The Global Fund to Fight Aids, Tuberculosis and Malaria has announced that it will be forced to cancel its 11th funding round, supposed to provide money for 2011 to 2013. The news could have devastating consequences for public health in Africa. By REBECCA DAVIS.
The Global Fund, launched in 2002, is the world’s largest funder of Aids, TB and malaria projects. About half of Aids drugs in the developing world and 85% of African TB programmes are financed by the fund. In short, the importance of the global fund to public health in Africa cannot be underestimated.
Since 2002, 95% of its funding (about $28, 3 billion) has come from the governments of developed countries, with the remaining 5% from the private sector. On Wednesday the fund’s board, meeting in Ghana, announced it would be cancelling its next round of grant-making. It’s not pulling the plug entirely though – it announced it will provide a “transitional funding mechanism” whereby countries can apply for finance for their “most essential” needs. This will allow people who are already on anti-retrovirals to continue their treatment, but it will not permit the roll-out of further drugs. It will also not fund treatment for drug-resistant forms of TB.
The reasons for the fund’s current problems are partly attributable to the global economic crisis and partly attributable to mismanagement. During its last fund-raising round in October 2010, it raised only $11,7 billion of $20 billion target. This was despite the heartfelt pleas of UN Secretary General Ban Ki-Moon, who warned at the time, “If we lose the ground we have gained, we will be back to square one – all that effort and investment, lost.” Of the $11,7 billion pledged, advocacy groups say Holland, Denmark, Italy, Belgium and the European Community have still not paid what they promised.
The fund’s largest single contributor is the USA, where foreign aid is currently an unpopular concept with widespread domestic unemployment. Republicans in the House of Representatives have lobbied for cuts. Another major donor, the UK, also indicated it would be cutting back on Aids spending by almost a third over the next four years.
The fund has also been accused of not monitoring with sufficient rigour how the funds were spent after grants had been given. Four African countries – Djibouti, Mali, Mauritania and Zambia – were accused of financial malfeasance amounting to $20 million. In response to this, Germany and Sweden froze contributions pending an audit.
Approved funding for South Africa from the global fund currently amounts to $465 million, according to the fund’s website. The lion’s share of this goes towards HIV/Aids programmes. There is rather a lot at stake for South Africa’s public health system.
Responses from health advocacy groups have been characterised by extreme concern. Medecins Sans Frontieres released a statement this week quoting the executive director of its access campaign, Tido von Schoen-Angerer, as saying, “Donors are really pulling the rug out from under people living with HIV/Aids at precisely the time when we need to move full steam ahead and get life-saving treatment to more people.”
For the Treatment Action Campaign, the situation is particularly dire. The TAC is waiting for a R6, 5 million chunk of aid from the global fund that was due in July, without which it cannot continue to function. “Unless the tranche is paid to TAC by the first week of January, we will go into an unsustainable deficit in February 2012, which means we would have to retrench all our staff and close our offices at the end of January 2012,” they said in a statement released yesterday, adding that they were not crying wolf, but facing a real crisis.
The reason the TAC has yet to receive the promised funding, they say, is less to do with the global fund and primarily due to poor administration by the department of health. If the TAC were to close, 230 jobs would be lost, but the real setback would be the loss of an important voice in South African civil society: no organisation has done more to hold the government to account in its handling of the HIV/Aids pandemic.
The global fund and the South African department of health met on Thursday to attempt to resolve the impasse. Even if the TAC survives, the wider issue remains that donor appetite appears simply not sufficient to sustain the global fund. In the view of Rebecca Hodes at UCT’s Aids and Society Research Unit, the problem – in addition to economic woes – is one of Aids fatigue.
“HIV is no longer the donor cause du jour,” Hodes told Daily Maverick. “The affluent world has shifted its sympathies to other causes such as climate change, while emerging economic powerhouses which should have supported the fund – including China – have made only puny contributions.”
A great irony of this all is that earlier this week UNAids reported that Aids-related deaths were down 21% from their peak in 2005 and the number of new HIV infections in 2010 also fell. Director Michael Sidibe attributed this to the major expansion in access to treatment. “We are on the verge of a significant breakthrough,” he said. If those who require treatment are not able to access it in coming years, however, that breakthrough will be delayed indefinitely. DM
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