Prescriptions of AIDS Activists ignore realities of African healthcare and may do more harm than good, say researchers.

September 26 2003 -- As the ICASA conference in Nairobi draws to a close, many NGOs and commentators have encouraged countries to over-ride drug patent laws in order to increase access to drugs. Yet according to two researchers in Kenya and South Africa, this ignores some of the basic realities of healthcare in Africa and could do more harm than good.

James Shikwati of the Inter-Region Economic Network in Nairobi, Kenya and Richard Tren of Africa Fighting Malaria in Johannesburg South Africa point out that the major barriers to drug access in Africa are poverty and poor governance.

"In Kenya, chronic corruption, staggering inefficiencies within the state health sector and low standards of living mean that even low cost generic drugs are not available to Kenya's poor" says Shikwati. This situation has been compounded by decades of economic mismanagement in most African countries, which has left the majority of people so poor that they are unable to afford food, let alone drugs.

The recent WTO resolution on drug patents, which gives greater flexibilities to poor countries, was welcomed by both researchers. However, they were quick to point out that it will make very little difference to healthcare in Africa. As Tren points out "Most (more than 95%) of the WHO list of essential drugs are off patent and could have been imported perfectly legally from any generics company anywhere in the world. Yet most African countries have not done this and access to these drugs is abysmal. Other barriers to access - poverty, stigmatisation, a lack of health infrastructure and a lack of political will - are so much more important than patents."

The researchers point out that there is no single solution to Africa's health problems. But clearly reducing the extent to which government intervenes in the economy - enabling poor Africans to escape from lives of subsistence and servitude - and reforming decaying healthcare systems are priorities.

Partnerships between the public, charitable and private sectors are also worth pursuing. In Botswana, a partnership between pharmaceutical company Merck and the Gates Foundation has led to more patients being treated with free ARVs than in any other African country. "It seems that forming partnerships with the drug companies produces far better results than combating them" says Shikwati.

It is also vital that the research drug companies continue to conduct research into AIDS and other diseases, but as Tren stresses "casting them as the villain in the access debate doesn't encourage them to increase research activities. Indeed it probably discourages small, start up research companies from engaging in AIDS research"

Richard Tren, +27 11 884 9578, or email,
James Shikwati, + 254 733 823 062, or email;

Africa Fighting Malaria is a health advocacy group based in South Africa and Washington DC. IREN Kenya is a think tank based in Nairobi, Kenya.