[e-drug] Sachs' unfashionable Rx for third world aid (6)

["Carolyn Green" <cgreen@aidsalliance.org>]

E-DRUG: Sachs' unfashionable Rx for third world aid (6)
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I have to differ from Paul Lobb's view that re-introducing user fees
would be a good idea, at least in the area of treatment for HIV and
related illnesses. Qualitative research that we did in Zambia - and
subsequent experience in the country when the government made the
decision to provide free ARV treatment and associated lab tests -
indicate very strongly that uptake both of HIV testing and of ARV
treatment escalated rapidly in response. There seem to be some effects
on prevention as well - people who learn to adhere well to their
treatment seem to be more careful generally about their own and other
people's health. There are nearly 60,000 people on ARV treatment in
Zambia now, and most of them would not have been if treatment had not
become free. The frequent funerals and hospital admissions would have
continued...

Most people in low-resource countries are too poor to afford even
low-level user fees. So, in these circumstances, user fees cost lives
and prolong serious morbidity. Even now, the costs of getting to clinic,
buying food, and time lost on income generation, are still serious
barriers for some. There may of course be different arguments for
situations where disease burdens and incomes are different - but the
poorest would still get a raw deal if everyone has to pay. 

And yes, there are serious challenges to the sustainability of high
levels of free treatment - but I really don't think user fees would make
much difference to that, since they are expensive to collect and don't
often generate much income. 

What will make ARV provision sustainable is the continued (and
increased) commitment of rich countries to supporting health systems and
funding the Global Fund, UNITAID etc to provide the money and health
goods that poor countries with high disease burdens will never be able
to afford on their own. All countries have to commit to ensuring
sustainable supply systems and health services, and to removing
corruption and improving prevention, but without external help for some
time, the tide won't turn easily. 

Carolyn Green
Senior Technical Advisor, Care & Support
Care & Impact Mitigation Team
International HIV/AIDS Alliance
104-106 Queens Road
Brighton BN1 3XF
United Kingdom
direct phone: +44 1273 718747
main phone: +44 1273 718900
cellphone: +44 773311 2368
cgreen@aidsalliance.org