Africa Health News May-june 2009

A WHITAKER GROUP PUBLICATION

MAY/JUNE 2009

AFRICA HEALTH NEWS AFRICAN HEALTH DELEGATION

DELEGATION CALLS FOR SUSTAINABLE ADVANCES THROUGH PARTNERSHIPS The 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, Tanzania and Uganda, and the African Union Commission in Washington from April 19 to 25 to advocate for expanded US support and funding for African health initiatives and to promote public-private partnerships in health. “With a new administration in the White House and a global economic crisis forcing a review of every US funding commitment, decision-makers in Washington are looking for new ways and new partners to promote sustainable advances in health.” said Mr. Chris Singer, President of PhRMA International, which is a leader of GHP. “It is imperative that they hear directly from African health leaders about their health priorities as well as the success of innovative health partnership models.” GHP seeks to bring researchbased biopharmaceutical companies and global health leaders together to improve health in the developing world. Its members are participating in a host of successful public-private partnerships across the continent that are transforming public health systems and improving access to treatments that PHOTO: GHP are returning millions of Africans The delegation at the Capitol to productive lives. Throughout the week the delegates engaged a diverse group of stakeholders, including NGOs, foundations, universities and the private sector. In recognition of World Malaria Day, the delegation participated in a Congressional forum on strategies to combat malaria, a disease that kills over 800,000 people in sub-Saharan Africa every year. Members of the delegation provided their perspectives at roundtable discussions on a range of issues, including counterfeit and substandard drugs, neglected tropical diseases (NTDs), successful public-private partnership models and public health education in Africa. Rep. Donald Payne (D-NJ), chairman of the House of Representatives Subcommittee on Africa and Global Health, and Rep. Chris Smith (R-NJ), the ranking Republican on the Africa and Global Health Subcommittee were among the members of Congress who engaged the delegation during the visit. The delegation also met with the US State Department, the Office of the Global AIDS Coordinator, Admiral Timothy

Ziemer of the President’s Malaria Initiative, the National Institutes of Health’s Dr. Anthony Fauci and World Bank Vice-President for Africa Obiageli Ezekwesili. While emphasizing the importance of continued support for African health concerns, members of the delegation also seized the opportunity to personally thank policy-makers for the 2008 $48-billion reauthorization of PEPFAR, the landmark legislation PHOTO: GHP that commits historic levels of US Dr. Kelita Kamoto, Director of funding to combating HIV/AIDS, HIV/AIDS, Malawi Ministry of tuberculosis and malaria in the Health at the AstraZeneca research developing world. “While it is true that only the and development facility in Boston United States has the capacity to sustain such a large program,” said Dr. Grace Kalimugogo, the African Union Commission’s Coordinator for HIV/AIDS, Malaria and Tuberculosis, “it is also true that only the United States has the will to show such unprecedented generosity.” “These delegates are at the forefront of African-innovated, Africanled development,” commented Ms. Rosa Whitaker, President and CEO of The Whitaker Group (TWG), which worked with GHP to coordinate the delegation’s visit to Washington. “They are engaging a diverse group of stakeholders to make very real advances in effective and sustainable health care in Africa. As the people who are implementing policies on the ground, it is critical that their voices are heard in Washington.” The delegation also presented a leadership award to President Jimmy Carter and The Carter Center for their work over the past 25 years in combating NTDs in Africa. At the awards reception, hosted by GHP and ONE, the global advocacy group, the center was given particular recognition for its work in all but eradicating guinea worm disease. Incidence of the disease has dropped 99.7% from 3.5 million cases in 20 countries in 1986, when President Carter launched the eradication campaign, to under 5,000 cases in six countries today. Accepting the award on behalf of President Carter were Dr. John Hardman, President and CEO of The Carter Center, and Dr. Don Hopkins, the center’s Vice President for Health Programs. “The Carter Center is not the main ingredient,” Dr. Hopkins said. Rather, he added, the center is a “catalyst,” working with African Ministries of Health and community groups on the ground. Following their meetings in Washington, the delegation traveled to Boston to tour the AstraZeneca research and development facility where innovative treatments for cancer and infectious disease are developed. Since 2007, AstraZeneca has partnered with the African Medical Research Foundation (AMREF) in Uganda to fight tuberculosis, HIV/AIDS and malaria in that country. The delegation also met with the Massachussetts Commissioner of Public Health.

