EPN - Ecumenical Pharmaceutical Network

• EPN FORUM 2005: Change of dates and venue!
• Access Work Starts in Cameroon
• HIV/AIDS Starting Point Study Completed in Burkina Faso
• EPN/HAI Collaboration on Rational Drug Use
• Coordinator participates at SEAM Conference
• EPN Represented at Peoples Health Assembly
• EPN Statement on PEPFAR: Feedback
• G8 Summit: EPN Signs Statement on Human Resources for Health
• News from Network Members

EPN FORUM 2005: Change of dates and venue!

The EPN Forum that was scheduled to take place at the Ecumenical Centre in Geneva, Switzerland between 18th and 21st October 2005 has been postponed.  It will now take place between 9th and 12th May 2006, in Tuebingen Germany.  In association with the EPN Forum, the board is also planning to put in place regional network activities as part of the 25th anniversary celebrations of EPN’s work!  Further details will be provided in the coming Netlink editions.

Access Work Starts in Cameroon

The second country baseline access study is underway in Cameroon! Under the Access to essential medicines programme, this study is similar to the one conducted in Malawi in April 2005.  The desk review has been completed and the self-assessment of hospitals is underway with the administering of questionnaires.  Emmanuel Nfor and Robert Chana are the facilitators of this process.  We wish them well as they embark on this exciting project which should be completed in the next two months.

HIV/AIDS Starting Point Study Completed in Burkina Faso

As part of EPN’s activities under its third programme of Increasing the capacity of church leaders and church-related health services to respond to the massive challenge of HIV/AIDS treatment, the starting point study was carried out between 13^th June and 1^st July in Burkina Faso. It was done in collaboration with EPN’s country focal point, Office de Développement des Eglises Evangéliques (ODE).  Burkina Faso is the third country for this study after Kenya and Rwanda.  The study focuses on finding the level of knowledge on ARV’s in various countries; and then having steps taken to increase access and understanding of ARV’s.

The ODE/EPN team that conducted the study was composed of Heather Budge-Reid as EPN consultant, Pastor Matthias Sawadogo from the local church of the Assemblies of God as translator (Mooré – French – English), and Hans Peter Bollinger, EPN program officer for Francophone Africa, for organizational matters.

The team visited government health departments, a national hospital, churches and church organisations, church-related health service units, VCT centres, associations of PLWHA, a Christian TV and radio station and other organisations active in HIV/AIDS and mainly ARV related issues. In four different locations across Burkina Faso namely Ouagadougou, Bobo-Dioulasso, Koudougou and Yako, the team conducted 26 key informant interviews, and 11 focus group discussions with different groups of church leaders, youth, women and PLWHA. The study concluded with a desk review undertaken in Ouagadougou.

The study provided interesting insights in the provision and understanding of ARVs, and the role of the church in treatment literacy of ARVs, the encouragement needed when visiting a VCT, the advocacy for affordable access to ARVs, the impact of stigma when taking ARVs and of being a PLWHA.

A detailed report of the study shall be available soon. The feedback meeting was held on 27^th -29^th July in Ouagadougou.

EPN/HAI Collaboration on Rational Drug Use (RDU)

In the May 2005 edition of Netlink, it was reported that an EPN team of four (composed of A Petersen, HP Bollinger, A Ojoo and E Ombaka) had in May attended the 58^th World Health Assembly in Geneva, Switzerland.  EPN, in collaboration with HAI, held a session on 18^th May to discuss strategies to make rational drug use part of the political agenda.  Suggestions from the participants who attended the session are presented below:

