"Capacity shortfall" could derail ARV rollout

As the recipient of a significant amount of donor funding for HIV/AIDS, money is no longer seen as a constraint to Malawi's treatment programme, officials told PlusNews. But the country is now faced with a "serious capacity shortfall" that could derail its rollout plan. Malawi has received funding pledges exceeding US $400 million over the next five years and is planning to provide antiretroviral (ARV) drugs to 40,000 HIV-positive people by December 2005, the National AIDS Commission (NAC) director of programming, Roy Huaya, told PlusNews. About 9,000 people were currently receiving anti-AIDS medication through the public and private sector, as well as treatment initiatives run by aid agencies like Medecines Sans Frontieres. "Our greatest concern is that we are moving at a slower pace than anticipated ... we are only just beginning to accumulate some speed," Hauya said. The biggest problem, according to UNAIDS country coordinator Dr Erasmus Morah, was the lack of human capacity in the health sector. Severe staff shortages as a result of a brain drain had caused many health facilities to close down, as there was "nobody to run them", he noted. Although there had been sufficient people on the ground to launch the programme, Hauya expressed concern that there would not be enough adequately trained doctors and nurses to sustain it. The government has responded to the exodus of skilled health personnel by drawing up a US $273 million dollar emergency relief plan to address the problem. Malawi will be using a Global Fund grant of US $196 million over the next five years to finance the ARV rollout. Although welcoming the financial support from the donors, activists from the National Association For People Living With HIV/AIDS in Malawi (NAPHAM) warned against "donor dependency". "We have to look forward. What will happen after the five years? The government can't just give free ARVs - they must also support and train us to become self-sufficient," Jacob Kambemba, a NAPHAM field supervisor, told PlusNews. Another challenge was to ensure that there would be a regular supply of ARVs, "to feed hospitals in a continuous cycle", said Hauya. He admitted that there had been "logistical nightmares" over the ordering and supply of drugs. Malawi does not have the capacity to manufacture ARVs locally, to eliminate possible drug shortages. "This is something we would like to consider, in collaboration with other countries in the region - we can't go it alone," he said. But, as Hauya pointed out, the Southern African region had "not done terribly well" in coordinating drug procurement efforts, as countries were working individually.