**[Department of Health and Human Services]{.underline}**

**[Meeting of the International subcommittee of the Presidential
Advisory Council on HIV/AIDS]{.underline}**

Testimony of Dr. Konji Sebati

December 18^th^, 2003

**[Diflucan Partnership Program]{.underline}**
![](media/image1.jpeg){width="2.8472222222222223in" height="1.15625in"}

**[Goal]{.underline}:**

To provide Diflucan (fluconazole), an anti-fungal medicine, for the
treatment of AIDS associated fungal opportunistic infections.

Priority will be given to developing countries with prevalence rates of
\>1%

**[Program Background:]{.underline}**

-   December 2000 the program was launched in South Africa in
    partnership with the Ministry of Health

-   The program was extended to the 14 Southern African Development
    Community (SADC) countries soon after

-   In June 2001, Pfizer's CEO, Dr Hank McKinnell announced the
    expansion of the program to the world's 49 Least Developed Countries
    and sub-Saharan Africa, and

-   In July 2003 the company expanded the Diflucan Partnership Program
    to all developing countries with a prevalence rate of \>1%

**[Program Components:]{.underline}**

-   The donation is in the form of 250mg tablets, IV and a Pediatric
    Oral Suspension

-   It is only for the treatment of two HIV-related opportunistic
    infections, *cryptococcal meningitis* and *esophageal candidiasis*

-   In eligible countries, the Government and qualified non-governmental
    organizations (NGOs) may apply to participate in the program. NGOs
    must provide a letter of support from the Ministry of Health to be
    considered since Pfizer does not want to create parallel, vertical
    and/or competing systems within a country

-   Applications are processed through Pfizer's partnership with Axios
    International, and can be either paper based or via the web at
    [www.diflucanpartnership.org]{.underline}

-   [Training]{.underline} of health care providers is a key component
    of the program, and is included as part of Pfizer's effort to build
    local capacity in the provision of HIV/AIDS care and support

-   ***[Diflucan will be provided free of charge; with no limit to cost
    and time]{.underline}***

**[Status as of October 2003:]{.underline}**

-   More than 15,000 healthcare workers have been trained in the
    treatment of opportunistic infections, in particular fungal
    infections

-   More than 4 million tablets have been dispensed

-   The program is now operating in 17 countries, and in more than 800
    facilities. The participating countries are;

> South Africa Tanzania
>
> Botswana Zambia
>
> Lesotho Zanzibar
>
> Malawi Zimbabwe
>
> Mozambique Namibia
>
> Rwanda Swaziland
>
> Kenya Uganda
>
> Ghana Senegal
>
> Haiti

**[Program Partners:]{.underline}**

-   Axios International: Program Administrator

-   Interchurch Medical Assistance which helps us with expanding
    outreach to the faith-based community

-   International Association for Physicians in AIDS Care (IAPAC), our
    training partner based in South Africa

-   International Dispensary Association (IDA): Distributor with
    shipping due to commence early 2004

**[2004 Expansion Plans]{.underline}**

-   Africa: Nigeria and Ethiopia, and several West African countries

-   Russia

-   The Caribbean

-   Asia: Cambodia

**[Lessons learnt]{.underline}**

A lot of valuable lessons were learnt from this partnership, and these
lessons continue to guide us as we expand the program to other countries
outside Sub Saharan Africa, namely:

[The value of partnerships]{.underline};

> This epidemic requires partnerships at all levels; partnerships
> between governments and the private sector, between governments and
> non-governmental organisations, between the private sector and
> International organisations like the WHO, the United Nations, the
> World Bank

What makes a true partnership? Our program has taught us that several
critical attributes have to be in place, and ideally several questions
have to be asked and answered before any program begins:

-   Does the partnership address a particular need identified by the
    recipient country? Is it appropriate? Does it add value?

-   Who are the real partners, and what will their individual roles be?
    Will there be some degree of shared decision-making and power
    sharing? Are the beneficiaries like People Living with HIV/AIDS
    involved in decision making?

-   Is there an agreement to achieve shared goals?

-   What is the level of resource commitment needed to fulfill the
    objectives of the partnership?

-   Are the programs integrated and fully aligned with the existing
    national and district health delivery systems and priorities?

-   What is the time commitment of the partnership? Are the any exit
    strategies in place?

[Understanding the local context]{.underline};

We also learnt to be highly sensitive to local conditions, political,
economic, social factors, and cultural factors. There is no "one size
fits all" solution.

[Building local capacity and transferring skills;]{.underline}

A new way of doing things has dawned, and public-private partnerships
are the answer, with the new generation of 'donor' being one that
becomes an active participant in the program, expecting relatively fast
and visible results, and demanding accountability and good governance

The days of the traditional development cooperation, of donors just
dropping cargo loads of medicine or signing cheques, with no concern for
capacity building and constant support are over.

[Caution not to overburden recipient countries with several, sometimes
opposing programs all at the same time;]{.underline}

Individual donors have often offered partnerships and programs, offering
products, services and funding to MOHs, and NGOs, sometimes with very
little co-ordination. This begs the question; how many new programs can
a country handle and try to integrate?

[Political will is vital for the success of programs;]{.underline}

The role of government in these partnerships is absolutely critical, it
extends beyond simply granting permission to operate, there has to be
strong political will

In conclusion, implementing any plan or program it is vital and pivotal
to the success of the program, to ensure that;

-   This epidemic requires partnerships

-   The intervention must be appropriate

-   The beneficiaries and recipient countries must be central to the
    strategy and implementation; it is not for the donor to dictate what
    needs to be done

-   Understand the local context and sensitivities

-   Build local capacity and transfer skills, train and train trainers
    for sustainability