ICASA 2011: For Nigeria to increase funding for HIV programme

By most accounts, investment in the health of Africans is considered to be a priority issue on the global development agenda.

For instance, the Abuja Declaration, which was adopted in April 2001 by African leaders, declared that response to HIV and AIDS, tuberculosis and other related infections should attract the highest priority in their respective national development plans.

The leaders then committed themselves to taking appropriate to ensure that the needed resources were pooled from available sources and utilised efficiently.

A salient aspect of the Abuja Declaration was the leaders’ pledge to allocate at least 15 per cent of their annual budget to the health sector, while mobilising the required human, material and  resources for the care, support and treatment of people living with HIV, tuberculosis and other related infections.

It is now 10 years down the line and observers note that only a few countries have been able to attain the funding target.

Prof. Peter Piot, the Director of the London School of Tropical Medicine and Hygiene, stressed that only six counties had so far been able to meet the target of devoting 15 per cent of their annual budgets to the health sector, as canvassed by the Abuja Declaration. Piot, who is the former Director of UNAIDS, identified the countries as Rwanda, Botswana, Niger, Malawi, Zambia and Burkina Faso.

He, therefore, proposed that a new form of intervention should be initiated, in view of the funding crises currently rocking the Global Fund to Fight AIDS, Tuberculosis and Malaria, usually referred to as the Global Fund.

“Global Fund’s crises mean Africa’s crises. Failure of donors to deliver their promises and the non-commitment of governments constitute a big problem to the fight against HIV,’’ he said.

The 2010 statistics on HIV prevalence revealed that some 6.7 million people were living with HIV in western and central Africa, while several of AIDS-related deaths were recorded last year.

Concerned observers, however, stress that funding shortages could seriously hinder the efforts of African countries to tackle the menace of HIV and AIDS. They also note that if funding HIV and AIDS programmes is not increased, opportunities to forestall the spread of HIV infections will be lost, thereby creating additional problems.

The problem of sustaining donor-funding for Africa’s HIV programmes is becoming more serious by the day.

For instance, the Medecins San Frontieres (MSF), an international medical, humanitarian aid agency, disclosed in November that at the Global Fund’s board meeting in Accra, the board took the unprecedented step of cancelling a funding round (known as round 11) due to low funding levels.

The MSF made this known in Ethiopia via a statement at the just-concluded 16th International Conference on AIDS and STIs (Sexually Transmitted Infections) in Africa (ICASA 2011).

The MSF said that the Global Fund decided that no new funding opportunity would be possible until 2014 and stressed that it’s contingency “Transition Funding Mechanism’’ would only support continuity of programmes, which never included treatment for new patients suffering from HIV or drug-resistant tuberculosis.

Such developments form the rationale behind the concern of some analysts who note that the Global Fund’s decision came at a time when global funding for the crusade against HIV and AIDS has been on the decline for two years in a row.

They regret that such decisions will invariably endanger the continuity of ongoing treatment schedules for people living with HIV and plans to scale up life-saving treatment for the victims.

Dr Leslie Shanks, Medical Director of MSF, noted that recent medical advances in the field of HIV therapy and the progress so far achieved in scaling up treatment to reduce the number of those in need of health care today were pointing Africans to the right direction.

“However, the awareness will be totally meaningless if there is inadequate funding to match the political promises we have accrued to date. All African governments should fund further treatment scale-ups, to save lives and reduce the transmission of the virus,’’ he said.

Besides, Shanks called on the Global Fund’s board to provide new funding opportunities and convene an emergency donor conference within 200 days before the International AIDS Conference, scheduled to hold in Washington, the U.S., in July 2012.

He, however, noted that this year had brought about some critical political commitments, as all governments at the UN High Level Meeting on HIV/AIDS in New York in June pledged to facilitate the treatment of 15 million people living with HIV by 2015.

Shanks said that the US government pledged on the World AIDS Day on Dec 1 to put an additional two million people on treatment over the next two years.

He noted that was a critical step in the midst of a break outlook for global HIV and AIDS programmes, adding, however, that the commitment should be backed up with the necessary funding to turn the pledge into a reality.

“We have been seeing the impact of the funding crisis in countries where we work. Some countries have to cap the number of people that would be allowed to start treatment; others have to delay the start of improved treatment protocols. Besides, many countries are forced to put on hold critical plans to roll treatment strategies that can have a serious impact on the epidemic,’’ Shanks said.

Prof. John Idoko, the Director-General of National Agency for the Control of AIDS (NACA), called for the categorisation of African countries into two groups to facilitate structured and improved funding arrangements in the fight against HIV and AIDS.

