Worldpress: HIV/AIDS: Looming Funding Crisis

[Guest guest]

-----Original

Message-----

From: CHINUA AKUKWE

[mailto:CAKUKWE@...]

http://www.worldpress.org/Africa/2123.cfm

H.I.V./AIDS:

Looming Funding Crisis

Chinua Akukwe

Worldpress.org contributing editor , July 27, 2005

Three

major recent events signal that financial support for international remedial

efforts against H.I.V./AIDS may be facing an uncertain future.

First,

the UNAIDS in a report released in June projected a looming funding gap of $18

billion for H.I.V./AIDS in developing nations between 2005 and 2007. The

funding gap, according to UNAIDS, can scuttle ongoing strategies for access to

comprehensive prevention programs against H.I.V. transmission. It would also

jeopardize the aim of providing antiretroviral treatment (ART) to 75 percent of

individuals clinically qualified to receive these medicines in 2008 (about 6.6

million individuals). A funding shortfall between now and 2007 would also slow

down the progress made in providing social and healthcare support for AIDS

orphans and other vulnerable children affected by the pandemic. Critical

programming costs and urgent training needs for health personnel would also

suffer, according to UNAIDS, if projected funding shortfall becomes a reality.

Currently, none of the major donor countries, including the United States have

stepped forward on how to end the looming funding gap identified by UNAIDS.

Second,

the Global Fund to fight AIDS, tuberculosis and malaria has already identified

a funding gap of $700 million for 2005 alone. In addition, the Global Fund

estimates that it needs additional  funding pledges from donor countries of

about $2.9 billion in 2006 and $3.3 billion in 2007 to continue its cycle of

replenishing successful country-based programs and supporting new grantees. In

2004, the Global Fund accounted for 20 percent of all H.I.V./AIDS funding

worldwide. These funding gaps has the potential to undermine an invaluable

by-product of the Global Fund mechanism: the belief by poor countries that they

can plan ahead knowing that accepted proposals will get financial support and

approved projects will get funded throughout the project cycle. It is

instructive to note that the 2005 Group of 8 communiqué on the Global Fund only

pledges to “meet the financing needs for H.I.V./AIDS, including through

the replenishment this year of the Global Fund to fight AIDS, TB and

Malaria.”

Third,

the apparent unlikelihood that the World Health Organization and its

collaborating partners will succeed in the goal to provide 3 million people

dying of AIDS with antiretroviral treatment by 2005 in resource-poor countries

(“3 by 5”). As of June 2005, the W.H.O. estimates that about 1

million qualified individuals are now on ART as a result of the “3 by

5” program. It is important to note that the W.H.O. estimates that 6.5

million individuals worldwide need urgent anti-retroviral therapy, immediately.

In Africa, despite the tripling of individuals on antiretroviral therapy since

W.H.O. launched the “3 by 5” program 18 months ago, nearly 90

percent of those in need do not have access to ART.

In

view of the major funding gaps in international H.I.V./AIDS remedial efforts,

what are the prospects for additional funds in the next two years?

Prospects

for Additional H.I.V./AIDS Funds

The

prospects appear mixed. The declaration by G-8 leaders at their 2005 summit in

Scotland to provide funds for “universal access” to antiretroviral

therapy by 2010 for those in need is a very significant positive development.

The political leaders of the richest nations on earth are now on record as

making a definite political commitment to end the current dichotomy of access

to ART in developed and developing nations. The implication of the declaration

is that G-8 leaders will increase financial and technical resources to meet the

2010 timeline.

The

commitment of G-8 nations to fully meet the financial obligations of the Global

Fund for 2005 is also encouraging. However, these commitments should be

counterbalanced with somber news: every day, every week, every month and every

year, fathers, mothers, sons and daughters who are clinically qualified for ART

will die without immediate assistance to readily available medicines. The cost

of avoidable delays in mobilizing and utilizing resources in the fight against

H.I.V./AIDS is very finite for millions of individuals in need of ART: they

will die.

The

situation is especially bleak for Africans dying of AIDS. For the 4.2 million

Africans currently in need of ART, the G-8 pledge of universal access to

treatment by 2010 will be academic since most of them would have lost the fight

against AIDS. Delays in providing a comprehensive H.I.V. preventive program can

only mean additional cohorts of newly infected individuals and affected

families.

Another

important development is that a looming war appears in the horizon between

donor and recipient countries on governance reforms. The 2005 G-8 communiqué is

the most specific documentation of rich nations resolve to hold recipient countries

accountable for verifiable progress in governance and anticorruption measures.

It is likely that G-8 nations will not redeem their pledges of additional

financial assistance to recipient countries deemed lacking in governance.

On

the other hand, recipient countries are likely to chafe against overt and

subtle pressures from donor countries on yardsticks for governance, especially

stamping out corrupt practices. Recipient countries will cite the need to let

the judicial system take its course once public officials are indicted for

corrupt practices rather than being stampeded to politically solve corruption

cases. The next few years may witness heightened tensions as G-8 and other rich

nations aggressively pursue governance reforms in recipient countries as a

condition for increased development assistance.

Thus,

a situation may arise within the next few years whereby disagreements on

governance between donor and recipient countries may hold up the disbursement

of urgently needed financial and technical resources for H.I.V./AIDS remedial

efforts. The irony is that H.I.V./AIDS target populations in recipient

countries will bear the brunt of the disagreements over governance reforms.

Future attempts by donor countries to “reward” good economic or

political “performers” in recipient countries will also consign

H.I.V./AIDS positive citizens of non-favored nations to second class status and

avoidable suffering and death.

What

can be done to end the looming funding crisis for H.I.V./AIDS remedial efforts

in resource-challenged environments?

