The Financial Gazette

Tabitha Mutenga, Staff Reporter

THE termination of funding by the Global Fund could jeopardise Zimbabwe’s under-funded health sector in the next two years, stakeholders cautioned this week, amid fears of a reversal in the gains achieved against the HIV and Aids scourge, tuberculosis (TB) and malaria, especially in the rural areas.
The United States-controlled Global Fund recently announced the termination of funding, sending shivers in the country’s tottering health sector, which has been heavily dependent on donor funding to fight the three major killer diseases — HIV and Aids, TB and malaria.
The introduction of the Global Fund to fight HIV and Aids, TB and malaria in 2002 had brought hope to many HIV positive people since it meant that all people living positively had access to anti-retroviral drugs (ARVs) despite being poor.
When the fund was established, only 40 000 people living with HIV in low-to-middle-income countries were receiving life-saving ARVs. Today, it is estimated that nearly six million lives have been saved by Global Fund supported grants, including in Zimbabwe.
The Fund has been the major source of funding for interventions that address HIV, TB and malaria with approved funding of US$ 19,5 billion for more than 780 grants in 140 countries. The Fund provides over 25 percent of all international financing for HIV and Aids, 66 percent for TB and 75 percent for malaria globally. However, the board of the largest provider of antiretroviral therapy (ART) in the world has taken the unprecedented decision to cancel Round 11 of funding. Zimbabwe National Network of People Living with HIV (ZNNP+) advocacy and communications officer, Paidamoyo Magaya, said while there were no immediate implications to the cancellation of Round 11 for Zimbabwe, effects were likely be felt at the end of the current round, in 2014.
As such, there was need for combined efforts between civil society, non-governmental organisations and government to come up with strategies to close the funding gap that would be created.
“The Global Fund has been contributing about 35 percent towards ART. It would be prudent for the country to tap into the local resources and channel some funds (from minerals) to contribute towards health. Already, not everyone in need of ART is receiving it,” she said.
“About 425 497 are receiving ART and the total (of those) in need is around 547 000 people. With Global Funds contributing 35 percent to this, it means if the current round ends then we will have an increase of people needing ART but not getting it. What then does that mean to the life of a person living with HIV? No treatment means immune system is compromised, open to many opportunistic infections, body is weak, not productive and gradual decline leading to death,” Magaya added.
She urged the government to adhere to the Abuja declaration of allocating 15 percent of its budget towards health.
“This will go a long way in shortening the gap that already exists.  Therefore there is need for efforts among various stakeholders across the board to come together and contribute to health funding. A healthy nation is a productive nation.”
While a Transitional Funding Mechanism (TFM) has since been created to cushion countries affected by the termination of the Global Fund, Zimbabwe may not qualify for the TFM.
The TFM is meant to cover the costs of “essential prevention, treatment and/or care” services in countries that have grants that would be expiring in 2014.
The new arrangement threatens to reverse all the gains made so far especially against HIV.
HIV prevalence in Zimbabwe declined, from 15,6 percent in 2007 to 14,3 percent in 2010 for ages between 15-49 years. New HIV infections dropped from 66 000 in 2009 to 47 450 last year.
More and more countries are on target to eliminate malaria from their territories, while the world is on course to halve TB mortality by 2015 in comparison with 1990.
Country Co-ordinating Mechanism co-ordinator, Rangarirai Chiteure, said there were no immediate implications on the country’s programmes since Round 11 implementation was targeted to start in the last quarter of 2013.
“The impact on programme funding would be felt starting in 2013 since it is the year the Round 11 was envisaged to start flowing. Impact on Global Funding funded programmes would be felt at the end of Phase II of Round 8 that is from January 2015.
“The Phase ll ARV support is expected as follows: 193 500 patients in 2012, 223 500 patients in 2013 and 238 500 patients in 2014. The country needs to prepare for programme takeover at the end of Round 8 Phase ll starting January 2015,” Chiteure said.
TB is a major public health problem in Zimbabwe. As of 2011, the country ranked number 20 out of 22 on the list of high-burden TB countries. The disease kills 1,3 million people every year and another nine million are suffering from the disease. TB is the biggest killer of people living with HIV and Aids.
The Parliamentary Health Committee reports that the country’s over reliance on donors for drugs was unsustainable and could give rise to a national crisis should the donors decide to withdraw.
“We are presently surprised that about 98 percent of the drugs in this country are donor funded and only two percent are provided for in the budget,” reads part of the Parliamentary Health Committee report.
Besides HIV and Aids and TB, malaria also remains a serious public health concern in Zimbabwe, affecting more than 50 percent of the country’s population. Malaria is endemic mainly in the hot and humid Zambezi Valley and in the western and central parts of the country. The worst affected areas are districts in Matabeleland North and South; Midlands; parts of Mashonaland West, Central and East. Pregnant women and children under the age of five are at greater risk of contracting malaria.
Zimbabwe has benefited from the Global Fund under rounds 1, 5 and 8.  Under Round 8 Phase 1 HIV grant (2010-2011), Zimbabwe received over US$73 million out of a budget of over US$84 million. For TB, Zimbabwe received over US$25 million and malaria US$31 million.