• Measuring the impact/obtaining the evidence
  Studies should be done to evaluate the impact on drug use of strategies that have been developed and implemented and the findings documented and disseminated to all stakeholders. This would provide evidence that rational use saves on time, finances and the health of individuals on a large scale and, vice-versa, that irrational use harms health and wastes resources.
  Activities proposed include carrying out cost benefit analysis; providing cost implication of irrational drug use to politicians; quantifying the drug misuse; documenting the cost in terms of burden of disease, mortality and morbidity due to irrational use; and publicising financial incentive fuelling irrational drug use.
• Formation of alliances
  Alliances should be formed between prescribers, consumers (community members) and politicians as this will ensure that all stake-holders are working towards common goals.  In addition, policies and strategies to promote rational drug use should overlap with major health programmes like HIV/AIDS, malaria, TB and drug and substance abuse.
  Activities proposed include inviting politicians to venues where the benefits of rational drug use to their constituencies is highlighted; provide evidence  to the youth and communities on the links between irrational drug use and their lack of access to useful and safe drugs;  integrate rational drug use requirements in development programmes.
• Communication strategies
  By using the media on a wider scale, clear communication strategies can be developed to put rational drug use on the political agenda. This gives knowledge to individuals, consumers and their communities and raises levels of awareness in areas like exposing risks of irrational use and giving information on the drug resistance problem.
  Activities proposed include providing regular updates to media on positive messages for rational drug use; highlighting consequences of irrational drug use such as deaths from resistant organisms; naming and shaming activities promoting irrational drug use.
• Empowerment of consumers and communities
  Consumers and communities can be empowered in the use of medicine e.g. in areas of antibiotics use which are amongst the most abused medicines.
  Activities proposed include carrying out simple rational drug use activities with  communities for step by step learning of rational drug use; providing communities with information to enable them and grassroots groups to demand appropriate use of  medicines.
• Providing practical messages
  Countries that have managed to implement policies with positive outcomes should document and promote their successes.  This can be done by starting to use simple and practical messages that focus on one issue at a time so as to avoid information overload that can cause confusion or misunderstanding.
  Activities  proposed include marketing widely the Sweden model on antibiotic use;  make the positive ICIUM outcomes more widely known and replicated; local successful experiences be shared within the country through support of local WHO offices and / or Ministries of Health.
• Advocacy and lobbying
  Advocacy for rational drug use should be done with all stake holders i.e. governments, donors, training institutions and student associations.  This ensures that all who are involved in medicines are made part of the political agenda.
  Activities proposed include making RDU part of training curriculum; making presentation on RDU at all possible venues; providing politicians with data for their deliberations in parliament; providing factual sheets on RDU to lobbyists.
• Address at global level
  Policies on rational drug use should be clearly defined and supported by organizations at the global level e.g. WHO, World Bank, Global Fund, PEPFAR etc. which makes it easier to implement the policies at lower levels i.e. regional, national, and community level.
  Activities proposed include passing of a strong resolution on RDU at the World Health Assembly; allocation of funds for promoting RDU in the budgets; including RDU as requirement in agreements; include addressing RDU as part of strengthening health systems.
• Address industry power
  WHO and other international organizations should address "big pharma" issues such as the pharmaceutical industry in developed countries which are producing and promoting drugs mainly for the very profitable markets of industrialized countries, while neglecting much-needed medicines for illnesses that affect the poor and vulnerable people in resource limited countries.
  Activities proposed include providing leadership in addressing excesses of the pharmaceutical industry that lead to irrational drug use; urging  industries  to live up to their social responsibilities.

The outcome on the discussion on RDU at the WHA will be reported in the next edition of Netlink.

Coordinator Participates at SEAM Conference

EPN’s Coordinator attended the Strategies for Enhancing Access to Medicines (SEAM) Conference from 20^th – 22^nd June, 2005 in Accra, Ghana.  She made a presentation on the Network’s Pharmaceutical Guidelines, and gave a preliminary report on the Malawi Access Study. 
During the conference, Management Sciences for Health (MSH) who are the project holders of SEAM, highlighted that schools are a neglected area in rational drug use.  This is seen as a possible area for EPN to work by having schools sponsored by churches as targets for rational drug use activities.

EPN Represented at Peoples Health Assembly

The 2^nd Peoples Health Assembly (PHA) organized by the Peoples Health Movement (PHM) took place from 17^th – 23^rd July in Cuenca, Ecuador.  EPN is thankful to Josefa Castro-Cobian from Servico de Medicinas Pro-Vida and who is EPN’s member in Peru who took time to attend the conference on the Network’s behalf.  Details of the conference will be provided in the next edition of Netlink.

EPN’s Statement on PEPFAR: Feedback

Almost one year after it was developed, EPN’s Statement on PEPFAR continues to draw reactions from various quarters around the world.   The statement has been extensively referred to in an article in PlusNews Newsletter.  The article: The Treatment era: ART in Africa highlights the statement’s key points such as PEPFAR’s insistence on FDA approved medicines and the preference for expensive brand-name drugs rather than cheaper generic ones.  The article is available on http://www.plusnews.org/webspecials/ARV/afrmon.asp

G8 Summit: EPN Signs Statement on Human Resources for Health

On behalf of the Network, the Coordinator joined more than 600 African doctors, nurses, development groups and associations in signing a statement urging leaders of the G8 countries to make a commitment to address the global crisis in human resources for health.  The statement was a call to enable thousands of health workers stay in Africa, where they are desperately needed, rather than migrate to Western countries.  The G8 Summit was held in early July with the agenda focusing on Africa’s situation in areas such as health, finances and socio-economic status.