Ending

a Potential H.I.V./AIDS Funding Crisis

First,

the G-8 and other rich nations should pledge

to meet all verified H.I.V./AIDS funding shortfalls between now and 2010

in order to satisfy two important remedial goals:

A)

Providing comprehensive preventive services to individuals at risk of

contracting H.I.V.; and,

Providing universal access to treatment for all individuals clinically

qualified to receive antiretroviral therapy.

A

pledge sooner rather than later by G-8 nations will have the benefit of

allowing bilateral and multilateral agencies and recipient governments to plan

ahead knowing that all legitimate H.I.V./AIDS program needs will be met. An

immediate pledge by G-8 and other rich nations to meet all legitimate

shortfalls in H.I.V./AIDS funding between now and 2010 would also set in motion

a comprehensive process for verifying H.I.V./AIDS funding needs so that

politicians and policy makers can make a more convincing case to their tax

payers. A funding pledge by G-8 and other rich nations would also force

recipient countries to set up verifiable indicators of governance since donor

countries have already pledged to support legitimate funding needs. G-8 nations

should honor their pledges as and when due.

Second, all poor countries

with more than 5 percent H.I.V. prevalence should have 100 percent debt

cancellation and savings invested in verifiable programs. The G-8 nations deserve

commendation for the cancellation of the debt of 18 poor countries. However, in

the fight against H.I.V./AIDS, AIDS-hit poor countries should not service

foreign debts when their citizens are dying because of lack of access to

available medicines. The cancellation of the debt burden of AIDS-hit poor

countries will also force recipient country governments to accelerate their

governance reforms and take concrete steps to combat corruption. In addition,

the civil society of these countries will become active watchdogs of their

government and policy makers.

Third, it is now critical to

resolve donor concerns about governance in recipient countries. It is no secret that

donor countries are growing increasingly frustrated with lack of progress on

governance issues in recipient countries. Misappropriation of funds,

difficulties with organizing legitimate elections, inability to secure lives

and property, lack of independent judiciary, marginalization of minorities,

limited capacities to enforce contracts and monopolization of political power

are major concerns of donor countries. The relatively weak standing of national

civil society organizations and human rights watchdogs is also complicating

governance reforms in many recipient countries.

It

is now time for donor and recipient countries to establish PRINCIPLES OF

GOVERNANCE with verifiable indicators that are public knowledge to tax payers

in donor and recipient countries. These principles should apply to all

governments and should have no sacred cows in recipient countries. Donors

should also not play favorites and should not provide sanctuary for ill-gotten

gains from recipient countries. For recipient countries, it is critical for

opposition parties, professional associations and the civil society to play a

verifiable watchdog role on H.I.V./AIDS remedial programs.

Finally,

it is critical to reform H.I.V./AIDS remedial

efforts with a principal focus on how to meet the needs of individuals and

families infected and affected by H.I.V./AIDS. In the last five

years, steady progress has been made on mainstreaming H.I.V./AIDS in the

political, economic and social arena. The rich nations have set a timeline

(2010) for universal access to ART. Recipient countries are moving more into

population-based democracy and making gains in governance. Debt cancellation as

a weapon in the fight against H.I.V./AIDS is now widely accepted.

However,

what has failed so far is how to make a difference in the lives of individuals

and families battling with H.I.V./AIDS. Very few domestic or international

H.I.V./AIDS remedial programs can provide a verifiable answer to a basic

question: How many individuals living with H.I.V./AIDS received direct benefits

as a result of the remedial effort? How many families affected by the

sufferings of a loved one living with H.I.V./AIDS received direct benefits from

the remedial effort?

Today,

while AIDS remedial efforts continue to mature and become more sophisticated,

the target population in resource-poor countries remains outside its sphere of

influence. There is a danger that the AIDS bureaucracy, public and private,

worldwide, may become more important than the needs of the target population. A

lack of impact on the target population may lead to an increasing emphasis on

process indicators as barometers of H.I.V./AIDS remedial efforts. The lack of a

significant, sustained impact on the target population may lead to the

celebration of modest program successes for a pandemic that kills more than 2

million people every year. For example, in Africa, is it correct to celebrate

the fact that only 500,000 people out 4.7 million qualified individuals (about

11 percent) are on ART?

For

a pandemic that had been around for more than 2 decades, the lack of impact of

remedial efforts at the individual and family level is remarkable. The needs of

the target population should now assume primacy.

Every

AIDS agency should focus on how its actions or inactions affect the individual

or family dealing with H.I.V./AIDS. Every measurable indicator should include

evidence of how specific action will impact individuals and families dealing

with the pandemic. Future funding estimates and projections should show

verifiable evidence of how past remedial efforts impacted individuals living

with H.I.V./AIDS and their families.

Conclusion

A

funding crisis looms in H.I.V./AIDS remedial efforts in resource-poor

countries. The UNAIDS estimates a funding shortfall of $18 billion between now

and 2007. A funding shortfall would have devastating consequences on steady

gains made in H.I.V. preventive programs and access to lifesaving,

antiretroviral therapy. G-8 and other rich nations should step forward and

ensure that H.I.V./AIDS remedial efforts remain fully funded. Recipient nations

should ensure that concerns about governance and corruption become a thing of

the past. H.I.V./AIDS remains a deadly pandemic, killing more than 2 million

people every year. Individuals and families infected and affected by

H.I.V./AIDS should become the cornerstone of future H.I.V./AIDS remedial

efforts.

Chinua Akukwe teaches graduate courses in

global health at the Washington University School of Public Health,

Washington, D.C.

Copyright

© 1997-2005 Worldpress.org. . Privacy Notice Home