Tanzania Daily News (Dar es Salaam)

16 June 2010

Tanzania: With a Leaner Budget, Will HIV-Positive Survive?

analysis

IN 2009, the sharp pangs of the global financial crisis led to the cutting of the HIV/AIDS national response budget by 20 percent. A very important donor had walked out.

This year, the US President's Emergency Plan for Aids Relief (PEPFAR)-the biggest funder of Aids programmes in Tanzania has reduced its budget for the purchase of ARVs in 2009 and 2010, and also introduced a freeze on its overall HIV/Aids budget in the rest of Africa.

US contribute 59 percent of Tanzania's 95 percent HIV national response budget chunk which comes from donors. With a reduction in the response budget last year,over 200,000 people were infected by HIV including 43000 children.

This, it is said, were through Mother to Child Transmission and with the older national HIV Guidelines, some 12,000 of these babies died before reaching the first anniversary on earth.

As the Day of the African Child is being commemorated, there was still subtle but powerful pointers that the 2010/11 budget for the Health and Social Welfare ministry would be cut by 30 per cent from the 906bn/- allocated in the current financial year to 678bn/-.

This is about 6.1 per cent of the 11.1 trillion/- Budget planned for the next financial year, far below the Abuja Declaration's proposal that 15 per cent of national budgets be dedicated to healthcare.

Health circles in the region have confided that the Abuja Declaration's proposal that 15 per cent of national budgets be dedicated to healthcare, is one elusive ideal.

In Shinyanga, the Regional Aids Control Coordinator Dr Mawazo Amri Saleh told 'Daily News' that the region which started giving ARVs in 2004 at regional hospitals, now have 41 centres giving care and treatment,-which is just a 48 percent penetration. But enrolment on ARVs is far higher among adults than children.

"We have noticed this,many parents are afraid of enrolling their children on HIV, to the detriment of the latter's health."he says "Its not easy sero status to tell a child's because the ordinary CD4 machines we use on adults are not effective on them,as they will only show their mothers' antibodies on taking measurements.' he adds.

In this case,they take Dry Blood Spots(DPS) ,from the 23 centres for HIV early diagnosis currently available in the region,which is 7 percent penetration.This service,he says,is catching the attention of mothers. By March 2010, HIV positive males below 14 were 1,166 females 1236 totalling up to 1236.

The HIV positive males between 15 and 24 years were 618 and 3350 females.Females above 25 were 17952. "The rate is higher among females because our survey shows they starat sex earlier than 15 years yet males start after 18. "he says But what is more grim is the low percentage of positive children who have enrolled for care and treatment as opposed to the number of adults, which is 6.54 percent.

The ARV enrolment lay out in the region shows that 17,331 people are on treatment. Among these,are 528 males below 14 years ,which is a half of the male sick children.Between 15 and 24 years are 238 males on treatment and some 6269 above 25 years are on ARVs.

There are 580 children below 14 years who are on ARVs out of 1236 young ones who are registered at HIV positive. Between 15 and 24 years are 877 females on ARVs out of 3350 registered as living with the virus. Those above 25 years and are on ARVs are 8,839 out of 17,952 living with the virus.

"There is shortage of care and treatment sites across the rural side," said the doctor Yet, with more simmering reductions in funding, where is the stake of children's health in all this? Will a generation survive? Major reductions Other donors, such as the World Bank have also announced reductions over the coming years in the funding for antiretroviral drugs in Malawi, Zimbabwe, Mozambique, Uganda and DRC.

Drug stock-outs and disruptions in drug supply are already a reality, and will become more frequent if sufficient funding is not made available. These reductions in overall funding have translated into a reduction in the number of people able to start their ARV treatment.

In the last one week, 'Daily News' probes in Isagehe and Samuye villages, having intimate interactions with children who live in various outlying rural areas,reveals a fear among locals of likely effects in reduction in funding of some programmes that have, for years,complimented government efforts.

According to World Vision Tanzania documents seen by 'Daily News' in Shinyanga, there is one Health Centre in the Samuye area, which serves 48,000 people. Antiretroviral treatment for HIV / AIDs was available for free at three hospitals in Shinyanga Province, for those with CD-4 counts below threshold levels (200). This, according to ground surveys has been made able by the existence of funding to the government and civil society projects.

The question is whether a reduction in funding would reverse some of these successes. "How can we give up the fight halfway and pretend that the improvement pattern will remain stable?asked Sam Shirima, a health worker at Bukombe. "The current donor retreat will prevent more people from accessing treatment and will threaten to undermine all the progress made since the introduction of ARVs," he said.

In an interview, the Health and Social Welfare minister David Mwakyusa said the government work extra' to make sure more sensitive aspects get adequate funding "it would be the task to work ahead especially in how we use the allocated budget,"he said.

A doctor at a Maswa health centre struggling to set up a more defined Centre for Care and Treatment says the issue of funding is what perhaps to not only solve children's health issues but to support the about 1.4million women who become pregnant a year. With an 8.2 percent HIV prevalence among pregnant mothers funding should go an extra mile in addressing the African mother and the Child. "it's the family,' quips the Maswa doctor.

As things stand, some 114 pregnant mothers get infected with HIV according to a 2009 National Aids Control Programme report which indicates that 120 children are infected everyday through Mother to Child Transmission (MTCT). At the country level, almost a quarter of the HIV new infections in 2008 which were 217704,some 43,300 were due to mother to child transmission.

And from the 596 people infected with HIV every day, some 118 children are infected by their mothers, which is 20 percent of all infections happening daily. However, even as there are mothers who get pregnant with positive sero status, the gap for Prevention of Mother to Child Transmission (PMTCT) services countrywide is still huge, according to Dr Pius Horumpende, a Muhimbili hospital specialist in HIV and TB.

Current settings, he says, show that 6 out of 10 HIV positive women access PMTCT services through 12.5 percent facilities which offer the service, a situation that puts 20 percent of the people on ARVs, who are children in more life danger.

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