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Cutting costs in accessing ART

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By Sam Majamanda:

MAKWEZA—I struggle to get ARVs

Eluby Makweza, 70, has survived on anti-retroviral therapy (ARTs) since 2012 when her laboratory test proved positive of the Human Immunodeficiency Virus (HIV).

Her life has been dependent on the drug which the Ministry of Health provides freely to every HIV posit ive citizen, owing to an agreement made at the United Nations Headquarters in New York.

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Makweza, who comes from Mfunda Village in Traditional Authority (TA) Chiwalo’s area in Phalombe District has to bear some hidden costs because she has to endure a six kilometre journey on every ART Clinic day to Nambazo Health Centre, a facility situated on the borders with Mozambique.

“Normally, when I am not sick, I need to go to the clinic every three months to access ARVs and getting my viral load checked,” she explained, adding that the two services happen on different dates, implying that she has to make the journey twice in every three months.

Makweza said when she has money, the trip costs her not less than K3,000 and that being an elderly woman who does not work, her children take turns in footing the bill; an arrangement that does not work sometimes.

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“They have to do piece works to raise the money; sometimes I get a bicycle taxi. Otherwise, I walk to and from the hospital. There are a number of us elderly persons living with HIV, so we usually go as a group to over the long distance,” she narrated with a tinge of sadness.

Makweza’s case and that of others living with HIV in Phalombe is similar to the situation in Chiradzulu District because their counterparts have to cough between K3,000 and K5,000 on transport fare to access ARTs.

Group Village Head Balakasi under TA Ntchema in Chiradzulu attests to the fact that some women in his area cover close to eight kilometres to get to Mauwa Health Centre deemed one of the closest facilities.

Despite the problem being general among women, it becomes more frustrating for women of child bearing age who have to cover the same distance more than thrice in a quarter since they have to go for sexual reproductive health services, including cervical cancer screening, besides making two designated trips to collect ARVs and routine check-up.

“We have to go to the hospital separately for each of the four services because according to arrangements in our clinics, each visit is assigned its own date. By t he way, when we get there we do not just receive the medication and return home immediately; we also have to endure long hours of waiting,” a patient, Mary John lamented.

Mary who hails from Nyimbiri Village in TA Ntchema in Chiradzulu added that on a typical ART clinic day, she starts off at 5:30 am in a bid to be at the clinic by 7:30 am. where she has to wait for three to four hours before being assisted and trek back home.

“That’s almost a whole day’s activity. Imagine that I have to do t his for each service on its own date. When I’m I going to do piece works to feed my children?” she quizzed.

Group Village Head Balakasi thinks the current arrangement where women with HIV travel long d istances to access health services has negative impact on development in his vil lage.

He argued that any developmental activity scheduled for the day on which ART clinic takes place at Mauwa Health Centre was negatively affected and that such an activity was consequently rescheduled.

“My village alone has over 30 women depending on ARVs and they all go for ART on the same day. When it’s their day; I cannot call for a community meeting because I know that the message that I will share will not reach many,” Balakasi pointed out.

Coalition of Women Living with HIV/AIDS (COWLHA) has embarked on an advocacy campaign aimed at liberating women from such bondage.

Project Officer for COWLHA in Chiradzulu and Phalombe, Esnart Mbandambanda said government through the Ministry of Health should consider establishing ways of bringing ART closer to people so that they do not suffer economic hardships to access it.

She proposed that government should adopt the Community ART Group (Cags) model whereby people living with HIV can form small groups with the aim of increasing access to ARVs within the communities.

The Project Officer added that the initiative was aimed at enhancing integration of HIV and sexual reproductive health right services to cut frequent travels to the hospital among women.

Mbandambanda observed that through its Support Groups spread across the country, COWLHA noted that the concerns are growing on a daily basis due to the current economic status in which women living with HIV have been pushed to with the Coronavirus (Covid-19) pandemic.

“Some of the women earn a l iving out of small scale businesses and they use some of the proceeds to travel to distant health facilities; but now you and I understand how such businesses have been affected by the Covid-19,” she noted.

“Currently most of the women aren’t earning anything at all and we think this is the right time for government to bail them out of this bondage,” Mbandambanda said.

COWHLA’s Monitoring and Evaluation Officer, Mtisunge Mikaya emphasized on the magnitude of the problem saying, “The burden might look small to people that earn a good living; however, for most of the women it very huge.”

“Most of them live on hand-to-mouth and to source K1, 000 takes a struggle. This campaign, therefore, considers such less privileged women who make up a larger population of people living with HIV in the country,” she stated.

Mikaya pointed out that, “The change will increase our chances of achieving the last 90 on the 90-90-90 goals that we’re targeting as a nation because currently some of the women are not adhering to ART while some of them are reportedly defaulting due to the challenges they face. This will eventually undermine national goal on suppressing the viral load for those on ART.”

Director of Health and Social Services (DHSS) for Phalombe, Ketwin Kondowe said the current ART policy creates room for the establishment of Cags, noting that there was need for more consultation on the implementation of the strategy.

“Government should have already started implementation of the model but the advent of Covid-19 interrupted everything because attention now has been directed to the pandemic,” he reaffirmed.

Kondowe added that while Cags might be ideal in the country, some people living with HIV, particularly those with underlying conditions and with history of absconding ART would have to be maintained on the facility-delivered ART system.

Secretary for Chiradzulu District AIDS Coordinating Committee (Dacc), Nelson Chakwiya said monitoring cannot be a challenge on administration of drugs in groups since government already has structures on the ground that trickle down to the communities.

He noted that capacity building on the handling of ART could be the only need for expert clients who could be acting as leaders for such groups so that the arrangement does not interfere with other loopholes in ART services.

“We need to harmonize all the interventions in the provision of HIV and AIDS related services so that we don’t leave any group behind and seal all the loopholes for a comprehensive fight against the pandemic,” Chakwiya suggested.

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