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HIV/AIDS funding fails to make the leap
20 January 2003. Republished courtesy of IRIN PlusNews.
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Hailed as a "quantum leap" in the fight against the HIV/AIDS pandemic, the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria has become a focal point for funding efforts to bring the epidemic to heel.
But a year after issuing its first call for funding proposals, the Fund remains seriously under-resourced, and concern is mounting over its sustainability.
UN Secretary-General Kofi Annan estimated in 2001 that US $7-10 billion a year was needed to fight the HIV/AIDS epidemic. "At the end of the year (2002), we [Global Fund] had received US $2.1 billion in pledges and approximately US $800-850 million was available," Global Fund spokeswoman Mariangela Bavicchi told PlusNews. "We don't know yet what is going to happen this year, but we are hopeful that it will continue to be supported," she added.
In 2003, the Fund will need an additional US $2 billion to finance the growing number of proposals it has already approved. A further US $4.6 billion will be required in 2004.
Activists maintain that the sums of money currently made available to the Fund by wealthy nations are an embarrassment. At last year's International HIV/AIDS Conference in Barcelona, Spain, campaigners targeted wealthy nations with slogans such as "Fund the Fund" and "Where is the 10 billion?"
"The poor response to the Global Fund has shown that the international community is not taking HIV/AIDS seriously enough," Daniel Mullins, regional HIV/AIDS Co-ordinator for OXFAM in Southern Africa, told PlusNews. "The momentum that was starting to build up has been completely undermined by the [looming Iraq] war. In 2003, Africa will have dropped off the map for the US [United States]."
Stephen Lewis, the UN Secretary-General's Special Envoy for HIV/AIDS in Africa, has accused wealthy countries of committing "mass murder by complacency" through their failure to contribute enough money to tackling the pandemic.
However, Alison Hickey, project Co-ordinator for the HIV/AIDS Budget Information Service at the Institute for Democracy in South Africa (IDASA), believes the Fund is trapped in a "catch-22" situation. "Donors are still waiting for them [the Fund] to demonstrate results, but they cannot demonstrate these results without the money. So they're under pressure to deliver quickly," Hickey said.
"They have to be careful how they tread," she warned, adding that an over-hasty approach could jeopardise the Fund's accountability. In South Africa, the money awarded to the government amounts to 25 percent of what the national government is spending on HIV/AIDS. This is a large chunk, so there has to be better co-ordination on both sides."
Disputes that have emerged between the Fund and several recipient countries appear to illustrate this dilemma.
The South African government tried to block the Fund's US $72 million grant to KwaZulu-Natal, arguing that the provincial government's funding application had by-passed national government.
Analysts pointed out that, at the time the province submitted its proposal, national government had not set up the country co-ordinating mechanism for handling applications to the Fund.
The dispute remains unresolved, and Hickey believes this is likely to slow down the release of an additional US $93 million the Fund has allocated to national programmes in South Africa.
Procedures were also at the centre of a dispute between the Fund and the Tanzanian government. Tanzania's finance ministry insisted that it should administer a US $12 million grant for malaria prevention, rather than the country's malaria control programme, which submitted the proposal to the Fund. The Fund refused to sign the grant agreement until the ministry relented.
In Uganda, the finance minister announced that the government's health budget would not be increased, despite the Fund's post-budget approval of a US $52 million provisional grant. This, analysts argued, was contrary to the understanding that grants by the Fund should not replace existing funds.
Alan Whiteside, who heads the Health Economics and HIV/AIDS Research Division (HEARD) of South Africa's Natal University, believes problems such as these make it difficult to be optimistic about the future of the Fund. "It is not getting more money," Whiteside predicted. "Countries will just have to rely more on their own resources, although they don't have much of these either."
Nonetheless, there are signs that some governments are prepared to commit more of their own money to tackling HIV and AIDS in their respective countries.
"The size of allocations in national budgets have increased, and in South Africa, funding for HIV/AIDS will rise to R1.8 billion (US $156 million) in 2004/5," said Hickey. "The budget for HIV/AIDS in 2001 was closer to R340 million (US $29.6 million) so there's been a significant increase."
But countries need to manage their existing HIV/AIDS resources better. Studies conducted by IDASA in South Africa, for example, show that provincial authorities have under spent on their HIV/AIDS budgets because they lack capacity in the areas of programme and financial management.
"The size of allocations is not the problem, it's the spending capacity, although this doesn't mean that more money is not needed," said Hickey.
The funding of anti-retroviral (ARV) drugs is likely to be at the top of the agenda in most African countries in the year ahead - a shift in priorities that many activists believe has been inspired by Botswana's bold plan to provide ARVs to all of its HIV-positive citizens.
However, Hickey argues that the Global Fund and national governments should not shoulder all the burden of funding HIV/AIDS treatment. Private sector involvement is crucial, she said, pointing out that corporate social responsibility became a buzzword during 2002.
In Botswana, the Bill and Melinda Gates Foundation and the drug company Merck both pledged US $50 million in assistance over five years. Merck is also offering an unlimited supply of ARV medicines. Meanwhile, the Harvard HIV/AIDS Institute has developed a training programme for the country's health care workers, and also has launched a new research laboratory.
"It seems from the discussions in Barcelona that people have moved beyond the dichotomy of treatment versus prevention and care, and there is a growing agreement that both should be funded," said Mullins. "But I'm not sure that this has seeped through to the donor community yet."
Donors also needed to address the mainstreaming of HIV/AIDS, Mullins continued. "Adding on a bit of awareness raising in different sectors of society is not the point anymore. Their responses have to be multi-sectoral."
This item is delivered to the English Service of the United Nations' Humanitarian Information Unit, but may not necessarily reflect the views of the United Nations |
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