PAGE TWO US HEALTH FUNDING

IMMUNIZATION

RWANDA FIRST DEVELOPING NATION TO OFFER PNEUMOCOCCAL VACCINE Rwanda has become the first developing nation to launch a national immunization campaign against pneumococcal disease, the world’s leading preventable killer of children under five. Working in partnership with the GAVI Alliance, Wyeth pharmaceutical company and other global partners, Rwanda’s Ministry of Health aims to vaccinate nearly all of the country’s children younger than one by the end of 2009, and all Rwandan infants on a routine basis thereafter. Pneumococcal disease can cause potentially life-threatening illnesses such as pneumonia, meningitis and sepsis. Worldwide, pneumococcal disease takes the lives of 1.6 million people every year, including about one million children under the age of five. More than 90% of these deaths occur in developing countries. Globally, 35 high and middle-income countries, including South Africa, currently provide routine childhood immunization against the disease. Rwanda is the first low-income country to do so. “This is a proud day for Rwanda and an important milestone for the developing world,” said Dr. Richard Sezibera, Rwanda’s Minister of Health, at the vaccine’s launch in Kigali in April. “We are committed to saving the lives and improving the health of our most precious national resource our children. With the introduction of this vaccine, our goal of significantly reducing child death in Rwanda will now be within reach.” Wyeth will donate 2.5 million doses of Prevenar®, the pneumococcal conjugate vaccine, to Rwanda this year - enough to immunize all Rwandan children under one. It has also committed to donating the vaccine to the Gambia, which is planning to launch its own immunization campaign later this year. Both the Rwandan and the Gambian campaigns are the first outcome of GAVI’s 2007 launch of a unique financing mechanism known as the Advance Market Commitment (AMC). An AMC is a binding contract, typically offered by a government or other financial entity, used to guarantee a viable market for newly-developed vac-

PHOTO: GAVI/09/THOMAS RIPPE

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 that guarantee, GAVI partners hope to provide an incentive to biopharmaceutical research companies to develop vaccines and drugs for neglected diseases that disproportionately impact low-income countries. The governments of Italy, the United Kingdom, Canada, Norway and Russia, and the Bill & Melinda Gates Foundation launched the pilot AMC against pneumococcal disease with a collective $1.5 billion commitment. The GAVI Alliance is a global partnership that includes governments of both industrialized and developing countries, the World Health Organization (WHO), UNICEF, the World Bank, research and technical health institutions, biopharmaceutical research companies, civil organizations and the Bill & Melinda Gates Foundation. Since 2000, GAVI has provided innovative financial support to accelerate the introduction of basic vaccines in developing countries. More than 200 million children in 72 countries have been immunized against a number of common, life-threatening diseases, including diptheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b (Hib) and yellow fever. The WHO estimates that between 2000 and 2008, GAVI-supported vaccines have prevented 3.4 million deaths. The pneumococcal vaccine could save the lives of more than 440,000 children by 2015 and contribute significantly to the attainment of the UN Millennium Development Goal of reducing by two-thirds the mortality rate for children under five.

PRESIDENT OBAMA ASKS FOR $63B FOR GLOBAL HEALTH President Barack Obama has asked the United States Congress for $63 billion over the next six years to fight global disease and provide more aid for prenatal and postnatal care, children’s health and fighting tropical diseases. The budget request builds on last year’s five-year, $48-billion reauthorization of the President’s Emergency Plan for AIDS Relief (PEPFAR). “We cannot fix every problem, but we have a responsibility to protect the health of our people, while saving lives, reducing suffering, and supporting the health and dignity of people everywhere,” President Obama said in a statement when his administration’s budget was released in May. “America can make a significant difference in meeting these challenges and that is why my administration is committed to act.” Between 2004 and 2007, PEPFAR saved 1.2 million lives in a dozen hard-hit African countries, according to a study published in April in the Annals of Internal Medicine. PEPFAR, the largest single foreign aid program for health in history, lowered the AIDS death rate on average by 10.5%, author Dr. Eran Bendavid of Stanford University asserted. “Treatment has worked,” he said, adding that the challenge now was to make prevention “a serious component of the program in the next five years.” The study found that the program’s cost per life saved was $2,450. To date, $18.8 billion has been spent, mostly to treat people already infected with the HIV virus. Dr. Bendavid found that the program was not successful in preventing new infections or lowering overall prevalence of the AIDS virus. “Bringing down prevalence is important and difficult,” Dr. Bendavid said. “You need to reduce the number of new people infected by at least as many as the number of people you’re keeping alive.” The focus countries included in the study were Botswana, Côte d’Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia. President Obama has committed to ramping up prevention programs under PEPFAR and has removed restrictions on giving funding to family-planning clinics.

