1. Issues of Access to Medicines in Swaziland Fortunate Fakudze The Royal Villas, Ezulwini 13 th October 2014

2. Outline Introduction Current Situation Treatment Fees (Public Sector) Sustainability & Affordability Patented Medicines used/to be used in country

3. What do we mean by ‘access to medicines’? Physical availability Geographical proximity Guaranteed sustainable supply Financial affordability Within financial means of individuals or the state MINISTRY OF HEALTH3

4. Current Situation The country has an Essential Medicines List that largely guides the choice of medicines procured in the public sector Medicines procured in the public sector are largely funded by government, these include essential medicines (such as ARVs, TB and Antineoplastics) These are procured using the government open tender method There is no pharmaceutical industry in country and all medicines are imported into the country MINISTRY OF HEALTH4

5. Treatment Fees in Public Sector Patients do not pay for medicines in the public sector but obtain them as part of the R10 ARVs, TB and Psychiatric treatment is free in country and government has MOU with some private health providers who obtain these medicines free from government to provide to their patients A larger percents of patients on ART are still on the first line regimen with fewer patients on second or third line regimen, these are mainly imported from India However, the country is treating a number of MDR and XDR TB patients Plans are also underway for the introduction of HPV (Human papilloma virus) vaccine MINISTRY OF HEALTH5

6. Sustainability & Affordability There is a need for medicines to be affordable both to the patients and the state as more patients are put on treatment Also, there is a need to plan for the management of patients that will go into third line treatment regimens in view of the fact that most of these medicines are patented and expensive Sustainability will become an important issue to consider for these patients MINISTRY OF HEALTH6

7. Patented Medicines Atazanavir (ATZ) Riyataz®, Novartis (BMS) expiration date 2017, its use in HIV, BMS expiration date 2022 EFV/FTC/TDF; Atripla® Gilead &BMS, expiration date 2026 Darunavir (DRV)/RTV/TDF, Tibotec, expiration date 2025 HPV vaccine, Gardasil® Rochester MINISTRY OF HEALTH7

8. THANK YOU SIYABONGA