The Political Economy of HIV/AIDS in Developing Countries
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The Political Economy of HIV/AIDS in Developing Countries

TRIPS, Public Health Systems and Free Access

Edited by Benjamin Coriat

The book is based on original data and field studies from Brazil, Thailand, India and Sub-Saharan Africa. Focusing on the issue of universal and free access to treatment (a goal now taken to heart by the international community), it assesses the progress made and presents a rigorous diagnosis of the obstacles that remain, especially the constraints imposed by TRIPS and the poor state of most public health systems in Southern countries. In so doing, the book renews our understanding of the political economy of HIV/AIDS in these vast regions, where it continues to spread with devastating social and economic consequences.
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Chapter 11: Procurement Policies, Governance Models and ARV Availability in French-speaking African Countries: An Overview

Mamadou Camara, Cristina d’Almeida, Fabienne Orsi and Benjamin Coriat


Mamadou Camara, Cristina d’Almeida, Fabienne Orsi and Benjamin Coriat With the implementation and increasing power of national AIDS control programmes (PNLS), the end of the 1990s saw a revival of procurement policies in French-speaking African countries. Two principles emerged. From this time on, procurement policies were organized around two objectives – on the one hand, an effort to generalize the management independence of central buying agencies, with a view to increasing their efficiency, and, on the other, whenever possible, to favour the prioritization of generic versions in drug supplier selection procedures. This new procurement policy, integrating ARVs, has gradually transformed the composition of the supply of available drugs, and is closely linked with the launch of national scaling-up programmes. Although consequences vary according to the country and the context, notably with regard to the methods of financing the purchasing programmes (and the restrictions involved), the implementation of this new policy often induced remarkable changes to the running of the old structures, as much in all that concerns stock management as in drug purchasing/distribution policies. However, while progress was often observed, many problems remain, especially the fact that the implementation of the new policy is accompanied by a certain instability in procurement and distribution chains, resulting in noticeable consequences with regard to the availability of ARVs. The problems of availability concern both variety (the nature and quantity of molecules present in the area under consideration) and pricing (price differences between different therapeutic regimens according to their molecular composition...

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