More than a month has passed since the exchange of letters between the Global Fund and the Venezuelan Network of Positive People (RVG+ in its Spanish acronym) concerning what Venezuelan civil society describe as “a humanitarian crisis.” Very little has happened in the interim, at least not that we can report publicly. Many of the persons and organizations in Latin America that Aidspan has talked to have been reluctant to comment, even off the record.
In its letter of 2 February to RVG+ (see GFO article), the Global Fund had offered to “consider any requests for assistance from partners who are leading in the response [i.e. PAHO and UNAIDS] for:
- access to competitive pricing for emergency procurement of commodities which could support a short-term to response with regards to essential commodities for HIV, TB and malaria;
- longer-term support through a multi-country malaria grant to provide support to address the regional consequences of Venezuela’s increasing malaria rates; and
- other needs that the Global Fund can provide within our mandate and resources.”
The Global Fund letter seemed to acknowledge that Venezuelan people living with HIV, TB and malaria are in an exceptional situation, worthy of exceptional measures. However, in the period since the letter was sent, no public announcements have been made by any of the parties involved.
A spokesperson for the Global Fund Secretariat told Aidspan that the Fund is waiting for UNAIDS and PAHO to take the lead.
A spokesperson for ACCSI, a Venezuelan NGO, told Aidspan that the health crisis in that country includes a stock-out of over 80 essential medicines, both in public and private health facilities, ranging from the most basic prescriptions to treatment for opportunistic infections such as TB, cancer and others. An article in The Guardian described an appalling inside view of the health system late last year – hospitals lacking the most basic supplies, leading to patients having even simple treatment postponed or denied; and health indicators such as maternal and child mortality rising to levels unknown to the country for decades. Diphtheria has returned to Venezuela after the country was the first one to eradicate it in the region.
In Venezuela, antiretrovirals (ARVs) have been procured for the past four years through a joint-purchase mechanism provided by PAHO called the “Strategic Fund.” RVG+ told Aidspan that procurement for ARVs for 2017 started in a timely manner in December 2016 but that the process was halted by the newly appointed Minister of Health in January. Should this purchase not go ahead, the country could experience a massive ARV stock-out in the first half of this year.
According to ACCSI, the official explanation for halting the procurement process was a desire by the new Minister to review the legality and transparency of the process. However, there is speculation that macroeconomic considerations could be behind the decision. After oil prices plummeted, the country’s economy shrunk dramatically in the last few years (by 5.7% in 2015 and by somewhere in the range of 8%-18.6% in 2016, according to figures allegedly leaked from the Central Bank). Inflation in 2016 was estimated at between 500% and 700%, according to several sources. The budget available for the purchase of medicines and other health commodities might have lost a significant proportion of its value in international currencies, making it impossible to proceed with the procurement process.
Aidspan understands that negotiations are taking place between the Venezuelan government and national and regional offices of UNAIDS and PAHO to determine how to make the best use of the existing mechanisms that the Global Fund offers. However, it appears that other solutions are also being explored. These solutions may involve the following:
- support for the improvement and optimization of treatment guidelines, to ensure a standardization of regimens that would allow the government to purchase the lowest-price quality treatment, reducing the number of different regimens and allowing for large-scale purchases at lower prices;
- the use of international purchase mechanisms provided by the Strategic Fund that could help to significantly reduce the price and increase the availability of treatment for HIV, TB and malaria, as well as other health commodities. These mechanisms should play an important role in a situation officially declared a “state of economic emergency”; and
- a greater involvement of civil society in the response to HIV, which could improve access to goods and services by people with HIV.
This is the first GFO article written by Diego Postigo, our new correspondent for Latin America and the Caribbean. Diego can be reach at firstname.lastname@example.org.