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THE twin decisions by United States President Donald Trump, after his inauguration for a new term on Monday, to leave the World Health Organisation and freeze all American aid programmes for 90 days to see if they are efficient and comply with his foreign policy objectives, will largely affect Zimbabwe’s highly successful programme to combat HIV and Aids.
It is vital that the programme continues, as it remains essential that HIV treatment is never rationed by availability or ability to pay.
Depending on how you count the assistance, as there are dual use programmes, it looks like more than US$200 million of the US$360 million of US aid allocated last year helps fund the programmes that have done so much to push back HIV and Aids in Zimbabwe, but will need to be continued for many years to maintain that gain, largely through ensuring all infected people receive life-long anti-retroviral treatment.
Much of the US support, routed through the Global Fund and through other agencies, is allocated under the US Presidential Emergency Plan for Aids Relief, Pepfar, set up by President George W. Bush in 2003. Pepfar has been one of the most effective medical assistance programmes in a range of hard-hit countries.
It has been decisive in the push back in large swathes of Africa against HIV infection and converting HIV to a treatable chronic illness that requires daily medication, but with that medication for life, people can live normal lives.
Zimbabwe has achieved the advanced 95-95-95 goals, that is at least 95 percent of the estimated population infected with HIV have been tested and known their status, at least 95 percent of those are being treated with anti-retrovirals, and 95 percent of those being treated have seen their viral load suppressed.
In fact we are doing somewhat better, especially with the percentage of those who know their status being treated, it being now almost automatic to go from positive test to immediate treatment.
Much of the remaining US aid budget spent in Zimbabwe last year went to special emergencies, basically a contribution to the special programmes to cope with the severe drought, which is not a regular item. Then there are several smaller health programmes and other assistance for women and youth.
The final batch are political support programmes, funding activities that are seen by the US as supporting democracy, basically grants to certain favoured NGOs opposed to the Government.
In none of the other medical and social assistance programmes where the US is a partner, it is as central as it is in the Aids programmes, largely providing very useful support that could probably be made up from other sources, including internal resources.
Commenting on the freeze and possible revocation of all US assistance programmes, Finance, Economic Development and Investment Promotion Minister Mthuli Ncube on Wednesday dwelt almost entirely on the Pepfar funding and the possibility that Zimbabwe would have to fund large sums via the budget to maintain the critical HIV and Aids programmes.
The largest ring-fenced internal source is the Aids levy, a three percent charge on the assessed income tax of individuals, companies and trusts. This has to be read with the fact that customs and excise duties and VAT, more important tax contributors, are not levied.
But the levy was a decisive contribution to the pot of money needed to combat HIV and showcased the Government’s determination to do something effective with national resources.
That along with other commitments was decisive in persuading development partners, including the United States, that it was worthwhile to back the Zimbabwean programmes since the national thrust was also centred on efficiency and a successful programme to eliminate corruption from the medical field.
Since the question of the efficiency of the US Pepfar programme can largely be assumed these days, in Zimbabwe and in other countries since the local US embassy has to investigate and report on this sort of thing, the criteria that will see whether it continues, and if so in which countries, will largely revolve around the political test, whether it conforms to the foreign policy of President Trump.
This will be a finding by the relevant agency heads and their political bosses, mainly the Secretary of State for most foreign assistance and that is largely an internal American matter.
Should Pepfar and other US health programmes be cancelled or cut back, Prof Ncube noted that Zimbabwe would have to step up its own contributions.
The two most critical parts of the Aids programme are ensuring that anyone who wishes to be tested, or needs to be tested as part of other medical arrangements, can be tested at an affordable price and then that everyone who needs to be on antiretroviral treatment (ART) can get on this promptly so their viral load can be suppressed.
It is important that testing and ART are never rationed, directly through shortages or indirectly through cost to the patient. So whatever happens the Government would have to find replacement funds.
That said, we probably have an opportunity, regardless of whether the US maintains Pepfar or not, to accelerate the administrative processes that are scheduled to see HIV being treated within a few years as a normal chronic illness, such as diabetes, hypertension and some of the psychiatric illnesses which require life-time treatment but also preventative measures.
This should allow a cutback in administrative costs and some of the special logistics and other programmes that had to be put in place, as well as a cut back in the education programmes as these are absorbed into the general health education work. Everyone by now knows how HIV is spread and how it can be prevented and how people can protect themselves.
There is also the argument that ART need not be a choice of paying the full cost or getting the treatment for free depending on economic status. We could provide partial support of some patients who have a modest income and full support for those who could afford nothing.
The growing density of the clinic network, the upgrade in medical staffing and other improvements in health infrastructure seem to allow HIV and Aids work to be fully absorbed into the general health system, as they already are to a large degree. This would allow funds earmarked for HIV treatment to be fully assigned to testing and ART supplies, and an end to the special “Aids industry” that does absorb critical funding.
Other programmes already in place, such as the growing enforcement of the ban on child marriages whether registered or not, and the growing practical protection for teenagers from sexual exploitation, also work to help push back HIV infection, so once again extra special work is not needed and can form part of expanding ordinary programmes.
Online Reporter