Thank you for listing problems that may contribute to drug resistance in children and infants. I would like to add a few from my experience of taking children and infants to facilities in Arusha, Tanzania.
Stock-outs were not frequent, but when the drug was close to its expiry date the pharmacy would refuse to issue it. This is despite the fact that several of the doctors explained that the drugs were still good for at least another year.
While pills could be counted, liquid formulations were issued by the bottle. One formulation I needed every month was enough for 14 days. So I would get 2 bottles a month, regardless of how many days there were in the month. Therefore, children may have ended up with smaller doses of liquid formulations sometimes.
Pharmacists were often very slow to calculate how many containers of pills were needed, and would generally make at least one serious error for at least one child, sometimes all of them, every month. I would get as little as one third of the pills I needed, and often had to spend a lot of time going through the simple calculation to persuade the pharmacist to hand over the correct quantity of drugs.
Collecting ARV prescriptions was an ordeal for me, and I could go straight to the supervisor. So I'm sure it was next to impossible for many people collecting drugs for themselves, and even worse for those collecting several prescriptions.
Pharmacists, nurses and others in healthcare do not like being questioned or challenged, and patients are afraid of them. This means people have no one to turn to when they have problems at that end of their visit to the clinic.
I believe they are experimenting with kiosks in some places and I wonder if that might be an improvement. But it's hard to know without being able to carry out the kind of research that you and others are doing.
HIFA profile: Simon Collery is an independent information consultant in London, with over 20 years experience working in information. He also has 11 years experience working in international development, mainly in East Africa - collery (@) googlemail.com