adminAids support programme.
She is one of the more than 600 people living with HIV in Gweru getting drugs from MSF but her joy of getting treatment from the same seems shortlived, as the organisation has started handing over the programme to the Government.
MSF-Holland started transferring over HIV and Aids programmes, which it has been running in the Midlands Province for the past six years, to the Government this year.
The organisation intervened in 2004 at a time when the economic decline posed major challenges to the country’s health delivery system.
The non-governmental organisation has already completed the handover of the Prevention of Mother to Child Transmission activities, adult voluntary counselling and testing, and the ambulatory feeding scheme to the Ministry of Health and Child Welfare.
The centres providing HIV drugs in the province are Mkoba Clinic, which has 2 891 clients on the first line and second line drugs, including children, and Lower Gweru which has 2768 patients.
An estimated 1,2 million adults and children are living with HIV in Zimbabwe. Only 55 percent of the 600 000 people are on treatment leaving almost half in urgent need of the life saving drugs.
The withdrawal of Médecins Sans Frontières operations in province is likely to see a similar fate occurring in Bulawayo City, Beitbridge, Epworth, Tsholotsho and Buhera.
Each programme provides comprehensive HIV/Aids care, offering counselling, testing, treatment and PMTCT.
In 2010, more than 34 000 patients were receiving antiretroviral treatment from the organisation and there are increasing fears that patients would be disadvantaged by the handover.
This has brought into the fore the need increase domestic funding of the country health delivery system to guard against withdrawal of external support.
With the bulk of the national health programme getting support form external partners there are always fears that a substantial number of people would be disadvantaged in the event immediate withdrawal of support.
In an interview at the sidelines of the Mine Entra in Bulawayo recently, National Aids Council financial director Mr Albert Manenji said although Zimbabwe has made significant progress in reducing the national
HIV and Aids prevalence there was potential danger for people already on treatment if donors decide to pull out.
“A lot can be done to improve the country’s HIV funding programmes. Local funding is more flexible to use that donated money that sometimes cannot be used the way we want,” he said.
Most donor funds are tied to certain programmes and thus cannot be diverted to urgent need even if its in the same line of programmes.
For instance, funds secured for acquiring drugs can not be re-channelled to buy diagnostic machines even when the greater need is in that area.
MSF-Holland medical programme manager Audrey Van der Schoot has allayed fears that patients would be disadvantaged by the handover.
She said there efforts were being made to ensure the transition does not affect patients there was no such guarantee once the programme was completed.
Van der Schoot, however, argued that the Ministry of Health and Child Welfare has the capacity to provide treatment to patients who were under MSF-Holland programme.
In 2003, an Italian non-governmental organisation, Cesvi pulled out after initiating a prevention of mother to child transmission (PMTCT) programme at St Albert’s Hospital.
Mr Manenji said there was need to broaden the tax base to include those in the informal sector as everyone is liable to fund such national programme.
“The input of all sectors is critical in improving revenue and increasing the aids levy tax base. Already, families are contributing something although we cannot quantify their support to the funding.
“Families assist their relatives leaving with the virus through user fees at hospitals and transport when they go for CD4 count and collecting ARVs.
“However, demand for resources continues to outstrips the resources available and that needs to be addressed,” said Mr Manenji.
The Aids Levy is currently paid by all workers in formal employment in the country but owing to ever decreasing workforce the resources are not adequate for HIV programmes only.
Local funding is easy to manage and has no strings attached like donor funds. External funding sometimes is not flexible and might be consigned to specific programmes that are not in tandem with our needs.
External funding partners contribute at least 76 percent to the total funding of TB and HIV and Aids programme in the country while the National Trust Fund caters for the remainder.
Of the total donor funding the Global Fund contributes 35 percent, United States government 18 percent followed by Expanded Support Programme with 23 percent leaving the nation at greater risk.
Analysts say there was nee to ensure that mechanisms are put to ensure everyone contributes something to the levy. This is because everyone is either affected or infected by the disease and can not push the burden to others.
They said there should be no overdependence on donated funds. The Aids Levy should be augmented by permanent mechanisms that will ensure the continuation in the provision of treatment in case the Global Fund and other organisations withdraw funding to Zimbabwe.
One such mechanism advanced has been collection of the Aids Levy as a percentage of the Value Added Tax (VAT). This would ensure all individuals contribute to the programme.
Efforts to resuscitate the industry’s utilisation capacity must be the Government’s priority. Currently, local industry is operating at an estimated capacity of between 40 and 45 percent and the country has failed to achieve the projected target of 60 percent by the end of first quarter.
When production levels improve, the tax collections would definitely improve, so is the Aids Levy which will be in this case National Trust Funds.
“We expect that all small-scale miners can formalise their operations though registering with the relevant authorities so that they can start to contribute. All registered companies contribute to NTF through corporate tax which is collected by Zimra.
“We are known to be tax evaders and I hope if all companies register the challenge of funding may be addressed better,” Mr Manenji said.
All companies and employees contribute three percentage to National Trust Fund towards the Aids Levy, which is deducted from Pay As You Earn (PAYE) and corporate tax respectively.
However, the money collected falls far too short to cover all the needs under HIV and Aids programme in the country.
It is also disheartening to note that some firms have not been remitting taxes to Zimra. Media reports last week revealed that 15 State enterprises have not been remitting taxes to the revenue authority.
These companies owe Zimra to the tune of US$150,9 million in unremitted tax. This is disturbing because State enterprises are least expected to shortchange the Government by evading tax.
According to the NAC half of the Aids Levy goes towards the procurement of drugs and machinery but is still inadequate.
Nearly 600 000 adults are currently in need of antiretroviral drugs but only 314 670 have been initiated.
There are also 89 490 children in need of drugs but only 32 502 have been initiated and that leaves a gap of 56 988 children who have not received the drugs.
Between 2009 to 2011 Government has received a total of US$106,3 million from the Global Fund and US$48,3 million from the Expanded Support Programme (ESP).
This scenario will not help the country in its endeavour of achieving universal access to HIV treatment by 2015 and the objective of eliminating new infections by the same year.
As a country committed to the response of HIV and Aids, Zimbabwe should find ways of funding HIV and Aids programmes as relying on external sources as is the current scenario might prove fatal in the event that they unexpectedly withdraw their support.
Deputy Minister of Health and Child Welfare Dr Douglas Mombeshora is on record as saying Government had introduced new regulations for external donors that are aimed at ensuring that they fulfill their contractual obligations.
He said that the ministry enters into an agreement with every NGO operating in the country to the effect that they can not abruptly suspend their activities.
The deputy minister said there was an exit plan and in the case of MSF-Holland, the suspension will not affect the patients in any way as they will continue to get their drugs from the local clinics and hospitals.
The Midlands provincial medical director, Mr Patron Mafaune, said Government had the capacity to take over from any non-governmental organisation in providing ARV drugs.
He said when these organisations come to assist the Government, there would be an exit plan and MSF has been working with as a partner.
Mr Mafaune also gave an assurance that drugs would be made available for all those who needed them.
Although the political will on HIV and Aids response in Zimbabwe is unquestionable lack of funding has seen Government failing to meet international guidelines.
Online Reporter