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The Procurement of Anti-Retroviral Drugs in Rwanda
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Kigali, Rwanda│ November 2005
Over the last year the number of HIV-infected Rwandans receiving anti-retroviral drugs (ARVs) increased from around four thousand people to nearly 16,000 people. The Rwandan Government, donors and implementing partners have pioneered an effective and accountable system to jointly procure ARVs for Rwanda. The donors and organizations currently providing ARVs in Rwanda include the US Government, the Global Fund, the World Bank MAP, the Clinton Foundation, Lux Development and Médecins Sans Frontières (MSF).
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In October 2004, the Rwandan Ministry of Health issued a Ministerial Order requiring that all ARVs be procured through CAMERWA, the national pharmaceutical procurement agency, in order to maximize purchasing power. The Ministerial Order requires providers to prescribe ARVs according to WHO guidelines, use WHO-approved generic drugs as ‘first line’ treatment, and limit the use of brand-name ARVs to patients requiring ‘second-line’ ARVs. The ‘second-line’ drugs are used for patients who have complications with the ‘first line’ treatment.
In December 2004, the first coordinated procurement took place, with donors purchasing portions of Rwanda’s overall ARV needs according to their individual procurement restrictions. Emergency Plan funds were used to buy FDA-approved ARVs for ‘second-line’ treatment, while Global Fund, MAP and other donors purchased WHO pre-qualified drugs for ‘first-line’ treatment. As a result of this new system, CAMERWA now distributes ARVs to the pharmacies according to their patient needs, regardless of which donor supports the site. This means all patients receive the most cost effective treatment, rather than the treatment offered by the donor supporting them.
There are several benefits associated with the combined procurement. Donors are getting a better price for the ARVs due to the larger quantities being ordered. Money is also saved through lower management costs and reduced transportation costs. According to Valerie Koscelnik, Chief of Party for CDC Rwanda, the cost of ARVs has decreased by approximately $400 per patient per year.
The system for the procurement and supply of ARVs in Rwanda is groundbreaking. I expect other African countries to follow this model in the future,” said John Dunlop, Supervisory Health Officer for USAID Rwanda.
With increasing numbers of people gaining access to treatment, the coordinated supply of ARVs has been vital. Family Health International (FHI) is an Emergency Plan implementing partner distributing ARVs. Jessica Price, FHI Director, Rwanda, notes the advantage of the combined procurement and supply of ARVs to the patient, “Although a branded drug and its generic copy are chemically the same drug, they can be "packaged" differently with different shapes, quantities and inscriptions. Prior to the coordinated procurement, these differences ran the risk of confusing patients who, for whatever reason, were transferred between clinical sites. A patient, for example, might question the appropriateness of the therapy he or she received at the transfer site because the drugs look different. Skepticism and lack of confidence regarding the quality of the product or the skill of the prescribing physician were potential problems. The coordinated procurement eliminates the potential for such confusion and the possibility of non-adherence to therapy as a result.”
More and more generic drugs are gaining FDA approval. As a result the Emergency Plan is now participating in the procurement of some generic drugs used in ‘first-line’ treatment. These generic drugs tend to be cheaper than the branded versions of the same molecule.
The spirit of cooperation among the donors, implementing partners and the Government of Rwanda is also resulting in support for a strong system for monitoring, tracking, reporting and auditing ARV consumption and supply. CAMERWA maintains statistics on the number of patients receiving ARVs, the current stock of each pharmacy and the consumption rate which makes projections for future procurements more accurate.
Over the next year the US Government supported Emergency Plan will scale up ARV treatment to 20,000 recipients in Rwanda.
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Wed, 30 Apr 2008 12:13:20 -0500
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