Idoko made the call in his paper entitled: “Accountability through Ownership, Shared Responsibilities and Financial Sustainability".

“The issue of financing has to be shared; some countries are doing better than others, in terms of their economy. As a result, those countries can actually look after themselves, so that the money that goes to them can go to poorer countries,’’ he said.

Idoko, however, stressed that for Africa to sustain the fight against HIV and AIDS, there was a compelling need “to own the response in Africa because it is only when we own it that we can really sustain it’.’ He also stressed the need for state and local governments to be involved in the finance of the campaign against HIV and AIDS in their different domains.

Idoko, nonetheless, stressed the need for African governments to exhibit appreciable political will to match their pledges with the required action for the proposed “African Solution’’ to become effective.

Dr Cheick Fall, the Executive Director, African Council on AIDS Service Organisation (AFRICASO), called on African countries to adopt interventions, evidence-based action and use increased resources to strengthen the fight against HIV and AIDS.

Fall, nonetheless, noted a very low domestic contribution to efforts to the fight against HIV and AIDS by developing countries. He stressed that the development had made it impossible for several African countries to achieve the target of the 2001 Abuja Declaration, which called for the setting aside of 15 per cent of annual budgets for the finance of the health sector.

Fall urged African people to hold their governments accountable for the failure to achieve the set target. “What we need today is not to do different things but to do them differently; don’t sit back,’’ he admonished Africans.

Mr. Stephen Lewis, Co-founder of AIDS Free World at ICASA, particularly called on US President Barak Obama to increase his country’s contribution to the Global Fund from four billion U.S. dollars to six billion U.S. dollars.

“In my respectful submission, it’s time for the U.S. to take a hard look at the situation. Many American speeches glow with claims that the U.S. is the largest donor to the Fund. Well, of course, the U.S. is the largest donor, the most dominant and wealthy economy in the world. I really think that apart from calling on the board of the Global Fund to reverse its decision, President Obama should tell the U.S. Congress that he wants six billion dollars for the Global Fund,’’ he said.

Lewis opined that the donor countries were greatly indebted to Africa for “ransacking’’ the continent for the last six hundred years, stressing that the donor countries had no right to withdraw funding for the health programme.

He noted that the use of the resources of the Global Fund and US President’s Emergency Plan For AIDS Relief (PEPFAR) was a tacit way of paying reparations to Africa for centuries of exploitation by advanced countries of the world.

Lewis, therefore, condemned the recent announcement of the Global Fund that it would be unable to provide aid money for Africa between now and 2014. “It’s indefensible, outrageous, it’s murder; and the donor countries expect to get away with it because there is a culture of fiscal impunity,’’ he said.

Lewis stressed that a study indicated that nine African countries had exported doctors to Canada, the US, UK and Australia, noting that the doctors’ emigration had cost Africa between two billion U.S. dollars and 13 U.S. billion dollars in education and training.

He argued that the presence of the migrant doctors in the four recipient countries had saved for the countries about 4.5 billion dollars, the amount they could have used in educating and training the quantity of doctors that was commensurate with the number of the migrant African doctors.

He listed the African countries, whose doctors were “exported’’ to the three countries, as Nigeria, Ethiopia, Kenya, Malawi, South Africa, Uganda, Tanzania, Angola and Zimbabwe.

“We talk endlessly about capacity building and Africa desperately needs its doctors and nurses. Instead, in the vital field of health, Africa loses billions in exporting its human resources,” he said.

Lewis emphasised succinctly that Africa might not be able to attain the Millennium Development Goals (MDGs), if AIDS was not vanquished on the continent.

To sustain adequate funding for HIV and AIDS programmes in Africa, the participants of ICASA 2011, therefore, called on all the stakeholders to continue to make tangible efforts to invest in global health via contributions to the Global Fund.

They made the call at the close of the five-day conference, which took place between Dec. 4 and Dec. 8, and also urged the Global Fund to reverse its decision to cut round 11 disbursements, saying that this would save more than 100,000 lives every month.

The participants particularly called on all African governments and political leaders to initiate ways of ensuring the sustainability and ownership of the HIV and AIDS response programme by remaining accountable to the various commitments they have so far made. The leaders were also urged to mobilise local resources for HIV and AIDS, tuberculosis and malaria programmes, while improving the health systems of their respective countries.

However, observers note that Nigeria is one of the countries which failed to achieve the targets of the Abuja Declaration, particularly the one regarding the allocation of 15 per cent of their annual budgets to the funding of the health sector.

The main question now is: After ICASA 2011, will the Nigerian Federal Government ensure proper budgetary allocations to health sector?