Africa, Development & Aid, Headlines, Health, Poverty & SDGs

AFRICA: ‘We Cannot Leave Lives of Nationals to Development Partners’

Laura Lopez Gonzalez

JOHANNESBURG, Mar 16 2011 (IPS) - As donors retreat from funding HIV prevention and treatment, the vulnerability of national programmes reliant on external funding has become apparent. Without long-term sustainability, the lives of millions could be at risk.

Kenyan nurse preparing ARVs for a patient in Kenya: activists are calling on governments to take responsibility for funding treatment. Credit:  John Nyaga/IRIN

Kenyan nurse preparing ARVs for a patient in Kenya: activists are calling on governments to take responsibility for funding treatment. Credit: John Nyaga/IRIN

In the run-up to this year’s U.N. High-Level meeting on HIV/AIDS, activists from East and Southern Africa are calling on governments to take increased ownership of these programmes to ensure treatment continues after donor funds have gone.

According to Dr Mbulawa Mugabe, UNAIDS deputy regional director for East and Southern Africa, the region has made considerable progress towards reaching the universal HIV treatment access target of 80 percent coverage among those in need of antiretrovirals (ARVs).

He added that the region is performing above average for low and middle-income countries. Under the WHO’s previous guidelines, Zambia, for instance, came just shy of meeting universal treatment access targets. The country has been able to increase the number of ARV clinics nationally from just two in 2004 to about 420 by the end of 2010, but donors continue to cover more than 90 percent of ARV costs, according to UNAIDS.

Mugabe noted that under new guidelines set by WHO in 2009, which start patients on treatment sooner, the number of people eligible for ARVs had increased: national universal access targets will have to be revised upwards.

“We have a major challenge around the sustainability of the response to HIV in this region,” said Mugabe. “Hardly any government is putting money in. This is a major problem. We cannot leave the lives of nationals to development partners.”


Decreased donor funding and programme sustainability are likely to be high on the agenda of the June meeting, which will review countries’ progress on commitments made a decade ago as part of the 2001 U.N. General Assembly Special Session (UNGASS) Declaration of Commitment on HIV/AIDS.

According to activists and many in the HIV/AIDS community, governments need to bridge the gap between domestic and external spending for ARVs to guarantee the sustainability of treatment programmes amid the uncertain future of HIV funding.

But researchers say without accurate country-level data, this gap becomes harder to estimate.

Focus on treatment

Research presented at a recent UNAIDS regional consultation by the Centre for Economic Governance and AIDS in Africa (CEGAA) showed that ARVs in not only Zambia, but also regional countries such as Swaziland, Zimbabwe and Mozambique remain predominantly donor-funded.

As part of its research, CEGAA measured HIV spending across sectors in six Southern African countries: Botswana, Swaziland, Lesotho, Zambia, Mozambique and Zimbabwe. CEGAA’s analysis found that only Botswana, which funds about 80 percent of its HIV response, shouldered the bulk of its ARV costs.

Conversely, donors funded at least 80 percent of all HIV programming in Zambia, Mozambique and Zimbabwe; and about one-third of services in Lesotho and Swaziland.

With the exception of Swaziland, CEGAA also found that HIV funding went predominantly to treatment programmes.

“ARV programmes dominate costs,” Shezi said. “Most economies are spending very little on behaviour change because you do not see the benefits immediately and they are under pressure to show results. With [the amount devoted to] prevention being so small, we are really just scratching the surface [in preventing new infections].”

Data poverty

But figuring out how much countries need to fund all this themselves remains difficult without the national data for things such as HIV hot spots and treatment uptake and retention levels, according to CEGAA researcher Silindile Shezi.

Without this data, governments often use generic mathematical modelling to estimate costs, he said. These models are not always reflective of specific characteristics of the epidemic in a particular country, as they are based on general assumptions regarding everything from patient retention to life expectancy, assumptions that continue to evolve as researchers come to understand more about the AIDS pandemic.

“Unfortunately, there have been limited efforts to cost universal access at the country level,” Shezi said. “Even those countries who do costings don’t have the country estimates, they actually use global estimates, and some they will actually just cost specific interventions, like your national strategic plans.”

South Africa continues to fund a large proportion of ARV treatment within its borders. Before the country adopted new guidelines in February 2010 to bring the country more in line with WHO recommendations, the National Treasury costed the proposed recommendations.

However, the first detailed costing of what it would take to bring the country fully in line with WHO recommendations was spearheaded not by Treasury, but by Boston University assistant professor Gesine Meyer-Rath as part of thesis research.

Mugabe urged countries to improve data collection and added that national HIV programming including ARVs would have to become part of mainstream planning if countries were going to increase national ownership.

“There is no way you can expect a national strategic plan [on HIV/AIDS] developed outside mainstream government planning to be funded,” Mugabe said. “We have to be voting on budgets… we have to be pushing that this is a planning responsibility like any other planning responsibility in our countries.”

While it remains unclear how the gap will be filled, the need to find long-term funding cannot be ignored.

Shezi suggested that countries look at innovative financing methods such as adopting airline or cellphone taxes to raise funds as well as increasing incentives for private sector involvement.

UNAIDS released a briefing paper on Mar. 15 calling on governments to use flexibilities built into the World Trade Organisation’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) to help secure the lowest prices for ARVs.

In a statement, UNAIDS Executive Deputy Director Paul De Lay urged countries to use all means at their disposal, including TRIPS flexibilities, such as parallel imports and compulsory licenses, to ensure the sustainability and scale up of HIV services.

 
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