GPHF Country Projects:
Kenya: Kibera Health-Care Project Reports the First Success
Encouraging Perspectives for the GPHF Projects in Kosovo and Russia
Local health-care projects in developing countries have always been a central part of the GPHF’s work since its foundation. The objective of these projects - which are exemplary, regionally limited and aimed at “helping people to help themselves” - is to help solve health problems in developing countries. At present, the GPHF is implementing such projects in Bhutan and in Myanmar. They target the diagnosis, the therapy and the sustainable combat of parasitic infections which are widespread in both countries. Further projects are currently being carried out in Russia, Kosovo and in Kenya.
The Kenya project covers Kibera, one of the slums at the outskirts of the capital Nairobi where far more than 600,000 people live. The average per-capita income totals only 0.2 US$ per day which is not nearly enough for survival. Besides poverty and the disastrous hygienic conditions, the widespread tuberculosis and AIDS/HIV infections constitute a particular hazard to human life. An estimated 60 per cent of the population of Kibera are infected with AIDS/HIV alone. This is the reason why, in co-operation with the African Medical and Research Foundation (AMREF) and Malteser Deutschland (Order of Malta in Germany), and in close integration with local initiatives, the GPHF last year launched a project aimed at building up an infrastructure, informing the inhabitants of Kibera on the hazards resulting from tuberculosis and AIDS, showing them ways of preventing infections and offering them a basic minimum level of health care.
Children and Youngsters as a Focal Point
The “Kibera Community Based Health Care Project” (KCBHC) which is funded in part by the GPHF, particularly targets women of child-bearing age, as well as children and adolescents. Information and prevention on the one hand, diagnosis and therapy on the other hand; these are the objectives of the KCBHC. In a first project report, the AMREF employees locally responsible gave an encouraging interim statement of their activities performed so far.
At the outset of the project, an information campaign basically explained the risks associated with tuberculosis and HIV/AIDS infections to the local populace and showed them ways to prevent infection. Special information kits such as posters and banners were produced and prominently displayed in the purpose-built Health Center. A central element of this campaign was a puppet theatre specifically aimed at drawing the youngsters’ attention to the campaign. For instance, the puppet theatre promoted the use of condoms which were distributed to the audience after the end of the performance.
Medicaments Free of Charge
Apart from information, the campaign offered tests for diagnosing tuberculosis and HIV infections and advice for the persons already infected. In this respect, the project managers emphasised that the objective of the campaign was in no way to expel infected persons from their community; instead, they were – in intensive conversations - provided with perspectives on how to continue to live in their familiar environment. This part of the project was supplemented by the launch of a medical programme focussing on the distribution of AIDS medicine free of charge.
At the same time, local Community Health Workers received a special training so that they are now capable of informing AIDS patients on how to prevent the spreading of their infection by changing their behavioural patterns.
Although the KCBHC project to date benefits only a few hundreds of the Kibera inhabitants, the interim report ends with an encouraging statement: “The people of Kibera demonstrated what is possible when a community gets involved in finding solutions to the unique challenges facing them.”
Partial Success in Russia
A first success was reported by the project partners, i.e. Auswärtiges Amt (German Department of Foreign Affairs), the Federal Ministry of Health, Johanniter International and the GPHF, from the Russian Saratow province. According to the project coordinator, in the last two years the foundations have been laid for controlling tuberculosis in accordance with the international WHO standards in Russia, too. The Saratow project is the first-ever GPHF health-care project launched in the territory of the former Soviet Union.
Drug Supply in Kosovo
That it is possible to achieve tremendous results with limited resources is demonstrated by a project supported by the GPHF until the end of this year in the Prizzren area in Kosovo. One of the consequences of the armed conflict was the almost complete interruption of the drug supply. With the support of the GPHF, the Albanian Primedic organisation has built up during the past months a makeshift pharmacy where the Albanian population is now provided with urgently needed medicaments against payment of a symbolic fee.
