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Africa: Funding Slowdowns Hit AIDS Programs
AfricaFocus Bulletin
Mar 1, 2012 (120301)
(Reposted from sources cited below)
Editor's Note
In the last 15 years, AIDS activists and medical
professionals, in Africa and around the world, have won the
recognition that the fight against AIDS, which
disproportionately affects the African continent, is a
shared global responsibility.
Millions of lives have been saved. But the fight against
AIDS and the wider commitment to health as a universal human
right is now threatened by "AIDS fatigue" and austerity
politics. It's time to build on success and reject the
callous assumption that millions more should simply be left
to die, whether from AIDS or as a result of other unmet
health needs.
Long-time readers of AfricaFocus will be aware that HIV/AIDS
and the right to health have been regularly featured in
AfricaFocus Bulletins, not only because of their intrinsic
importance but because this issue has been an indicator of
global willingness to take on its share of responsibilities
in confronting global crises which disproportionately affect
the African continent.
Spearheaded by groups such as the Treatment Action Campaign
in South Africa, joined by international groups, the
international AIDS conference in Durban in 2000 marked a
launching point for attacking the assumption that African
lives did not count. Practical and institutional changes
since then have been enormous. The Global Fund to Fight
AIDS, TB, and Malaria was created. The Bush administration,
in which the AID director in 2001 offered the view that AIDS
treatment for Africa was useless because "they don't know
what Western time is"
(http://www.africafocus.org/docs01/nat0106.php), was forced
to shift course, launching a bilateral AIDS initiative
(PEPFAR). The South African government eventually moved from
denial to taking the global lead in responding to AIDS
(http://www.africafocus.org/docs11/hiv1107.php).
Yet today, except for those on the front lines of the fight
against AIDS, there is a tendency to regard the issue as
solved, or at least of lesser priority.
With the 19th International AIDS Conference scheduled for
July this year in Washington, DC, activists will be
mobilizing to call for renewed action. As a modest
contribution to these efforts, AfricaFocus is adding a new
"Featured Issue Focus" on the home page
(http://www.africafocus.org). Readers are encouraged to use
this and to pass it on to their colleagues, friends, and
students. Included are links to "Ten Talking Points"
(http://www.africafocus.org/healthexp.php), "Key Groups &
Agencies" (http://www.africafocus.org/healthexp2.php), "Key
News & Issue Links" (http://www.africafocus.org/healthexp3.php), and, for those
interested in exploring the history of the issue, a full
archive of relevant AfricaFocus Bulletins
(http://www.africafocus.org/healthexp4.php).
Your feedback and suggestions of material for future
AfricaFocus Bulletins or for this Featured Issue Focus are
welcome.
Today's AfricaFocus Bulletin contains (1) a report on the
partial release of delayed funds to Global Fund recipients
in South Africa, including the Treatment Action Campaign,
(2) a report on progress, and rising costs, in South
Africa's national strategy to fight AIDS, and (3) excerpts
from a report by the International HIV/AIDS Alliance from a
survey of its affiliates on the current and potential impact
of the global slowdown in AIDS funding growth. Countries
surveyed in more detail in the Alliance report included
South Sudan, Zambia, and Zimbabwe.
Additional recent related reports of interest include:
Center for Strategic and International Studies, "Righting
the Global Fund," Feb. 27, 2012
http://csis.org/category/topics/global-health/hiv/aids
Global Fund Observer, "Demonstrators Rally to Urge African
Leaders to Spend More on Health," Jan 24, 2012
http://allafrica.com/stories/201201250006.html
Inter Press Service, "Burkina Faso: More Money Needed to
Guarantee Availability of ARVs," Feb. 14, 2012
http://allafrica.com/stories/201202141323.html
Kaiser Family Foundation, "Budget Tracker: Status of U.S.
Funding for Key Global Health Accounts," Feb. 15, 2012
http://www.kff.org/globalhealth/8045.cfm
Update on Senegal:
The first round of election concluded without a winner, and
a second round vote will be held this month. President Wade
received 34,82% of the votes cast, and the leading opposition
candidate Macky Sall received 26,57%. Complete provisional
results are available at http://tinyurl.com/7hwxmjy National
and international observers agreed that the polling itself
was orderly and remarkably free of questionable incidents.
