Gratification delays delivery of AIDS medication to those who cannot afford the bribes
The experiences of the people on record are common stories in Malawi for people wishing to get ART treatment. The patients have to endure long spells of waiting either to have their CD count done or to receive ART treatment.

Experts say the problem of access to ART treatment in Malawi is compounded by a number of factors.

National Association for People Living with HIV and Aids in Malawi Councillor James Misi says his organisation received reports of people dying on the waiting list for drugs. He did not give statistics.

He says Malawi should do a lot to win the fight against HIV/AIDS.

" Malawi is doing fine on prevention as compared to the care for the people living with the virus," Misi says.

He says people face many challenges to have access to drugs in the public hospitals.
Misi says there is need for an open system to help people access treatment once they become eligible. Many patients, he says, prefer private service providers over public hospitals because public hospitals are too slow to attend to clients.

He says there is need for public hospitals to review their systems to enrol many people. Misi says QUECH registers only 200 patients per month.

The few people the organization knows that died on the waiting list represent thousands of Malawians who die of AIDS while on the treatment waiting list.

The ART Officer in the Ministry of Health, Amon NKhata, says that more than 110,000 people are receiving treatment.

The National Aids Commission (NAC) report shows that about a million Malawians are living with HIV, the virus that causes AIDS.

Nkhata says that the government will establish 144 ART centres in the country by the end of this year. He says eligible patients will access treatment in their respective districts.

The Ministry of Health procures drugs to match the number of patients, he says. However, he says the hospital is flexible enough to adjust the number of drugs depending on the need at any particular time.

He says that more than 70 percent of patients on ART have survived. These figures conform to the World Health Organisation (WHO) guidelines on the survival rate for people on ART treatment.

Nkhata says some people die while on treatment because they do not adhere to treatment guidelines. Others are drug resistant.

According to information provided by the Department for International Development, The World Bank has lent $35 million to Malawi as part of its Multi-Sector AIDS programme.

The Global Fund has, so far, approved grants of $228 million to Malawi to allow the Malawi Government to implement its ARV treatment programme, the DFID report says.

The report also says donors and the Malawi government committed a total of US$ 724 million to finance the National HIV/ AIDS Action Framework up to 2009 as follows: Government: 27 percent, United Nations including World Bank: 22 percent, Global Fund: 37 percent, and bilateral donors: 14 percent.

The report says that HIV/AIDS Pool Funding Partners will provide $72 million between 2003 and 2008 directly to the National Aids Commission, including $7.2 million from DFID.

The Global Fund, which DFID contributes to has committed US$ 262 million until 2009.

Malawi still faces challenges in the fight against HIV/Aids, despite receiving millions in funding.

According to the DFID report, lack of human resources remains a challenge in the implementation of HIV/AIDS programme.

“Malawi has just one doctor per 100,000 people - one of the lowest levels in the world. Although funding for healthcare has increased, there are simply not enough trained staff available,” the DFID report says.

Minister of Health Marjorie Ngaunje says she is not aware that some health personnel receive bribes to access treatment.

"ART is free in Malawi. I am not aware of any health personnel taking bribes,” she said. This is something that my office has to investigate."

Ngaunje says the Ministry has allocated K36 million to purchase ART drugs this year. She says the ministry will also buy 20 additional CD 4 count machines.

For now, however, the only way for some to get past the waiting lists and other obstacles is a dab of palm oil on the hands of the corrupt providers.
By Theresa Kasawala Penelope Paliani Kamanga and Emmanuel Luciano
The life of 23-year-old Alice Maganga is at risk. Doctors diagonised her as HIV-positive in January, but she says she is not sure whether she will get access in time to the life-saving Anti-Retroviral Therapy (ART).

Maganga says she fears for her life because she is on waiting list for the CD 4 count test. CD 4 count refers to the number of blood cells that provide protection to the human body.

She says she's already suffering from opportunistic diseases. A week, she says, doesn't go by that she doesn't get sick.

"I might die any time because I don't know what the future holds for me," she says.

Temwa Khumba says she lucky that she's alive today. Most of her friends, she says, died without getting any treatment. The 34 year old Blantyre resident says her experience was different from others.

Khumba says she owes her life to a health worker she 'palm-oiled' to access Anti Retroviral Therapy Treatment.

Corruption is preventing deserving people from accessing Anti Retroviral Therapy. Maganga and Temwa's cases are contradicting the government's policy on ART. According to Policy on Equity in Access to Antiretroviral Therapy in Malawi, ART is "free-of charge at the point of delivery in the public health sector."

The policy also says access to ART enrollment is "on an open first-come, first-served basis".

Maganga says a doctor at the Dream Centre Clinic in Blantyre told her to go for the CD 4 count test on September 25. She went to Dream Centre because the service is free, she says.
But she says Dream Centre put her on the waiting list for CD count because the hospital has no specific number of people it handles per day.

Temwa Khumba says she was on the verge of death before she bribed a health worker.

"I owe my status today to the little favour I gave to hospital personnel. He made sure that I was put on the Anti-retroviral-therapy receiving list," she says.

Temwa says a health worker put her on a waiting list six months later than her due date.

“Six months was just too long I was very sick and frail,” she said. “It pained me that I could die while a chance of living longer was available.”

Khumba says she is a “bubbly, ambitious young woman, planning to study medicine one day."

John Kambalame says he was also in the same predicament. He says he struggled to get access treatment to a clinic near his home in Ndirande Township in Blantyre. His brother, he says, paid K2500 at Queen Elizabeth Central Hospital (QECH) for the CD 4 count. Kambalame says he paid because he was a referral patient from a non-governmental organization called the National Association of People Living with HIV/AIDS in Malawi (NAPHAM).

After waiting for the CD 4 count, Kambalame then found himself waiting again, he said. This time he was on a waiting list for ART. Kambalame says he waited for six months to start treatment. He says he finally started treatment in April this year.

"I am now a healthy person," he says.

Dan Mulule of Ntcheu says he's a victim of the same ordeal. The Doctor diagnosed him three years ago.

"I waited for a year before getting treatment,” Mulule said. “A nurse told me to wait for more than six months before getting treatment. When I went back to the hospital six months later my name was missing.

“This was not good enough. I had to do something," he says.

Mulule says he informed his uncle, who knew someone at the Hospital. He says his uncle convinced one of the hospital personnel at Ntcheu to facilitate his nephew's inclusion on the receiving list.

"I know my uncle did not give any money but I was included on the list because he knew somebody,” Mulule said. “I can imagine what would have happened had I not known anyone."

.A member of Malawi Network of People Living with HIV/Aids (Manet +) support group remembers how hard it was for her to access treatment at Queens.

“I was very sick because my CD4 count was 50,” she said. “The doctors recommended that I should start the therapy, but I had no access.”

She says that her help came when her sister smuggled some ARVs' from South Africa.

“After taking the drugs for three months I was introduced to Partners in Hope, who have since been providing me with the ARVs,” the woman said. “I am happy to say that I am well because of them.”