adminsources, although since the shortages have been around for some months, and since Zimbabwe was coping before that, it seems that money supplies are probably the most critical.
Whatever the reason, Zimbabwe should be able to cope better, a lot better.
Parliament did provide funding. Every taxpayer pays a levy of 3 percent of their income tax, with this money going from Zimra to the National Aids Council. What happens then is anyone’s guess, since the council is reluctant to publish up-to-date accounts, or even engage in public debate over how the funds should be allocated.
But several critical ratios need to be known, debated and analysed.
For a start, everyone needs to know what percentage of the funds is allocated to administration, which includes travel, attendance at conferences, vehicles and their running costs and salaries and allowances. Anything over 10 percent would imply gross inefficiency and most people would probably be happier with well under 5 percent.
We bring this point up because there are stories floating around that some Zimbabwean delegates flew to the recent International Aids Conference in the USA by business class with substantial allowances for subsistence and travel. It would be nice to know the truth. It would also be a good idea if we knew how many people went on the NAC budget. Zimbabwe needed to be represented, but a two-person delegation might have been too large.
A second group of expenses would be the grants to various groups for education and similar purposes leading to behaviour change. There is a feeling that some of these might well exist purely to provide someone with a salary.
Has a value audit been done? Again we need debate on just how much money should be spent on education. At the beginning of the crisis this was vital work. But by now everyone over 12 in Zimbabwe knows exactly how HIV is transmitted, and how transmission can be prevented or the risks of transmission seriously reduced. This is even taught in schools so the next generation is far more ready than their parents and grandparents.
Education needs to continue, but the pioneering work has been done.
It is the same with the organisations that group people “living with HIV and Aids”. Again this used to be critical, but these days it is actually more important to ensure that such people have access to their ARV medication. Again what was an appropriate spending model for the 1990s needs to be switched to modern realities.
In our view the overwhelming bulk of the Aids levy needs to be spent on the critical services of; testing, supply of the necessary drugs to prevent mother-to-child transmission, and the supply of ARV medication to those living with HIV so that they can continue to live, and live as self-supporters. In other words, we need to spend the money on things rather than words.
HIV infection, thanks to some brilliant research, has switched from a fatal illness to a serious chronic illness, like diabetes or similar diseases. What Zimbabwe faces is a large pool of infected people, some of whom can buy their medicine themselves but many of whom require help.
We would still like to see several stages between free help with drugs, which is the public programme, and full payment. Many of those receiving free help could afford US$10 or US$20 a month, and a simple means test could identify them. This would allow the Aids levy dollar to go further. Even those able to pay in full should be able to access drugs at cost price from State pharmacies, to cut their burdens and perhaps allow more on free schemes to buy their medication in full.
What we want to see is a full breakdown of the spending and a debate on how we should move forward. The NAC and its programmes seem, to an outsider, to be a collection of former emergency programmes tacked together.
Those now needing lower priority are still funded at old levels; those now not needed are maintained. There has been no complete rethink of how we should move forward. This is way overdue. Just how much of an “Aids industry” do we need? Donor funding will decrease soon, so we must be ready and that means that a clear public debate is needed, with everything on the table.
Online Reporter