Additional sites of interest, in addition to those cited
last week, include http://www.sunu2012.sn,
http://www.senevote2012.com/, http://samabaat.com/, and
http://www.preventionfitnasenegal.org/
++++++++++++++++++++++end editor's note+++++++++++++++++
South Africa: Global Fund Monies Finally Released
22 February 2012
IRIN
[This report does not necessarily reflect the views of the
United Nations ]
http://www.irinnews.org /
http://allafrica.com/stories/201202141323.html
[For additional background on the delays in disbursement of
Global Fund grants in South Africa, see
Global Fund Observer, Issue 176: 20 February 2012
http://www.aidspan.org/gfo /
direct link: http://www.aidspan.org/index.php?issue=
176&article=1]
Cape Town - More than seven months overdue, the Global Fund
to fight AIDS, Tuberculosis and Malaria grant will finally
be released to key South African AIDS organizations that
have been struggling to survive. Some were on the verge of
shutting down.
The Global Fund released US$7,106,426.91 to the South
African National Treasury on 6 February, the same day seven
of the grant's sub-recipients delivered an open letter to
Minister of Health, Aaron Motsoaledi, pleading for
intervention to bring the Fund's "life-threatening delays"
to an end.
Signed by the Treatment Action Campaign (TAC) and six other
sub-recipients of the Fund's Round 6 HIV grant to South
Africa, the letter warned of imminent closure of vital
community-response programmes across South Africa, a country
with one of the world's highest HIV burdens.
The payment, of which US$2,722,555 will be released this
week to the sub-recipients, represents about half the total
owed by the Global Fund to these community organizations for
July-December 2011. It covers human resources only and no
programmatic costs.
Funding crisis
The Fund cancelled its Round 11 funding last November after
a funding crisis and allegations of corruption, and early
this year executive director, Michel Kazatchkine, resigned.
The new general manager, Gabriel Jaramillo, is expected to
spearhead a reform process.
The South African sub-recipients of Round 6 funding would
like to see some change. "Almost every tranche has been late
since the beginning," said TAC treasurer Nathan Geffen. He
said that when the July 2011 tranche failed to appear, TAC
was initially unsurprised. However, as weeks and then months
passed, the situation became untenable.
The blame game
"What has become patently clear is that the Global Fund
systems are so complex that neither the Fund nor its
principal recipient, the Department of Health, is able to
manage the system properly," Geffen told News.
Organizations such as TAC, which deliver services on the
ground, are not funded directly by the Global Fund. Instead
it contracts with a single principal recipient, the health
department, encouraging organizations from different sectors
to work together.
If all these programmes were to collapse, there's no doubt
in my mind that there would be a negative impact on the
reduction in new infections, which is the holy grail of HIV
programmes
In theory, this system should simplify administration. But
with multiple organizations trying to meet complex reporting
requirements, the result appears to have been additional
complications that TAC says the health department is not
adequately equipped to administer.
Complications
According to the Global Fund Observer (an independent
newsletter on the Global Fund produced by Aidspan), the
situation was further complicated by the South African
Country Coordinating Mechanism's (the implementing body for
the grants, made up of government and local stakeholder
organizations, including TAC) desire to consolidate the
Round 6 grant with its Round 9 and new Round 10 funding, all
of which would then be managed by the health department.
Thus the department and Fund embarked on implementing a
"singe-stream-of-funding" negotiation, a process that took
longer than expected and was not finalized until 15 December
2011.
"Yesterday, in a formal meeting, the Global Fund people
admitted that the main reason for the delay was the attempt
to consolidate the round 6, 9, and 10 grants into a single
system," Geffen told News.
The Fund acknowledges that the single stream funding did
slow the grant disbursement, but maintains the fault lay
with the grantees. "The Single-Stream-of-Funding grant was
delayed as the grant documents did not contain information
requested by the Global Fund," Fund spokesperson Marcela
Rojo told News by email.
Meanwhile, Minister Motsoaledi, who acts as chair of the
Country Coordinating Mechanism, told News he was not "very
sure" if the funding stream was the reason. "We are looking
at what [caused] the delay, and we tried to correct
everything that could have been wrong," Motsoaledi said.
David Garmaise, a senior analyst at Aidspan, told News that
most people working on Global Fund programmes agreed that
single stream funding was preferable, but that in practice,
it was not easy to realize. "The Global Fund, as the agency
pushing for this change, has a responsibility to ensure that
the transition is handled smoothly, and that care,
treatment, prevention and other services are not disrupted
in the process," Garmaise said.
Under pressure
Regardless of who is at fault, services in South Africa have
been disrupted, and the reality on the ground is grim.
Nearly all the sub-recipients have dug deep into reserve
funds. Furthermore, the ability to plan activities has been
hamstrung.
One of the casualties of the delayed funds has been Soul
City, an organization that uses mass media for public
health. Soul City's HIV prevention radio programme,
broadcast in nine languages across the country, has been
scrapped for the time being. "It means that we're not
reaching poorer, more rural people in their own languages.