NEWS FROM NETWORK MEMBERS

CHAZ Signs Grant Agreement with The Global Fund

Congratulations to one of the Network's member organizations! The Churches Health Association of Zambia (CHAZ) has signed a grant agreement with the Global Fund for two years to implement and scale up ART programs in Faith-based organizations.  CHAZ is preparing a Procurement and Supply Chain Management Plan (PSM Plan) which has to be approved by the Global Fund before funds can be released.

DIFÄM participates in Networking for Procurement NGOs

In May, one the Network members, DIFÄM, invited all German organisations that are involved in procurement of drugs on behalf of Faith-Based Organizations (FBOs) and secular institutions to discuss issues related to ARVs.  The discussion focused on local production of ARVs and Active Pharmaceutical Ingredients (API’s) in least developed countries; and TRIPS, specifically the new Indian law.

EPN Chairperson presented Difäm’s activities where Difäm supports several ART projects on small scale bases to get first steps done and acts as an advisor for Mission Institutes including Bread for the World and EED.   Difäm also hosts the office of the “Action Campaign against Aids” that is lobbying the German Government and the pharmaceutical industry in the area of procurement of ARVs.  EPN Chairperson also introduced EPN to the participants and explained EPN’s activities on ARVs and procurement of essential medicines.  The representative from “Action Campaign against AIDS” gave information on the levels of quality of medicines which will be accepted by GFTAM in future. These are a Federal Drug Administration (FDA) or WHO approval, a Pharmaceutical Inspection Commission (PIC) approval or approval from the local drug authority. There was great pressure to drop the local drug authority approval but that would be a big disaster for local companies as some locally produced essential drugs do not have FDA, WHO or PIC approval.

Other organizations that presented their reports are Action Medeor who gave a report on their project in DR Congo where Pharmakina started to produce ARVs. In Tanzania, Action Medeor International was founded to procure essential drugs partly manufactured in the country for mission hospitals. Medeor started a project to assist a local company in Arusha in production of Artesunate tablets. MSF explained that the new development in India will have great influence for the availability of generic drugs worldwide as all drugs developed after January 2005 are licensed under the WTO rules which gives the manufacturers a patent of 20 years.  Malteser International explained how they moved their ART project from the rural area of Kenya into a slum area in Nairobi.  This will ensure more compliance by patients using ARV’s.

A representative from GTZ reported that the German government through GTZ, is funding a project where 15 pharmaceutical producers in Kenya, Tanzania and Syria are identified and assisted over a 2-year period to improve the standard of quality for their medicines to that of the Pharmaceutical Inspection Commission (PIC) level. The initial results of the project are very positive.  The project includes procurement where the involved companies are asked to respond to a tender for most of the essential medicines that they stock.  The prices will be fixed for two years and all partner NGOs are invited to place orders four times a year to cover the needs for their projects in the region. Negotiations have begun on how some of the distribution and quality checks can be taken over by MEDS.

As the participants to the meeting found the discussions beneficial, they agreed that they would, on a regular basis, hold similar forums which would be called “EPN Germany”.  The next meeting was tentatively set for November 2005.

DIFÄM participates in German Government’s Discussion on ARV’s

EPN Chairperson also attended another workshop where the German government tried to get an overview about the existing local production areas of ARVs and about participation in future projects.  The discussions focused on how to improve quality standards of medicines, how to lobby local governments to break down hurdles regarding import tax which hinders an increase of local production and about the very expensive but very needed ARVs for second line treatment.

The situation in Eastern Europe was discussed at length where ART is often not available as the governments are not very active in the area of ART.  The church and NGOs are starting to get involved but the situation is still grim as most of the infected are drug addicts and therefore branded criminals. ARVs or drugs for combating opportunistic infections are not available at affordable prices because most of these countries are not considered “developing” countries.

There was an agreement that more information is needed in this situation before further steps can be taken.

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