SECURE SUPPLY CHAINS

SUSTAINABLE DRUG PROCUREMENT KEY TO ENHANCED HEALTH CARE IN AFRICA Across Africa, ministries of health are racing to manage the flow of drugs and other health sector commodities into their countries. For many countries in Africa, health sector supplies come through multiple channels, from multiple funders, vendors and distributors, all operating with differing and sometimes contradictory quality criteria. Two case studies illustrate how African governments are leading the way in addressing this challenge and establishing strong country ownership of national procurement processes. Botswana Botswana was the first African country to launch a national, public sector antiretroviral (ARV) treatment program and has adopted an ambitious goal of having no new HIV infections by 2016, while bearing 90% of the cost of AIDS prevention and treatment at a cost of almost $200 million a year. Given its enormous national investment, the government is determined to ensure that drug procurement is as cost effective as possible, without jeopardizing quality. It has established rigorous standards of quality, safety and efficacy through its Drug Regulatory Unit (DRU), which is responsible for registering all drugs used in the country. Working with Supply Chain Management System (SCMS), a PEPFAR-funded implementing partner, the Ministry of Health has also introduced standardized tools of quantification and supply planning, and improved training of ministry staff in the DRU and at the country’s Central Medical Stores in Gaborone. In addition, it has strengthened ARV registration systems, installed an updated version of the WHO recommended software for drug registration, and established a national system

Standardized packaging and strict importation rules help ensure quality control

for quantification and pipeline monitoring for laboratory supplies. The Ministry and SCMS are currently establishing a computerized Logistics Management Information System (LMIS) to track supplies and promote sustainable availability of pharmaceuticals and other medical commodities. Today, Botswana is considered by international development agencies to be well on its way to becoming a center of excellence where health officials from other African countries can come for training and information on procurement systems. Rwanda The Government of Rwanda has pioneered an effective national procurement system through the national drug purchasing agency, Centrale d’Achat des Médicaments Essentiels du Rwanda (CAMERWA), that has been key to its success in centralizing and streamlining drug procurement. This has led to an increase in the number of Rwandans receiving ARV treatment for HIV/AIDS from around 4,000 in 2004 to nearly 45,000 today. CAMERWA introduced the Coordinated Procurement Distribution Systems (CPDS) to centralize and oversee procurement of drug purchases from different funders, such as PEPFAR, the Global Fund to Fight AIDs, Tuberculosis and Malaria, the World Bank and others. Under CPDS, all international partners purchase portions of ARVs, approved by the Ministry of Health, based on central government planning and in accordance with the country’s procurement practices. Through this coordination, CAMERWA saves money on lower prices for drugs as well as lower management and transportation costs. As part of its overall strategy to ensure that all pharmaceuticals distributed in Rwanda are of the highest quality, the Rwanda National Parliament recently revised the country’s drug importation laws to ensure quality control upon receipt. Visas and import licenses are issued only after the exporter undergoes a list of stringent requirements. These include certification of good manufacturing and distribution practices, and accurate packaging lists with batch numbers, manufacture dates, appropriate expiry dates, quantities and country of origin. Drugs are also monitored for efficacy.

PHOTO: MIKE BLYTH/FLICKR

Effective drug procurement and distribution to hospitals and pharmacies is considered key to enhanced healthcare in Africa In addition, the Rwandan government has discovered that a further clinical advantage of centralizing procurement and distribution is that CAMERWA is able to standardize and manage packaging, quantities and inscriptions, which differ depending on their source. In 2006, CAMERWA contracted with SCMS, to provide port clearance, storage and distribution services for all PEPFAR commodities in Rwanda. SCMS provides technical support to enhance the capacity of CAMERWA so that it can qualify in the future to become a direct recipient of US government funds. CAMERWA is also installing a computerized warehouse management system, which will enable it to control stock movement, inventory and warehouse operations even more efficiently as drugs begin to be pushed out to regional stores.

PRINCIPLES OF SUCCESSFUL PROCUREMENT AND SUPPLY CHAIN MANAGEMENT ■ STRONG NATIONAL LEADERSHIP ■ CENTRALIZED & STREAMLINED DRUG PROCUREMENT ■ STRINGENT QUALITY CONTROL ■ EFFICIENT & TRANSPARENT MANAGEMENT ■ COORDINATED FORECASTING ■ EFFECTIVE MONITORING, TRACKING AND DATA MANAGEMENT

