Rwanda: Coordination paves road to treatment success (February 2006)

Over the last year the number of HIV-infected Rwandans receiving antiretroviral drugs (ARVs) increased from around 4,000 people to nearly 16,000 people. The Rwandan Government and its international and implementing partners have pioneered an effective and accountable system to jointly procure ARVs for Rwanda. International partners include the U.S. Government (USG), the Global Fund, the World Bank, and others.

In October 2004, the Rwandan Ministry of Health issued a Ministerial Order requiring that all ARVs be procured through CAMERWA, the national pharmaceutical procurement agency, in order to maximize purchasing power. The Ministerial Order requires providers to prescribe ARVs according to World Health Organization (WHO) guidelines, use generic drugs as first line treatment, and limit the use of brand-name ARVs to patients requiring second-line ARVs due to complications with the first line treatment.

In December 2004, the first coordinated procurement took place, with international partners purchasing portions of Rwanda's overall ARV needs according to their individual procurement parameters. Emergency Plan funds were used to buy HHS/FDA-approved ARVs for second-line treatment, while the Global Fund, World Bank and others purchased other WHO-prequalified drugs for first-line treatment. As a result of this new system, CAMERWA now distributes ARVs to pharmacies according to their patients' needs, regardless of which donor supports the site. Now, as more generic drugs gain HHS/FDA approval and tentative approval, the Emergency Plan is also supporting procurement of some generic drugs used in first-line treatment.

There are several benefits associated with the combined procurement. Rwanda is getting a better price for the ARVs due to the larger quantities being ordered, and money is also saved through lower management costs and reduced transportation costs. The coordination also has a clinical benefit: different drugs can be packaged differently with different shapes, quantities and inscriptions, leading to confusion and potential non-adherence, but coordinated procurement reduces the risk of confusion. In light of Rwanda's success, other African countries may well adopt similar approaches.

The system is also helping to build a strong system for monitoring, tracking, reporting and auditing ARV consumption and supply. CAMERWA maintains statistics on the number of patients receiving ARVs, the current stock of each pharmacy, and the consumption rate, making projections for future procurements more accurate.

The spirit of cooperation among the Government of Rwanda, implementing partners, and international partners such as PEPFAR, the Global Fund, and the World Bank, is making an essential contribution on the ground in Rwanda - and lives are being saved as a result.

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