adminage start cutting back the numbers.
Our success adds to the direct pharmacy costs, although keeping productive people healthy does benefit the country, and costs a lot less than dealing with vast numbers dying in hospital.
At the same time donor funding is likely to fall. The Global Fund is paying 35 percent of the bills right now. But donors made it clear last year that they would not be chipping in after 2014.
The council’s finance director, Mr Albert Manenji, estimates that there will be a US$10 million gap in funding this year, the gap being between what the free ARV programme costs, and what the Aids levy brings in and what donors add. By 2018 the gap will have risen to US$227 million, and 350 000 people who need help will not get it.
The problem is not insoluble.
While the National Aids Council has to deal in millions of dollars, for the individual the costs are low. The first three months of treatment are not cheap; around US$80 a month is required for this brief period. But then the person living with HIV goes on a maintenance dose, costing around US$10 a month for the rest of their life.
We believe that far more people now receiving free ARVs could afford that sum themselves, especially when they consider this is life-saving medication.
In fact we would imagine that if they had to pay personally this would be the number one item on their monthly budget.
The initial three months treatment will need more relaxed rules, although even there many living with HIV could find some of the money.
So a large block of people could be taken off the State’s books and the money now spent on them could be spent on those who are in need, including the growing number of pensioners, who will start flowing into the system in large numbers within a decade.
There are some who think that because they have paid the Aids Levy they are somehow entitled to free ARVs. But that levy is in fact a tax, not an insurance premium, and like all taxes is spent on those who need, not necessarily those who pay.
We note, for example, that childless people still pay their full income taxes, even though they are not benefiting from the 20 percent or so of taxes that go on education.
In any case, carrying that logic to its daft conclusion would mean those who are not infected should get infected so they can claim their money back.
Others feel upset that some wealthy people have somehow slunk onto the free programme. We agree the authorities need to vet better, but just because someone else cheats does not mean that more honest people should follow their example.
Obviously to keep costs as low as possible for those self-financing their treatment the authorities need to have a system where anyone can buy the necessary drugs at cost price, without a private pharmacy mark-up. But we think it would be easy to add a payment counter to the distribution system.
If necessary there could be an intermediate stage where some, who earn something but very little, paid half price, that is US$5 a month. There are many permutations.
Knowing that there is a cost, even a modest cost, for treatment could also help more people to be more careful so that they do not become infected.
Even taking the self-employed and the employed off the free list will probably leave a gap at some stage.
The National Social Security Authority might need to pay the US$10 a month for its affected pensioners, which would help, but in the end the taxpayer may have to pay more through an increased Aids Levy.
Taxpayers may do so, without a revolt, so long as they are sure that their money is going to the truly needy and that administrative costs are as low as possible.
It will be a hard sell unless the NAC can give the necessary assurances, preferably backed by audited accounts.
And taxpayers will want it clearly understood that the free scheme is not an entitlement, but something that is there to help children, the aged and the totally needy. Most people should pay something.
With these sort of adjustments to the programme, we would expect the funding gap to be a lot less, and hopefully would be in the region where Zimbabwe could cope.
Online Reporter