Africa: Less Global Funds, More ProblemsBy Laura Lopez Gonzalez,
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.