There's a whole range of things we're having to do away
with," said programme director Sue Goldstein.
Jack Lewis, director of the Community Media Trust (CMT), a
fellow Round 6 sub-recipient, is concerned that the ultimate
result of the collapse of programmes like Soul City's and
CMT's own popular "edu-tainment" offerings, as well as major
programmes such as TAC's treatment literacy campaign, will
mean reversing gains in reducing new infections and
increasing ART adherence.
"If all these programmes were to collapse, there's no doubt
in my mind that there would be a negative impact on the
reduction in new infections, which is the holy grail of HIV
programmes. We'd also see a worsening of adherence. The need
to maintain adherence through motivation versus policing is
a vital component of these programmes, so you'd expect to
see more problems with that, which means more people have to
go on second-line treatment, which is more expensive and
adds the possibility of the passing on of the resistant
virus," Lewis said.
Meanwhile, the sub-recipients still do not know when they
can expect the balance owed from 2011, or 2012's first
payment. "I don't see any light at the end of the tunnel.
After the meeting [with the Global Fund], we are feeling as
hopeless as when we entered," said Geffen.
The Fund maintains that now that single stream funding is in
place, recipients will see some change. "The Global Fund is
working with the [primary recipient] to improve the quality
of grant documents so that the disbursement processes can go
more smoothly in the future," said Rojo.
South Africa: New reports chart progress - and costs - in
HIV fight
IRIN Humanitarian News and Analysis
http://www.plusnews.org/report.aspx?reportID=94968
Johannesburg, 27 February 2012 (PlusNews) - Mothers, babies
and newly diagnosed HIV patients are receiving more of the
services they need but progress comes at a cost, according
to a new report that predicts a funding shortfall for HIV
treatment in South Africa.
On 23 February, the Health Systems Trust released the latest
versions of its annual District Health Barometer and South
African Health Review.
Although in its sixth year of publication, this year's
barometer is the first to include data on early infant HIV
testing for babies born to HIV-positive mothers and shows
that about half of all babies born to HIV-positive mothers
are now being tested for the virus at six weeks of age, an
important step to ensuring they access the early HIV
treatment recommended for all children younger than one
under national guidelines. In 2009, only about a quarter of
such babies were being tested using the sensitive polymerase
chain reaction - tests that confirm whether HIV-exposed
infants are HIV-positive.
The report also found that almost all pregnant women are now
tested for HIV, which has helped lower mother-to-child HIV
transmission to below 4 percent in the country.
The latest barometer is also the first to include data on
tuberculosis (TB) screening among newly diagnosed HIV
patients. In 2008, only about a third of new HIV patients
were screened for TB; in 2011 about 70 percent were checked.
People who have both HIV and carry latent TB are up to 30
times more likely to develop active TB as their HIV-negative
peers and TB remains the leading cause of death in South
Africa and among people living with HIV worldwide.
Funding shortage
The HST also launched the South African Health Review, an
independent review of the public health sector funded by the
South African government. While the report notes that
HIV/AIDS spending has increased substantially since 2007, it
predicts the country will need up to US$5.3 billion extra
every year to sustain its HIV/AIDS response, particularly
treatment.
The review notes that this year alone the government will
spend about $3.1 million on HIV and AIDS; less than a fourth
of this comes from donors such as the Global Fund to Fight
AIDS, TB and Malaria or the US President's Emergency Plan
for AIDS Relief (PEPFAR).
The South African government already shoulders about 80
percent of its HIV treatment costs domestically and authors
of the review predict that treatment will be the main driver
of the escalating costs of the country's HIV/AIDS response.
In late 2009, the World Health Organization revised its HIV
treatment guidelines to recommend that people living with
HIV start treatment sooner, at CD4 counts - a measure of the
immune system's strength - of 350 or below. Since then,
South Africa has gradually fallen into line, first extending
earlier treatment to at-risk groups, such as pregnant women
and TB patients in 2010 and finally to all patients in 2011.
While activists bemoaned the wait, policy-makers argued they
had to make sure the country, which shoulders about 80
percent of its treatment costs domestically, could afford
it.
As of March 2011, about 1.5 million people were on ARVs in
South Africa. The review expects that number to rise to
about three million by 2015.
Don't Stop Now: How Underfunding the Global Fund Impacts on
the HIV Response
Jan 24, 2012
The International HIV/AIDS Alliance
The International HIV/AIDS Alliance supports communities in
developing countries play a full and effective role in the
global response to HIV/AIDS. It is a partnership of 37
Linking Organisations (national, independent, locally
governed and managed NGOs) around the world that support
approximately 2,000 community organisations delivering HIV
prevention, treatment and care services to just under 3
million people.
