worth US$525 million, will cover the implementation period from 2018 2020.

Tanzania’s heavy reliance on donor support for HIV and STD drugs cannot be overlooked because the withdrawal of this support could worsen existing shortages and uneven supply chains, as a 2014 report by research institute REPOA shows.

According to REPOA, medicine shortages and stock-outs can be attributed to delayed orders, or the fact that many of these drugs were never ordered in the first place. Essential medicines and medical supplies were found to be lacking, showing that the problem goes beyond financing into supply chain management.

Therefore, the claim by Daud Misasi that the shortage of HIV/AIDS medication in Tanzania is due to the withdrawal of development partners who financed their supply is PARTIALLY TRUE.

While the withdrawal of donors has adversely affected the supply of medication, major organizations are signing new funding agreements which could potentially improve the situation. Additionally, the shortage appears to be largely due to poor supply chain management, and this needs to be remedied in order to make medicines more readily available.

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This report was written by PesaCheck Fellow Kiki Otieno, a data journalist based in Tanzania, and edited by PesaCheck managing editor Eric Mugendi. The infographics are by Eunice Magwambo, a Kenyan graphic designer, visual artist and digital content producer.

PesaCheck, co-founded by Catherine Gicheru and Justin Arenstein, is East Africa’s first fact-checking initiative. It seeks to help the public separate fact from fiction in public pronouncements about the numbers that shape our world, with a special emphasis on pronouncements about public finances that shape government’s delivery of public services linked to the Sustainable Development Goals, such as healthcare, rural development, and access to water and sanitation. PesaCheck also tests the accuracy of media reportage. 
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PesaCheck is a joint initiative of Code for Africa, through its local Code for Tanzania chapter, and the Data Zetu initiative to give Tanzanian citizens actionable data, in partnership with a coalition of local media organisations, with additional support from the International Center for Journalists(ICFJ).

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