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AFRICA HEALTH NEWS
A WHITAKER GROUP PUBLICATIONMAY/JUNE 2009
A
FRICAN
H
EALTH
D
ELEGATION
DELEGATION CALLS FORSUSTAINABLE ADVANCESTHROUGH PARTNERSHIPS
e Global Health Progress initiative (GHP) hosted a delegation of senior health officials from 11 African countries including Botswana,Ghana, Kenya, Lesotho, Malawi, Mali, Namibia, Niger, Nigeria, Tan-zania and Uganda, and the African Union Commission in Washing-ton from April 19 to 25 to advocate for expanded US support andfunding for African health initiatives and to promote public-privatepartnerships in health.
“With a new administration in the White House and a global eco-nomic crisis forcing a review of every US funding commitment, deci-sion-makers in Washington are looking for new ways and new part-ners to promote sustainable advances in health.” said Mr. Chris Singer,President of PhRMA Internation-al, which is a leader of GHP. “It isimperative that they hear directly from African health leaders abouttheir health priorities as well asthe success of innovative healthpartnership models.”GHP seeks to bring research-based biopharmaceutical com-panies and global health leaderstogether to improve health in thedeveloping world. Its members areparticipating in a host of successfulpublic-private partnerships acrossthe continent that are transform-ing public health systems and im-proving access to treatments thatare returning millions of Africansto productive lives.roughout the week the delegates engaged a diverse group of stake-holders, including NGOs, foundations, universities and the private sec-tor. In recognition of World Malaria Day, the delegation participated ina Congressional forum on strategies to combat malaria, a disease thatkills over 800,000 people in sub-Saharan Africa every year. Membersof the delegation provided their perspectives at roundtable discussionson a range of issues, including counterfeit and substandard drugs, ne-glected tropical diseases (NTDs), successful public-private partnershipmodels and public health education in Africa.Rep. Donald Payne (D-NJ), chairman of the House of Representa-tives Subcommittee on Africa and Global Health, and Rep. Chris Smith(R-NJ), the ranking Republican on the Africa and Global Health Sub-committee were among the members of Congress who engaged the del-egation during the visit. e delegation also met with the US State De-partment, the Office of the Global AIDS Coordinator, Admiral Timothy Ziemer of the President’s MalariaInitiative, the National Institutesof Health’s Dr. Anthony Fauci andWorld Bank Vice-President forAfrica Obiageli Ezekwesili.While emphasizing the impor-tance of continued support forAfrican health concerns, mem-bers of the delegation also seizedthe opportunity to personally thank policy-makers for the 2008$48-billion reauthorization of PEPFAR, the landmark legislationthat commits historic levels of USfunding to combating HIV/AIDS,tuberculosis and malaria in thedeveloping world.“While it is true that only theUnited States has the capacity tosustain such a large program,” said Dr. Grace Kalimugogo, the AfricanUnion Commission’s Coordinator for HIV/AIDS, Malaria and Tuber-culosis, “it is also true that only the United States has the will to showsuch unprecedented generosity.”“ese delegates are at the forefront of African-innovated, African-led development,” commented Ms. Rosa Whitaker, President and CEOof e Whitaker Group (TWG), which worked with GHP to coordinatethe delegation’s visit to Washington. “ey are engaging a diverse groupof stakeholders to make very real advances in effective and sustainablehealth care in Africa. As the people who are implementing policies onthe ground, it is critical that their voices are heard in Washington.e delegation also presented a leadership award to President Jimmy Carter and e Carter Center for their work over the past 25 years incombating NTDs in Africa. At the awards reception, hosted by GHPand ONE, the global advocacy group, the center was given particularrecognition for its work in all but eradicating guinea worm disease.Incidence of the disease has dropped 99.7% from 3.5 million cases in20 countries in 1986, when President Carter launched the eradicationcampaign, to under 5,000 cases in six countries today.Accepting the award on behalf of President Carter were Dr. JohnHardman, President and CEO of e Carter Center, and Dr. Don Hop-kins, the center’s Vice President for Health Programs. “e Carter Cen-ter is not the main ingredient,” Dr. Hopkins said. Rather, he added, thecenter is a “catalyst,” working with African Ministries of Health andcommunity groups on the ground.Following their meetings in Washington, the delegation traveledto Boston to tour the AstraZeneca research and development facility where innovative treatments for cancer and infectious disease are de- veloped. Since 2007, AstraZeneca has partnered with the African Medi-cal Research Foundation (AMREF) in Uganda to fight tuberculosis,HIV/AIDS and malaria in that country. e delegation also met withthe Massachussetts Commissioner of Public Health.
