Health facilities with drugs for opportunistic infections and palliative care in stock
However good the diagnostic, nursing and counselling skills of health service providers, they will have little impact unless the necessary drugs are available. At the end of the 1990s, the provision of anti-retroviral drugs outside an antenatal care setting was so low in the countries most affected by HIV that measuring it could hardly be seen as a good use of resources. The provision of drugs to treat common opportunistic infections is a more realistic target, and one that in itself may deliver years of healthy and productive life to infected people at relatively reasonable cost. Palliative care, too, can improve the quality of peoples lives at low cost. In consequence, many national AIDS programmes have been attempting to provide drugs to treat opportunistic infections and provide palliative care in public health facilities. This indicator aims to measure the uninterrupted supply of drugs in public facilities to treat locally common opportunistic infections and provide palliative care.
NUmber of health facilities that have two designated drugs for opportunistic infections and one for palliative care in stock currently, and that report no stock outs of these drugs in the past 12 months
Total number of health facilities surveyed
During a health facility survey, a stock-check is taken for drugs defined by national guidelines as appropriate treatment for three locally common opportunistic infections, along with one drug for palliative care. The drugs will vary according to locally common pathogens and approved drugs, but are likely to include ORS for diarrhoea, anti-fungal drugs and painkillers. Clinic management is questioned about stockouts in the last 12 months, and clinic stock records are reviewed for that period. The presence of anti-tuberculosis drugs would be very important as well, but cannot be measured in all clinics as such drugs are usually distributed by designated TB clinics. The indicator is the number of health facilities that have two designated drugs for opportunistic infections and one for palliative care in stock currently, and that report no stockouts of these drugs in the past 12 months, divided by the total number of health facilities surveyed. Facilities surveyed should include primary health care facilities as well as higher levels.
Geographic location: N/A
Pregnancy status: N/A
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Type of orphan: N/A
Vulnerability status: N/A
Where no national guidelines for care exist and reliable data about opportunistic infections is limited, it will be difficult to determine which drugs should be included in the stock-take. WHO and UNAIDS provide international guidelines on essential drugs for opportunistic infections: in some cases these may be substituted for national guidelines. Countries that are not focusing efforts on providing appropriate care at all levels of the health care system will have little interest in this indicator. Even in countries that are making a significant effort at this level, this indicator may be very low since the inconsistent supply of drugs is a persistent weakness of many health systems. However, unless serious efforts are made to rectify this weakness, investments in training staff in the adequate management of HIV-related conditions will be wasted. It is therefore worth monitoring progress in this area.