Fund medicines or fund the programmes that support uptake and adherence? That's the choice countries are now facing amid Global Fund shortfalls. With money tight, countries are slashing civil society-led HIV and TB programmes - treatment supporters, community-based volunteers, support for people living with HIV - to safeguard essential services, according to preliminary research being conducted by the Open Society Foundations.
In November 2011, the Global Fund to Fight AIDS, TB and Malaria faced US$2.2 billion in unpaid donor pledges and cancelled its Round 11 of funding. This was the most dramatic manifestation of years of broken donor promises.
Two years earlier, Global Fund donors reneged on almost 15 percent of pledges - a figure that rose to almost a quarter of donor pledges in 2010, according to former Global Fund Executive Director, Michel Kazatchkine's November 2011 report to the board.
To ascertain the impact on civil society of these Global Fund shortfalls, OSF undertook research in three countries that had planned to apply for Round 11 funding - Swaziland, Malawi and Zimbabwe.
Through interviews with nearly 45 representatives from civil society, Global Fund Country Coordinating Mechanisms (CCMs), HIV and TB programmes, and UN agencies, OSF found that these countries are facing funding gaps for essential services such as HIV and TB testing and treatment, prevention of mother-to-child transmission services (PMTCT), and support for orphaned and vulnerable children (OVC).
The research found that to free up funding for these initiatives, all three countries are cutting the kinds of complementary, civil society-led activities identified as 'critical enablers' in the UNAIDS Strategic Framework.
Swaziland has now halted HIV prevention programmes with the exception of PMTCT and medical male circumcision and may re-programme phase II of its current Global Fund money to shift more money towards buffer ARV stocks, according to Vusi Nxumalo, CCM member and Vice Chairperson of the Swaziland National Network of People Living with HIV and AIDS.
Swaziland's Round 11 application - like that of Namibia - would also have been the first to include HIV prevention programming aimed at criminalised, most-at-risk populations, such as sex workers and men-who-have-sex-with-men. In addition, the country would have addressed the needs of its small population of injecting drug users.
Malawi and Zimbabwe have already cut CSO activities under their Phase II renewals to shift money towards medicines, HIV testing kits and PMTCT.
For example, Zimbabwe's recently approved Round 8, Phase II renewal has slashed funding for behaviour change communication in communities and schools by 54 percent; institutional capacity building and strengthening of PLWH networks by more than a quarter (27 percent); and OVC support by almost a fifth (17%) - all without consulting CSO implementers.
"The removal of behaviour change communication is not justified," said Joyce Siveregi, deputy director for programmes at the Zimbabwe AIDS Network.
It's not the first time that countries have had to cut CSO programming to preserve drug stocks and diagnostics.
In 2009, the Global Fund mandated a 10 percent 'efficiency gain' in Round 8. Unpublished OSF research found that during grant negotiations, most countries felt resources for commodities such as medicines, lab equipment and infrastructure could not be reduced. Instead, gains were achieved by decreasing resources devoted to programmatic components primarily implemented by CSOs, such as information, education, and communication materials and campaigns, prevention activities, and outreach services targeting marginalised and vulnerable groups
Under OSF's current research, about 80 percent of CSOs said organisational funding had declined in the past two years, with several, longstanding organisations citing funding cuts of up to 30 percent.
To cope, CSOs have scaled back or cut both staff and the kinds of programmes they were forced to cut in 2009 - most prominently, community systems strengthening, human rights and/or community mobilisation programming.
Ironically, respondents reported that community-based organisations, including those comprised of PLWH, were among the types of CSOs most affected.
"These are not organisations that are going to be supported under the Transitional Funding Mechanism," Vusi Nxumalo told OSF. "We are losing the community structures that we've built up. If there comes a time when there is more money for HIV, we're going to have to go back into communities and build these structure all over again."
Now that the Global Fund has announced that it has US$1.6 billion available to begin investing in new programmes, it needs to prioritize investments in the communities it was set up to serve.
Comments Post a comment
The three RCTs were seriously flawed, and it is clear that circumcision does NOT prevent/reduce HIV sexual transmission.
There are now several published critiques of the African RCTs showing these studies to be invalid. http://www.salem-news.com/articles/december112011/circumcision-hiv-rg.php http://www.circumcision.org/hiv.htm
In fact, circumcision can only worsen the HIV epidemic because: 1) Some men may become HIV infected from the circumcision procedure itself when surgical instruments, syringes etc are used on multiple patients, but inadequately sterilized. 2) At least 25% of men engage in sexual intercourse before their circumcision wounds have healed (half as early as 3 weeks). http://www.aidsmap.com/Quarter-of-men-resume-sex-before-wounds-from-circumc ision-fully-healed-in-Zambian-study/page/2227154/ 3) Many circumcised men mistakenly think that they have a "natural condom" so they believe they are "immune to HIV infection" and can be promiscuous with impunity. How wrong they are!