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: GHP
e delegation at the Capitol 
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: GHP
Dr. Kelita Kamoto, Director of HIV/AIDS, Malawi Ministry of Health at the AstraZeneca researchand development facility in Boston
 
P
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MMUNIZATION
RWANDA FIRST DEVELOPING NATIONTO OFFER PNEUMOCOCCAL VACCINE
Rwanda has become the first developingnation to launch a national immunizationcampaign against pneumococcal disease,the world’s leading preventable killer of children under five.
Working in partnership with the GAVIAlliance, Wyeth pharmaceutical company and other global partners, Rwandas Minis-try of Health aims to vaccinate nearly all of the country’s children younger than one by the end of 2009, and all Rwandan infantson a routine basis thereaer.Pneumococcal disease can cause po-tentially life-threatening illnesses such aspneumonia, meningitis and sepsis. World-wide, pneumococcal disease takes the livesof 1.6 million people every year, includingabout one million children under the ageof five. More than 90% of these deaths oc-cur in developing countries.Globally, 35 high and middle-incomecountries, including South Africa, current-ly provide routine childhood immuniza-tion against the disease. Rwanda is the firstlow-income country to do so.“is is a proud day for Rwanda and animportant milestone for the developingworld,” said Dr. Richard Sezibera, Rwanda’sMinister of Health, at the vaccine’s launchin Kigali in April. “We are committed tosaving the lives and improving the healthof our most precious national resource -our children. With the introduction of this vaccine, our goal of significantly reducingchild death in Rwanda will now be withinreach.”Wyeth will donate 2.5 million doses of Prevenar®, the pneumococcal conjugate vaccine, to Rwanda this year - enough toimmunize all Rwandan children underone. It has also committed to donating the vaccine to the Gambia, which is planningto launch its own immunization campaignlater this year.Both the Rwandan and the Gambiancampaigns are the first outcome of GAVI’s2007 launch of a unique financing mecha-nism known as the Advance Market Com-mitment (AMC). An AMC is a bindingcontract, typically offered by a governmentor other financial entity, used to guaranteea viable market for newly-developed vac-
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Rwanda’s Health Minister, Dr. Richard Sezibera, delivers the first dose of  pneumococcal vaccine at a clinic in Kigali.
cines or other medicines. By providing thatguarantee, GAVI partners hope to providean incentive to biopharmaceutical researchcompanies to develop vaccines and drugsfor neglected diseases that disproportion-ately impact low-income countries.e governments of Italy, the UnitedKingdom, Canada, Norway and Russia,and the Bill & Melinda Gates Foundationlaunched the pilot AMC against pneumo-coccal disease with a collective $1.5 billioncommitment.e GAVI Alliance is a global partner-ship that includes governments of both in-dustrialized and developing countries, theWorld Health Organization (WHO), UNI-CEF, the World Bank, research and techni-cal health institutions, biopharmaceuticalresearch companies, civil organizationsand the Bill & Melinda Gates Foundation.Since 2000, GAVI has provided inno- vative financial support to accelerate theintroduction of basic vaccines in develop-ing countries. More than 200 million chil-dren in 72 countries have been immunizedagainst a number of common, life-threat-ening diseases, including diptheria, teta-nus, pertussis, hepatitis B, Haemophilusinfluenzae type b (Hib) and yellow fever.e WHO estimates that between 2000and 2008, GAVI-supported vaccines haveprevented 3.4 million deaths. e pneu-mococcal vaccine could save the lives of more than 440,000 children by 2015 andcontribute significantly to the attainmentof the UN Millennium Development Goalof reducing by two-thirds the mortality rate for children under five.
US H
EALTH
F
UNDING
PRESIDENT OBAMAASKS FOR $63B FORGLOBAL HEALTH
President Barack Obama has asked theUnited States Congress for $63 billion overthe next six years to fight global disease andprovide more aid for prenatal and postnatalcare, children’s health and fighting tropicaldiseases.
e budget request builds on last year’sfive-year, $48-billion reauthorization of thePresident’s Emergency Plan for AIDS Relief (PEPFAR).“We cannot fix every problem, but we havea responsibility to protect the health of ourpeople, while saving lives, reducing suffer-ing, and supporting the health and dignity of people everywhere,” President Obama said ina statement when his administration’s budgetwas released in May. “America can make a sig-nificant difference in meeting these challengesand that is why my administration is commit-ted to act.”Between 2004 and 2007, PEPFAR saved 1.2million lives in a dozen hard-hit African coun-tries, according to a study published in April inthe
 Annals of Internal Medicine.