Full report, including country-specific annexes, available at:
http://www.aidsalliance.org/publicationsdetails.aspx?id=90566
A crisis for the Global Fund or a crisis for everyone?
In November 2011, the Global Fund to Fight AIDS,
Tuberculosis and Malaria (the Global Fund) announced that
its next scheduled funding round was cancelled and that no
new grants could be funded until 2014. This news hit just as
major scientific breakthroughs and signs of real progress in
hard-hit countries were starting to generate the most
widespread optimism in the history of the AIDS epidemic.
Now, all hopes of entering a new phase of the HIV response
are effectively put on hold until at least 2014, and
progress on many fronts may actually be reversed. The effects on individuals and
communities will be devastating.
This report draws on recently collected field data from
numerous countries where the International HIV/AIDS Alliance
operates to explain why the funding crisis requires urgent
action on the part of Global Fund donors and all other
stakeholders. The Allianceâ�TMs recommendations for responding
to the crisis are based on our analysis of the implications
of funding shortfalls in the following specific areas: HIV
treatment; HIV prevention; care and support; services for
key populations at higher risk of HIV infection; and efforts
to create an enabling environment.
Particularly compelling evidence of the need for urgent
action comes from in-depth country impact studies in five
countries: Bangladesh, Bolivia, South Sudan, Zambia and
Zimbabwe. Each of these countries was, until the funding
crisis, making strong progress towards reducing HIV
infections and AIDSrelated
deaths. The country impact studies document the many ways in
which these countriesâ�TM HIV responses are now endangered. For
example:
- In Bangladesh, cancellation of Global Fund Round 11 means
that the 20% planned increase in coverage of HIV services
for most-at-risk populations will now not be possible; the
national response to HIV will effectively stall.
- The cancellation of Round 11 leaves Bolivia with no means
of scaling up HIV prevention services for key populations
affected by HIV, including at-risk groups not currently
being reached such as prisoners and indigenous people.
Therefore an increase in HIV transmission amongst vulnerable
populations is expected.
- In the new Republic of South Sudan, 80% of the national
AIDS plan remains unfunded. South Sudan was counting on
Round 11 to cover antiretroviral treatment costs and to fund
a nascent HIV prevention strategy facing extra stress from
returnees from neighbouring countries with high HIV
prevalence.
- In Zimbabwe, an earlier Global Fund grant has funded care
and support services in every district, including mobilising
clients for HIV testing, positively contributing to
treatment adherence, and providing incentives, equipment,
and training for caregivers. The funding crisis puts all of
these services in jeopardy.
- In Zambia, where 80% of tuberculosis (TB) patients are
HIV-positive, Round 11 funding was seen as critical for
strengthening TB/HIV services. Priorities include
strengthening intensified TB case finding and TB diagnostic
capacity, as well as scaling up isoniazid preventive
therapy. Failure to fund these services will threaten hardwon
recent progress in reducing HIV-related deaths.
In short, the scale-up of the worldwide HIV response will be
seriously affected and important existing services will be
reduced or eliminated in the absence of urgent measures. If
the global community is to prevent this enormous setback
threatening the health and lives of millions of people � and
realise the numerous commitments made by United Nations
member states through the Millennium Development Goals and
at the 2011 High Level Meeting on AIDS � then swift and
decisive action is imperative.
For donors and other stakeholders to reduce funding for the
HIV response in difficult economic times is short-sighted
and counterproductive. While trillions of dollars have been
found by governments to bail out the reckless financial
sector, donors have left the Global Fund short of the funds
it needs to save millions of lives. The Global Fund is the
best mechanism the world has for realising the possibility
of a world without AIDS but can only do so with sufficient
investment.
As we approach the 10th anniversary of the Global Fund, the
International HIV/AIDS Alliance urgently calls for donors
and national governments to respond to the funding crisis:
- Donors must honour existing pledges and increase
investment to provide the Global Fund with financing
(approximately $2 billion) for a new funding opportunity in
2012.
- National governments must increase investment in their
own HIV responses and in the implementation of national AIDS
strategies that reflect the epidemiology in their countries.
- Bilateral donors must take immediate steps to fill
critical HIV service gaps that will not be covered by
existing funding mechanisms.
...
AfricaFocus Bulletin is an independent electronic
publication providing reposted commentary and analysis on
African issues, with a particular focus on U.S. and
international policies. AfricaFocus Bulletin is edited by
William Minter.
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