Brazzaville, May 30, 2015. An estimated 100 thousand people in Congo-Brazzaville infected with the AIDS virus are at risk because they are not getting their medications, according to western diplomats and Congolese activists.
«I haven’t got any medicine in over three weeks,» says Ulrich Makama, who runs an AIDs activist group in Pointe-Noire where prevalence is believed to be nearly ten percent in a country with an estimated three-point-two percent infection rate. « We’ve been without medicine for two or three months. »
There have always been problems with Comeg, the structure set up by the Congolese government in association with international donors (WHO, EU, UNICEF, UNFPA) to buy quality generic drugs and send them to distribution centers but the situation detriorated so much last year that it was decided to dissolve Comeg.
Under the deal, Congo buys and issues the antiretroviral drugs (ARVs) for free to those infected. International donors supply 40% of the funding and Brazzaville 60%. But Comeg say they do not get the money the government budgets for the project.
« The Minister of Health is supposed to buy the generics and make them available, » says Isabelle Edet, Political Advisor for the European Union in Brazzaville, « but he has almost never provided the financing. When we asked him why he is not giving Comeg the money, the Health Minsiter told us ‘because we don’t trust them.’ And we said ‘Well, replace them!’ »
Transparency International lists Congo as extremely corrupt, at number 152 out of 175 countries. Getting a government job often has more to do with who you know and who you are related to than what your competence is.
Dr. Fatoumata Diallo, who runs WHO activities in Congo, down plays what is happening, claiming it is merely « an organizational problem.» But for Thiery Maba, the founder of the AIDs sufferer’s RENAPC advocacy group in Brazzaville, « it is corruption. Since it was decided the Health Minsitry would do the buying, » says Mr. Maba, « we have no more medecins. »
« The money is being embezzled, » says Mr. Makama in Pointe-Noire. Donors have no control over the process and many have dropped out because of the poor management.
« The EU pulled the plug and the government refused to let UNICEF manage the program because they would have too much control, » says Joel Chahab, a health expert at the US Embassy in Brazzaville.
« The medecins are supposed to be bought by the Health Ministry but there are’t enough and delivery is aleatory, » says Jérémie Sibeoni of the French Red Cross which handles distribution in the country. « I have been here for a year and we have never had any visibility beyond two or three weeks. I just don’t understand what the problem is.»
To make matters worse, the Congolese government decided to reduce its budget for the AIDs program by 30% this year. Moreover while they are buying medication at the last minute from stocks in places like Burkina Faso to deal with existing cases, there are no drugs available to treat new patients.
Because the medicins are bought in a panic, « the minister does not respect the contract and buys poor quality drugs at above market prices, » says the EU’s Isabelle Edet. However, AIDS activists say this shows the money is there when the government wants it.
The shortage of ARVs also means the wrong drugs are being distributed. « Phase one drugs are being given to phase two patients, » says Lasar, a journalist at Radio Congo-Pointe-Noire who investigated the shortages. « The lack of drugs and the wrong drugs means the virus is developing resistence. » This was confirmed by doctors working with AIDS patients.
« When they have medecin, they only give us enough for five to ten days, » says the patient advocate, Mr. Maba. Recipients are supposed to get a supply for a month. When confronted with the problem, the Minister of Health said he was issuing such a small amount to « prevent them from stealing the medecin. »
« Does he think we are so stupid as to sell the drugs which would save our lives? » asks an exhasperated Mr. Maba. He underlines that people in the regions have no transportation and no money for a taxi which makes it impossible for them to reach a distribution center once a week. The situation is growing worse as new cases are being diagnosed every day.
Dr. Herman Ongouo, who heads the WHO’s AIDs program in Congo says they have only identified 12% to 15% of those infected « because AIDS testing is on a volontary basis. » He insisted the WHO has nothing to do with the purchase of ARVs or distribution of treatment. « We only advise the government and provide expertise. »
On May 23, the Congolese government decided to create a new structure to replace Pharma-Comeg. Isabelle Edet fears this will be no more successful than the previous two which were both shut down because they did not deliver.
It is of little consolation to those who need the treatment. « If I don’t get my medicins, I will die, » says Mr. Makama in Pointe-Noire, his voice cracking with emotion.
For the American diplomat, Joel Chahab, « The absence of treatment is a death sentence for 100 thousand people! »