PEPFAR, thelargest single foreign aid program for healthin history, lowered the AIDS death rate on av-erage by 10.5%, author Dr. Eran Bendavid of Stanford University asserted.“Treatment has worked,” he said, addingthat the challenge now was to make preven-tion “a serious component of the program inthe next five years.”e study found that the program’s cost perlife saved was $2,450. To date, $18.8 billionhas been spent, mostly to treat people already infected with the HIV virus. Dr. Bendavidfound that the program was not successful inpreventing new infections or lowering overallprevalence of the AIDS virus.“Bringing down prevalence is importantand difficult,” Dr. Bendavid said. “You need toreduce the number of new people infected by at least as many as the number of people you’rekeeping alive.”e focus countries included in the study were Botswana, Côte d’Ivoire, Ethiopia, Ke-nya, Mozambique, Namibia, Nigeria, Rwanda,South Africa, Tanzania, Uganda and Zambia.President Obama has committed to ramp-ing up prevention programs under PEPFARand has removed restrictions on giving fund-ing to family-planning clinics.
 
S
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UPPLY
C
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SUSTAINABLE DRUG PROCUREMENT KEY TO ENHANCEDHEALTH CARE IN AFRICA
Across Africa, ministries of health are racingto manage the flow of drugs and other healthsector commodities into their countries. Formany countries in Africa, health sector sup-plies come through multiple channels, frommultiple funders, vendors and distributors,all operating with differing and sometimescontradictory quality criteria.
Two case studies illustrate how African gov-ernments are leading the way in addressingthis challenge and establishing strong country ownership of national procurement processes.
Botswana
Botswana was the first African country tolaunch a national, public sector antiretroviral(ARV) treatment program and has adopted anambitious goal of having no new HIV infec-tions by 2016, while bearing 90% of the costof AIDS prevention and treatment at a cost of almost $200 million a year.Given its enormous national investment,the government is determined to ensure thatdrug procurement is as cost effective as pos-sible, without jeopardizing quality. It has es-tablished rigorous standards of quality, safety and efficacy through its Drug Regulatory Unit(DRU), which is responsible for registering alldrugs used in the country.Working with Supply Chain ManagementSystem (SCMS), a PEPFAR-funded imple-menting partner, the Ministry of Health hasalso introduced standardized tools of quanti-fication and supply planning, and improvedtraining of ministry staff in the DRU and at thecountry’s Central Medical Stores in Gaborone.In addition, it has strengthened ARV registra-tion systems, installed an updated version of the WHO recommended soware for drugregistration, and established a national systemfor quantification and pipeline monitoring forlaboratory supplies.e Ministry and SCMS are currently estab-lishing a computerized Logistics ManagementInformation System (LMIS) to track suppliesand promote sustainable availability of phar-maceuticals and other medical commodities.Today, Botswana is considered by interna-tional development agencies to be well on itsway to becoming a center of excellence wherehealth officials from other African countriescan come for training and information on pro-curement systems.
Rwanda
e Government of Rwanda has pioneeredan effective national procurement systemthrough the national drug purchasing agency,Centrale d’Achat des Médicaments Essentielsdu Rwanda (CAMERWA), that has been key to its success in centralizing and streamliningdrug procurement. is has led to an increasein the number of Rwandans receiving ARVtreatment for HIV/AIDS from around 4,000in 2004 to nearly 45,000 today.CAMERWA introduced the CoordinatedProcurement Distribution Systems (CPDS) tocentralize and oversee procurement of drugpurchases from different funders, such as PEP-FAR, the Global Fund to Fight AIDs, Tubercu-losis and Malaria, the World Bank and others.Under CPDS, all international partners pur-chase portions of ARVs, approved by the Min-istry of Health, based on central governmentplanning and in accordance with the country’sprocurement practices.rough this coordination, CAMERWAsaves money on lower prices for drugs as wellas lower management and transportationcosts.As part of its overall strategy to ensure thatall pharmaceuticals distributed in Rwanda areof the highest quality, the Rwanda NationalParliament recently revised the country’s drugimportation laws to ensure quality controlupon receipt.Visas and import licenses are issued only aer the exporter undergoes a list of stringentrequirements. ese include certification of good manufacturing and distribution prac-tices, and accurate packaging lists with batchnumbers, manufacture dates, appropriate ex-piry dates, quantities and country of origin.Drugs are also monitored for efficacy.In addition, the Rwandan government hasdiscovered that a further clinical advantageof centralizing procurement and distributionis that CAMERWA is able to standardize andmanage packaging, quantities and inscrip-tions, which differ depending on their source.In 2006, CAMERWA contracted withSCMS, to provide port clearance, storage anddistribution services for all PEPFAR commod-ities in Rwanda. SCMS provides technical sup-port to enhance the capacity of CAMERWA sothat it can qualify in the future to become adirect recipient of US government funds.CAMERWA is also installing a computer-ized warehouse management system, whichwill enable it to control stock movement, in- ventory and warehouse operations even moreefficiently as drugs begin to be pushed out toregional stores.
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Effective drug procurement and distribution tohospitals and pharmacies is considered key toenhanced healthcare in AfricaStandardized packaging and strict importationrules help ensure quality control 
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