Second GPHF Seminar under the Auspices of the Federal Ministry of Health
Second seminar on management of drug supply in developing countries scheduled for end of September.
Das GPHF seminar “Management of Drug Supply in Developing Countries” has again met with tremendous response. More than 70 applications were received for this seminar which is scheduled for September 21 through 26 in the Evangelische Akademie Arnoldshain in Schmitten im Taunus near Frankfurt. 28 persons from eleven countries finally received a confirmation letter. This seminar which is jointly organised with the Mainz University, will again take place under the auspices of Ulla Schmidt, the Federal Minister of Health.
The seminar targets in particular student doctors and students on advanced pharmacy courses from developing countries who plan to return to, and work in, their home countries after receiving their pharmacy degree. The lecturers on this highly practice-oriented training course will include experts from the Missionsärztliche Klinik Würzburg (Würzburg Hospital for Missionary Medicine), of Mainz University, of the Bundesinstitut für Arzneimittel und Medizinprodukte (Federal Institute for Medicaments and Medical Products), of the Zentrallaboratorium Deutscher Apotheker (Central Laboratory of German Pharmacists), of Pharmacists without Frontiers, of the Malteser Hilfsdienst (a German relief organisation), of the Deutsche Gesellschaft für Technische Zusammenarbeit (German Service Enterprise for Development Co-operation), of the Kreditanstalt für Wiederaufbau (a German promotional bank), of Schering AG, of Boehringer Ingelheim GmbH and of Aventis Pharma AG.
Participants from Eleven Countries
The central element of this training course, with participants from countries such as Cameroon, Sudan, Jordan, Togo, Benin, Eritrea and from Iran, will be to provide participants with practical and solution-oriented knowledge of the specific conditions of, and requirements for, drug supply in developing countries. The four main seminar topics will be drug quality and safety, drug procurement and logistics of drug supply, business management and economic aspects. The one-week programme will be supplemented by the presentation of various field reports on development aid projects, and by discussions on the employment opportunities for pharmacists in international aid and relief programmes. The training course will end with a final examination before the Zentrallaboratorium der Deutschen Apotheker (Central Laboratory of German Pharmacists), with the latter also issuing the corresponding certificates.
Thanks to Donors
The GPHF would like to thank the following companies for their generous support of its project work:
Demand for the GPHF-Minilab® Constantly Growing
The mobile compact laboratory now being deployed in 35 countries / Training courses realised in India and Thailand / Test methods for AIDS medicines to be available before the end of this year
The world-wide demand for the GPHF-Minilab® is unabated. During the past three months, no fewer than 20 additional minilabs were supplied to health-care centres in Asia and Africa. In the meantime, this mobile compact laboratory is being used to identify counterfeit drugs in 35 countries, with Tanzania accounting for the lion’s share. In this East-African country, 20 minilabs are being used for drug quality control.
Starting in the autumn, six antiretroviral agents (Didanosine, Indinavir, Lamivudine, Nevirapine, Stavudine and Zidovudine), and combinations thereof, can be identified using the minilab test methods. A total of 36 agents will then be able to be tested. The GPHF is confident that the increase of the number of testable agents will in future further boost the demand for the minilab.
Training Courses in Asia
During the past two months, Dr Richard Jähnke, the GPHF project manager, has carried out two further training courses for the use of the minilab in India and Thailand. In the Himachal Pradesh province in the North of India, Dr Jähnke trained 15 physicians and pharmacists in the handling of the compact laboratory. There, in the India-China border region, four minilabs are now monitoring the quality of the drugs supplied. Indian experts estimate that the proportion of counterfeit drugs distributed in the Indian medicine market is as high as 25 per cent.
The minilab training course organised in Thailand which was attended by 18 government pharmacists from China, Vietnam and Thailand, was part of the Drug Quality and Information Program of the United States Pharmacopeia (USP). As part of an international USP project aimed at combating malaria in the countries bordering the Mekong river, 22 minilabs are being used. Here, too, tests have shown that a high proportion of the locally supplied drugs are counterfeited or substandard drugs.