WHILE THE KNOWLEDGE IS THAT THIS VIRUS WAS INDEED A LAB VIRUS USED ESSENTIALY BY THE APARTHIED GOVT. WHILE WE EXAND ON THAT CIRCUMSISION HAS BEEN PART OF AFRICAN CULTURE FOR THOUSANDS OF YEARS WE KNOW FROM BIBLICAL TEXT THAT THE ISRAELITES WERE FOND OF THIS METHOD AS A WAY OF CLEANLINES. WE MUST ALOS RECOGNISE THAT IT WAS PART AND PARCEL OF EVERY NATION IN AFRICA. WE HAVE BEEN DENIED THESE CULTURAL ACTIVITIES WHILE THE ZIONIST ARE NOT CRITISED NOR ARE MUSLIMS BUT THE ANSWER IS CLEAR ; AFRICANS WERE INDEED THE PEOPLE OF SCRIPTUAL PASTY. AS WE SEE MOST OF EUROPE DOES NBNOT PRACTISE THIS BEHAVIOR AND DOES NOT ACCEPT IT AS A RIGHT. AFRICANS HAVE BEEN FROCED TO DEENY THEIR CULKTURES BECAUSE WHITES HAVE BEEN TRYING TO SEPERATE THEM FROM CIVILIZATIONINSISTING THAT THEY WETE THE FIRST TO CIVILIZE THEM ETC. WHAT WE ARE SEEING IS THEIR UNEXASUTED EFFORTS TO SUPPRESS THE TRUTH. CIRCUMSISION A BIG PART OF ISRAEL AND THEIR TRADITIONAL RIGHTS. YET WE SAW ALL OF AFRICA PRACTISING THESE AS CULTURAL AND NATURAL RIGHST. BY THE WAY DEMOCARCY WHAT W PRACTISE IF ALL AFRICA WANTS TO DO THIS THEY ARE WELCOME. WE SEEM TO HAVE THESE RIGHST PEOPLE WANTING AFRICA TO ASSIMILATE TO THEIR UNGODLY BELIEFS THEY ARE THEY WHOM WISHES FOR AFRICA TO ONCE AGAIN RETURN TO SODOMY SOME THING THAT WAS ABOLISHED WITH SUCH DEVASTATION FROM THE AFRICAN CONTINENT. WE CAN SAFELY SAY THAT THE SAHARA WHICH LOCATED SODOMAND GOMOROH A PLACE WHERE THERE IS ABSOLOUTE DEVASTATION DUST NMOTHING. FORTUNATELY THE BIBLE WAS KEPT AND RETURNED TO ITS RIGHFUL OWNERS THERE MIGHT BE SOME THAT ARE INCORRECT BUT THE TRUTH IS DEFINITELY EVEN WITH UNTRUE TRANSLATIONS ,THE ELEMENT OF FACTS OF REGIONS ARE OVERWHELMING AND COINCIDENCE DOES NOT EVEN COME INTO IT. TRUTH IS OEVRWHELMING THE BIBLE IS OF BLACK AND ABOUT BLACK. I SAY TO AFRICA WE DONT HAVE TO ARGUE WE DONT HAVE TO BE PURSUADED OF OUR CULTURE. FACTS AND TRUTH WITH KNOWLDGE THAT IS AVAILABLE TO US TODAY WE KNOW FOR A FACT THAT THE MID EAST IS AFRICA AND WAS ALWAYS AFRICA AND WE KNOW THAT AFRICA WAS THE PLACE OF ALL BLACK BORN PEOPLE SO WHEN WE HEAR STORIES THAT WHAT WE DO IS WRONG AND WE DONT DO THIOS RIGHT OR THAT RIGHT "WE MUST JUST LET THIS FLY IT DONT APPLY" WE ARE THE EARTHS MOST GIFTED THE MOST CREATIVE OUR MUSIC OUR CULTURE HAS BEEN ADOPTED WORLD WIDE WHETHER ITS RIGHT OR WRONG THE FACT THAT IT WAS BLACK MAKES IT THE WAY TO BE.
Africa has ungratefully sat back and expected to be spoon-fed by the international communities whilst her leaders have lived on the hog with no care. African people must either choose supporting their ruthless dictators, do without outside aid and die like flies or pull themselves together and make the best go for their countries by doing away with dictatorship, brutality, greed and corruption because one of these days the international community will wisen up.