UNAIDS HIV Drug Access Initiative: Providing Wider Access to HIV-related Drugs in Developing Countries, Pilot Phase

* Health system impact: The larger impact of the Initiative on the health
system in each country will also be evaluated. Evaluation will provide
important information on the impact in localized areas with possible
projections in view of the expansion.
* The subsidy mechanism: All financial transactions of the NPC will be
reviewed in terms of their efficiency and ease of application. NPC
accounts will be audited annually by a recognized international firm of
auditors whose reports will be made available to UNAIDS, the participating
companies, and the government of the participating country. In addition, a
confidential report detailing the NPC's financial transactions will be
produced and disclosed to the Board of Directors. Any company
participating in the Initiative may have access to the relevant section of the
detailed report.
LESSONS LEARNED
Implementation of the UNAIDS Drug Access Initiative - The Political
Context
Improving access to drugs requires strong political will to change current drug
supply and delivery systems. An important element in the programme design
has been the inclusion of mechanisms for political decision-making that
involve all interested parties. This has resulted in new constellations of
political stakeholders.
One of the values of the initiative is that it diminishes the boundaries between
public and private sectors. The Initiative has served to strengthen
public/private sector linkages, not only in terms of public sector negotiations
with the pharmaceutical companies, but also, for example, in developing
training courses, the provision of private sector facilities for use by the
Initiative, and the incorporation of drugs obtained through the private sector.
Concerns: ARVs and 1OI drugs
SThe more or less explicit assumption among international agencies dealing
with health and drugs has been that if countries focus attention on making
ARVs available to their populations, less attention and funds would be
available for other drugs, such as those used to treat Ols. To date, there is no
evidence that access to these drugs has actually worsened. The evaluation of
the Drug Access Initiative will provide data to determine whether the Initiative
has had positive or negative consequences on the provision of different types
of drugs.
In terms of providing wider access, there is little difference in terms of costs,
infrastructure requirements, and difficulty in administration between ARVs and

expensive 01 drugs. The more important distinction is between expensive

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