National ARV programme: Options for sustainability

Source: Access Alert newsletter (A bi-monthly
publication of Journalists Against AIDS Nigeria)
No. 10 September/October 2003

SINCE its commencement in January 2001, the Nigerian
government-funded national ARV programme has cost the federal
government an estimated US$6m (six million US dollars).

Although the programme set a target of providing
ARVs for 10,000 adults and 5000 children, a little over
10,000 clients in 25 centers are currently on treatment,
according to information available to Access Alert.

Drugs for the programme are purchased from two
WHO-recognised Indian pharmaceutical firms: Cipla (at an
average cost of $350 per patient per year); and Ranbaxy
($320 per patient per year). Till date, the federal
government has borne all expenses for drug purchases, which
is sold to PLWH at a heavily subsidized rate of $96 per
year (or $8 per month). Patients however bear full costs
for associated tests, such as viral load and CD4 count.

Experts and activists alike agree that, while the
government initiative is highly commendable, it presents
much challenge for sustainability of the programme. As the
saga of the past few months have shown, other longer-term
strategies are needed to reduce the financial burden on
government and guarantee uninterrupted supplies of the
life-saving drugs.

Experts also agree that local production of ARVs is the
best way to address problems such as the shortage in supply
and circulation of expired drugs, which delays in the
importation from outside the country have created.

Over the past several months, a number of approaches have
been explored by different interest groups for sustaining
the programme.

These options include:

1. Foreign-local collaboration for local manufacture of
generic versions. The most promising initiative in this
regard is a partnership agreement signed mid-2003
between Evans Pharmaceuticals, a local pharmaceutical
company and Cipla/India, one of the major suppliers of
drugs for the ARV programme. Under this agreement, Cipla
will develop and utilize Evans production line for local
production of the drugs. It is unclear when actual production
will commence.

2. Establishment of Ranbaxy plant in Nigeria. Ranbaxy, the
other Indian ARV manufacturer is also considering a plan
to resuscitate its old production lines in Nigeria. The
company maintained a manufacturing presence in the country
till the early 80s, when it closed shop.

3. South-south transfer of technology. This approach, being
pushed by Economic Community of West African States
(ECOWAS) will take advantage of offers made by governments
of Brazil and Thailand, the two leading Third World
countries that have built local capacity for ARV
production. With support of these two countries, ECOWAS
seeks to establish an ARV production plant in Nigeria,
which will serve other countries in the ECOWAS sub region.
Several intensive meetings have held on this over the past few months,
spearheaded by Nigeria's Ministry of Cooperation and Integration
in Africa. Much progress seems to have been made on this option,
including a visit to Abuja by a Brazilian team in October 2003.

4. Upgrading of facilities at NIPRD, Abuja. Under this
proposal by the ministry of health, the production lines at
the government-owned Nigeria Institute for Pharmaceutical
Research and Development (NIPRD), Idu near Abuja, will be
massively scaled up to produce ARVs locally by 2006. NIPRD
currently has a small production line and modest
phamarcological research and manufacturing capabilities.

Olayide Akanni
Email: [email protected] [2]