For people to use a treatment, it must be available - meaning that it can be found anywhere that is appropriate.
A treatment is available if the materials needed to treat a health problem can be found in the community. For example, basic drugs (such as paracetamol and simple antibiotics) are available in many countries, especially in towns. However, newer drugs (such as antiretrovirals) may not be widely available. Some reasons why a drug might not be available include the following:
• the drug is new and not yet legally allowed for general use;
• the drug is not imported into the country for commercial reasons;
• the public health system does not allocate funds to purchase the drug; and
• only specialists are allowed to give the drug.
So the first step in making certain that people have access to the drugs they need is to ensure that these drugs are available within their own countries by securing the economic, legal and technical resources that can allow this to happen. When they are available, it is important to work on ensuring that people can actually have access to drugs for treatment when and where they need them.
Access to drugs depends on four key factors:
• rational selection - choosing drugs that are safe, effective, valuable to public health and guaranteed to be of good quality;
• affordable prices - governments and individuals must be able to afford their essential medicines and maintain people's health;
• sustainable finances - the money to pay for treatments must continue to be available when needed and in changing circumstances;
• reliable health systems - access to drugs needs to be supported by systems that ensure availability whenever the drugs are required.
Participatory group activity
To identify where drugs for HIV/AIDS-related treatment are available in the community.
1. Explain the aim of the activity.
2. Present participants with a definition of access to drugs for HIV/AIDS-related treatment (see above). Brainstorm about some examples of what it means in practice at a community level.
3. Lead a group in brainstorming about what is meant by availability of drugs for HIV/AIDS-related treatment. Share some local examples of what it means in practice.
4. Divide the participants into three groups.
5. Give each group an example of drugs for HIV/AIDS-related treatment, such as:
Group 1: a simple treatment (such as paracetamol for pain relief);
Group 2: a well-known but less simple treatment (such as for tuberculosis);
Group 3: an antiretroviral drug.
6. Ask each group to draw a simple map of their community on a large piece of flipchart paper. Ask them to include all the main local features (such as roads and buildings).
7. Ask each group to mark the places in their community where the drugs for HIV/AIDS treatment are available to people living with HIV/AIDS. These might include their homes, the clinic, hospital, pharmacy, NGO, traditional healer or marketplace.
8. Bring everybody back together and ask the groups to share their results. Encourage the participants to ask each other questions and make comments.
9. Facilitate a group discussion about what has been learned from the activity, based upon questions such as:
• What do the maps show about the overall availability of drugs for HIV/AIDS-related treatment in the local community?
• What types of drugs are more available than others? Why?
• How might the availability of drugs vary in different types of communities, such as those in rural or urban areas?
• Encourage participants to use the majority of their time to plot the availability of the drugs for their particular treatment rather than to develop elaborate maps of their communities.
• Encourage participants to think of informal sources of drugs (such as traditional healers and market stalls) as well as formal sources (such as doctors and pharmacies).
At a skills-building workshop, NGO/CBO participants drew a map to show the different places where rifampicin (a TB drug) is available in their local community. The places marked with a star indicate where the drug is found in the community.
Afterwards, the facilitator led a group discussion about what had been learned from the activity. For example, participants agreed that informal sources of drugs (such as traditional healers) can play an important role in supporting people living with HIV/AIDS by helping them make better use of available drugs for treatment.
Reference: Adapted from a workshop on access to HIV-related treatment, India HIV/AIDS Alliance and the International HIV/AIDS Alliance, India, February 2001.