When the United States suspended its major aid programme in Africa that was supporting the battle against HIV and AIDS, and dealing with the associated tuberculosis, plus providing significant support for the battle to eliminate malaria, there was a great deal of concern in Zimbabwe that decades of progress would vanish.
The Government promised that essential health support for those living with HIV would be maintained with local resources and that while stocks of the critical anti-retroviral medication were adequate to June, steps were being taken to ensure that these stocks would be replenished.
This has now been done, using the time granted by the buffer stocks, to ensure that another three-month supply was bought, taking the stocks to September.
The Government has delivered.
As we have noted before, the Second Republic Government can deal effectively with emergencies through budgeting flexibility, something it had already proved with the Covid-19 pandemic and the need last year to ensure no-one went hungry with the dismal harvest after the El-Nino drought. So it should not have been a surprise that it is coping again.
The US had been pumping in more than US$200 million a year under the US President's Emergency Plan for Aids Relief, leaving a substantial hole that had to be filled. And this suspension came with no warning and was immediate, with no notice period to allow any country to readjust. All the adjustments had to be made promptly.
Some of the US support money went on the extra overheads of using non-government organisations in preference to the Ministry of Health and Child Care, an American preference with Zimbabwe, and there was on the published breakdown a large sum to gather data that now can be filled by the Health Ministry and ZimStat.
But that still left the supply of the ART medication, the need to maintain the TB programme, and the need to maintain the quite separate anti-malaria programme from purely internal resources with perhaps some foreign support from other countries.
There was also need to maintain the health staff working under the PEPFAR programme and its contracted NGOs. Steps were already in progress from last year to bring the operational health staff, mainly community health workers but with a top layer of professional medical and nursing staff, into the Ministry of Health and Child Care.
They were doing such good and essential work that they should be in the Ministry and efficiencies would be boosted further if the relationship between this staff and the basic system of provincial and district health officers was formalised, instead of just relying on almost everyone showing common sense. This inclusion needs to be finalised and again provides a cost saving by eliminating much of the independent layer of administration driven by the US preference for NGOs.
For medical supplies, the Government moved swiftly with Minister of Health and Child Care Dr Douglas Mombeshora taking the lead and ordering available funds from the Aids Levy on taxpayers and other available money to be spent as a priority on the ART supplies and other associated medicines.
This is why there is now an extra three-months supply and that, in turn, should ensure that those who need this medicine must continue taking it as prescribed. Dr Mombeshora noted when he announced the new order that some people were skipping some treatment to build up their personal stocks in case there was a shortage.
Already steps are in progress to fund continued purchases automatically through ring-fenced taxes. Minister of Finance, Economic Development and Investment Promotion Mthuli Ncube has discussed assigning some taxes and duties for this, so that the needed cash flows directly, like the AIDS Levy, from Zimra to the supply chain.
Zimbabwe is well on course to eliminating new HIV infections before 2030. The heart of the programme is to ensure that everyone infected with HIV is identified and put on ART treatment. After a while on treatment, the virus is suppressed and the patient is no longer infected.
Once all those living with HIV in Zimbabwe have their virus levels suppressed there is no new infection, simply a continuing need to supply the ART medication until old-age has taken off the last person living with HIV, probably at the end of this century. Hence the need for everyone prescribed ART to take the medication, not just for their own sake but for the health of the nation.
Already Zimbabwe has met the 95-95-95 target. That is at least 95 percent of those with HIV know their status, at least 95 percent of those living with HIV are on ART, and at least 95 percent of those on ART now have their virus suppressed.
Our best performance is with those tested for HIV taking the medication, more than 98 percent. That is because there are adequate stocks of medication to ensure that everyone can start the treatment as soon as it is confirmed they are living with HIV, and the one percent not taking their tablets simply need a good shove.
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Time is simply needed to get a similar figure for those with suppressed virus. Suppression is not instant, but so long as the person living with HIV takes the right dosage as prescribed they will reach that stage.
The somewhat sticky statistic is getting those infected but not knowing their status to be tested so they can start treatment. This is almost 5 percent of the estimated infected. We now know that most of these are young people and here there are the additional complications of underage marriage, underage sexual relations and the like. Most teenagers cannot just sneak off from home for a test.
Since many of the infections in this age group result from contact with older people, there is the additional complication that these older people are committing a crime and so hiding what they do. Major efforts are being made for all sorts of reasons to end child marriages and sexual exploitation of underage children, and those efforts will also translate into fewer HIV infections in those age groups. But we also need to reach out to those in these age groups so they come forward for testing.
