PEPFAR treatment lifeline threatened by weaknesses at receiving end, GAO report says

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GAOSUPPLYCHAINA third in a series of reports examining components of treatment provided through the President’s Emergency Plan For AIDS Relief  details how the the program has strengthened and streamlined antiretroviral drug supply planning, procuring and tracking, but also reveals a wide range of weaknesses hindering partner country management of the lifesaving medicines.

The United States Government Accountability Office produced the report examining PEPFAR drug supply chains in response to a request from Republican Senators Lamar Alexander (R-TN), who is ranking member of the Senate Health, and Education, Labor and Pensions Committee, Richard Burr (R -NC), Michael Enzi (R-WY) and Johnny Isakson (all ranking members of HELP subcommittees), and Tom Coburn (R-OK), ranking member of the Senate Committee on Homeland Security. The senators also requested two previous reports, covered here last week, on treatment costs and results.

While all three reports focus on the durability of treatment efforts as changes loom —  in growing numbers of people eligible for treatment, as well as transitions to “country ownership”  — this report draws the most attention to fragile country capacities that could lead to patients not receiving the treatment they need.

GAOelementshealthsupplychainExamining each link in the supply chain, the report lauds PEPFAR’s progress in centralizing its procurement system, sharing information with other donors, establishing an emergency procurement system, and helping countries better manage supplies. But, the report notes,  PEPFAR relinquishes control of the supply chain once drugs arrive at partner country warehouses, where lack of staff, training, electronic record-keeping, and other challenges, including that “in at least one country, their fear of shortages may have led to hoarding of drugs” hinder monitoring supplies of medicines. The result, the report concludes, in both missing records and missing drugs, “limit the ability of some partner-country health systems to track consumption, putting them at risk for shortages, waste, and loss.”

The GAO recommends that the office of the U.S. Global AIDS Coordinator require PEPFAR teams to develop plans to strengthen partner countries inventory control and record keeping capabilities, and to track partner countries progress in managing drug supplies. But it also notes that according to a USAID official current training and technical support efforts are not expected to show results in less than five years.

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