■ STRATEGIC PARTNERSHIPS THAT BUILD CAPACITY

PAGE FOUR FINANCING HEALTH

LEADERS IN HEALTH

PRIVATE EQUITY FUND LAUNCHED TO STRENGTHEN HEALTHCARE IN AFRICA

DR ERIC GOOSBY GLOBAL AIDS COORDINATOR NOMINEE

The African Development Bank (AfDB), the International Finance Corporation (IFC), the Bill & Melinda Gates Foundation and the German development finance institution Deutsche Investitions- und Entwicklungsgesellschaft mbH (DEG) announced in June that they have created a new private equity fund that will invest in Africa’s health sector. The Health in Africa Fund will invest in small and medium-sized companies in subSaharan Africa, such as health clinics and diagnostic centers, with the goal of helping low-income Africans gain access to affordable, high-quality health services. It will be managed by Mauritius-based Aureos Capital, a private equity fund management company specializing in providing expansion capital to small to mid-cap businesses in Africa, Latin American and Asia. The four institutions have made an initial combined investment of $57 million, including $20 million from AfDB, $20 million from IFC, $10 million from DEG, and $7 million from the Gates Foundation. A second closing is expected to raise up to $63 million more. The new fund will help implement key recommendations of the IFC’s report, The Business of Health in Africa: Partnering with the Private Sector to Improve People’s Lives. The

report found that the private sector already delivers about half of all health-related goods and services in Africa, and that greater investment in private health companies could have major health and economic benefits for Africans. The fund plans to make about 30 investments, ranging from $250,000 to $5 million. While any viable investment opportunity in any part of Africa will be considered, priority countries for early investment include Côte d’Ivoire, Ghana, Kenya, Nigeria, Senegal, Tanzania and Uganda. “The Health in Africa Fund is likely to have considerable growth potential despite the global economic slowdown, and we are committed to supporting this landmark initiative,” said Mr. Donald Kaberuka, AfDB President. The fund will make long-term equity investments in socially responsible and financially sustainable private health companies with the aim of scaling up successful businesses, taking proven business models to new regions, and identifying and investing in areas where there are critical gaps. Investments will be made in a wide range of companies that deliver health services, including hospitals, labs, health management organizations, insurance companies, pharmaceutical companies and providers of medical education.

CONGRESSIONAL MALARIA CAUCUS

DELEGATION OBSERVES WORLD MALARIA DAY ON CAPITOL HILL The African health delegation joined Rep. Donald Payne (D-NJ) and Rep. John Boozman (R-AR), co-chairmen of the Congressional Malaria Caucus, to observe World Malaria Day on April 23 with a discussion on the US President’s Malaria Initiative and successful public-private partnerships to combat the disease. Dr. François Bompart, Vice President for Access to Medicines at sanofi-aventis, gave a presentation about the roll out of the pharmaceutical company’s new artemisinin-based combination therapy (ACT) that simplifies the daily dosage from four tablets twice a day for three days to two tablets once a day for three days. Sanofi-aventis developed the non-patented treatment in partnership with the Drugs for Neglected Diseases Initiative (DNDi). It will be offered to African governments, in-

ternational organizations and NGOs for less than $1 for an adult treatment and for 50 cents per child. Sanofi-aventis has agreed to give 3% of private sector sales revenue to fund government health proPHOTO: GHP grams. Dr. Sam Zaramba, Congressmen Payne Director General, and Boozman co- Uganda Ministry of sponsored a resolution Health, with Rep. that passed the House Payne of Representatives on World Malaria Day recognizing that malaria is preventable and reaffirming US commitments to combating the disease. PREPARED AND DISTRIBUTED BY THE WHITAKER GROUP

Dr. Eric Goosby, a pioneer in the fight against HIV/AIDS, has been nominated by President Barack Obama to head the Office of the Global AIDS Coordinator. Dr. Goosby, currently the CEO and Chief Medical Officer at the Pangaea Global AIDS Foundation, was a leader in implementing national AIDS policies under Dr. Eric Goosby the Clinton Administration and played a key role in the development and implementation of HIV/AIDS treatment scale-ups in Rwanda, South Africa and Uganda, as well as China and Ukraine. He was one of the first US physicians to develop a specialty in treating AIDS patients when he worked at the San Francisco General Hospital, and went on to serve as Deputy Director of the White House National AIDS Policy Office and Director of the Office of HIV/AIDS Policy in the Department of Health and Human Services under President Bill Clinton. Since joining Pangaea in 2001, Dr. Goosby has been a central figure in a number of public-private partnerships in Africa to extend HIV/AIDS treatment and prevention. In 2003, he and the Pangaea team worked closely with the South African government as it developed a comprehensive strategy to make antiretroviral treatment available to the 5.3 million citizens living with HIV and AIDS. In Uganda, under Dr. Goosby’s leadership, Pangaea partnered with pharmaceutical company Pfizer Inc., Makerere University and the Academic Alliance for AIDS Care and Prevention to create the Infectious Diseases Institute (IDI), a regional HIV/AIDS training and research center. Dr. Goosby also helped develop initiatives in Tanzania to more closely link HIV prevention and treatment activities, as well as implementing special programs focused on women’s health. He will take office upon confirmation by the US Senate.