MOZAMBIQUE: MSF to ensure sustainabiliity of ARV programme

[ This report does not necessarily reflect the views of the United Nations]

MAPUTO, 17 Jan 2006 (IRIN/PLUSNEWS) - In a bid to ensure the sustainability of its antiretroviral (ARV) treatment programme in Mozambique, the international NGO, Medecins Sans Frontieres (MSF), has focussed on skills transfer with the aim of handing over the running of its sites to the government.

This would see the government and local community taking over the responsibility for running MSF's Lichinga site in the northern Niassa province, which treats 370 patients, by the end of 2008.

In South Africa, MSF has also been training local health officials to take over its ARV treatment programmes.

"It is not our role to substitute government and take over its responsibility to its citizens," said Patrick Wieland, MSF coordinator in Maputo. As a relief organisation rather than a development agency, MSF did not not seek a permanent presence in Mozambique, he added.

"We discussed this in Lichinga last week and people understood that we cannot replace the ministry of health," Wieland said.

He noted that MSF's programme in Maputo, which treats 4,000 patients, would take longer to be absorbed into the public health sector.

Around 17,000 Mozambicans are on antiretroviral treatment, out of an estimated 200,000 who need it, and the country has a HIV prevalence rate of 16.2 percent.

Wieland said MSF had accomplished what it set out to do. "We proved that a certain model of ARV treatment could work in poor settings, using non-medical people and community involvement," he commented.

Since 2001, MSF treatment programmes in South Africa, Malawi and beyond have proved that with strong community participation, drug adherence rates higher than those of Western countries could be achieved. When the price of ARV drugs plummeted from US $10,000 a year to US $300 by the use of generics, MSF extended treatment to thousands of people.

The organisation will officially hand over their three South African sites, where 3,600 HIV positive people receive treatment, to the Western Cape provincial health department in April 2006.

In Maputo, Amos Sibanda, executive director of the National Network of People Living with HIV/AIDS [Rensida], admitted to having "a bit of concern" about MSF's planned pull-out.

"We have doubts about the efficiency of the public service, its bureaucracy and lack of training," he told IRIN. "The success of the handover hinges on government's commitment, [but] at the same time, this process may boost it [government commitment]."

MSF said it would only hand over programmes to a capable partner and not leave people without life-saving treatment. "We understand the fears, but we are training local staff very carefully," explained Wieland. The training includes theory and practice.

"MSF is never going to pull out and leave people without treatment: that would be ethically and medically unacceptable," added James Lorenz, MSF press officer for Southern Africa.

In Lichinga, the ministry of health has taken over the regular supply of drugs originally managed by MSF.

The next component of the programme to be transferred will be the prevention of mother-to-child transmission. MSF has been training midwives, nurses and doctors at the city hospital and rural clinics, as well as community activists to help patients follow their treatment regimen.

One day per week, hospital doctors work alongside MSF staff at the treatment site. At the provincial health directorate, MSF logisticians show officials how to log statistics and manage the supply of drugs for ARV treatment and opportunistic infections.

"It is a slow process and we go one step at a time," said Nuria Domingo, the MSF field coordinator in Lichinga.

[ENDS]