In the course of his numerous trips to India and Thailand, Dr Jähnke was also given the opportunity to present the minilab and its manifold application capabilities to representatives of international health authorities.
Expert Conference in London
“Combating Pharmaceutical Fraud & Counterfeiting” is the title of an international expert conference scheduled for October 6 and 7, 2003 in London. On this occasion, Dr Gabriele Küsters, the GPHF chairwoman, will present the minilab as a practical example for protecting the inhabitants of developing countries against the lethal hazards resulting from counterfeit drugs. The conference programme and further details on this event, at which representatives of the World Health Organisation (WHO) and the US-American Food and Drug Administration (FDA) will participate, can be downloaded from the Internet under www.smi-online.co.uk./fraud.asp.
In the meantime, the awareness of the GPHF-Minilab® has considerably increased in Germany, too. For instance, the n-tv news-broadcast station informed its audience in a detailed feature on the minilab test methods and its capabilities.
Under the “publications” keyword, the GPHF homepage www.gphf.org now also features abstracts of the latest minilab manuals that can be ordered at the GPHF office in English, French and Spanish. Another new feature of the GPHF homepage is a map showing the countries and regions where minilabs are in use.
GPHF Press Meeting in Berlin
For Wednesday, November 12, 2003, the GPHF has provisionally scheduled a press meeting in Berlin to present the new tests for antiretroviral agents available with the GPHF minilab. Detailed information on this event is available at the GPHF office.
Drug Counterfeits: A Hazard on the Increase
If the number of public statements and the volume of media coverage is an indicator of the importance of a subject, then the topic of drug counterfeiting is undoubtedly a hot one. Although in many cases, the extent of this phenomenon and the consequences for the people affected can only be estimated on account of the dearth of precise statistics, there is a prevailing impression that the danger is increasing.
For instance, the World Health Organisation (WHO) reported in March that on average, in developing countries, 10 to 20 per cent of all drugs supplied are substandard or counterfeit products. World-wide, the WHO even assumes that up to 7 per cent of all drugs supplied fall into this category.
In February, the Associated Press news agency had reported that in Nigeria, the most populous African country, taking drugs could only be compared with Russian roulette, because 60 per cent of all drugs distributed in Nigeria were either counterfeit products or of substandard quality. In large parts of India, the situation is apparently the same: according to a report published on August 20 by the Pharmabiz industry data service, several district courts have up to 1,000 drug-counterfeit cases pending. And country boundaries have since long ceased to stop the cross-border migration of counterfeit drugs. In the neighbouring country of Bangladesh, the “Daily Star” newspaper reported on June 25, 2003 that recently, the license for manufacturing drugs granted to 44 companies (most of them small enterprises) had been revoked: their pills and tablets were counterfeited.
Only some weeks ago, the US-American Food and Drug Administration made clear that drug counterfeits are not only a problem developing countries have to cope with. On its homepage www.fda.gov, it introduced the “Initiative to Combat Counterfeit Drugs”. According to the FDA, the number of drug-counterfeiting cases reported in the United States has risen from 6 in 2000 to 22 in 2002.
Similarly, the European Union felt it necessary to point to the increasing number of drug counterfeits in a special bulletin published in July of this year. According to the sources quoted, the number of drug-counterfeit cases in Europe had increased tenfold between 1998 and 2001. Horrifying figures are reported from China where almost 200,000 persons are said to have died in 2001 as a consequence of having taken counterfeit drugs.
According to the Der Spiegel news magazine (issue 30/2003) and the Deutsche Apotheker Zeitung (13/2003), Germany is no longer exempt from these criminal practices. Unscrupulous dealers are said to have succeeded in selling manipulated drugs even to German pharmacies. Fortunately, no negative consequences for the patients’ health have been reported so far.
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