NGOs doubt $1.4 bn HIV, Aids plan

Despite the pulling out of the Global Fund, Malawi has an ambitious K234 billion ($1.4 billion) HIV and Aids Plan targeting 465 000 people with ARVs in the next five years.

Out of these, 50 000 are children.

Amid controversy on the subject, the plan also targets men who have sex with men (MSM) by developing procedures, guidelines and minimum packages for interventions to reach the MSM and identify their locations and numbers so that their health needs are met.

But some health and HIV and Aids NGOs have cast doubt on the plan, given the Global Fund’s pull-out. According to the Malawi National HIV and Aids Strategic Plan (NSP final draft) covering January 2012 to December 2016, the overall goal of the strategy is to prevent further spread of the virus and mitigate the impact of the disease on the country’s population.

The programme cost for 2012 alone is estimated at  K34 billion ($203 million) with an anticipated rise to K55 billion ($327 million) in 2016, representing over 60 percent increase. This increase is a result of a planned up-scaling of resources mobilisation strategies outlined in the plan, a staggering amount is expected from the national budget, the NAC Pool Fund, the Health SWAp Pool Fund and discrete donors or other funding sources.

The strategy comes at a time when the Global Fund, which is the major funding agency of HIV and Aids-related programmes, announced the cancellation of its 11th Funding Round due to lack of resources.

But Principal Secretary in the Office of President and Cabinet responsible for Nutrition and HIV and Aids Mary Shawa in December played down the negative impact of the cancellation.

She argued it does not pose any immediate danger to the country because Malawi still has $300 million (over K50 billion) from previous Global Funds rounds to support programmes in the next three years.

The Malawi Network of People Living with HIV and Aids (Manet +) is on record describing the cancellation “as a disaster to the country” which registers about 70 000 new HIV infections every year.

“Things will be difficult, especially now that we are implementing the new WHO guidelines which recommend that people should start treatment when their CD4 count is less than 350. We are switching to a more expensive drug because the old one has Stavudine which is very toxic and has side effects,” said Manet + executive director Safari Mbewe in a recent interview.

He added: “I don’t see government [achieving NSP goals and objectives] without support from Round 11. Statistics show that about 70 000 people are getting infected annually and those are contributing to the pool that would require treatment. This means issues of prevention also need much attention.”

Malawi Health Equity Network (MHEN) executive director Martha Kwataine said the plan is ambitious because in the absence of a reliable sources of funding, such as the Global Fund, it would be difficult for the country to implement the strategy.

“The strategic plan should explain the envisaged sources of income so that we can track the commitments,” said Kwataine.

She said Malawi does not seem to appreciate the global paradigm shift in investment of funds. She said the country still has unresolved issues with the Global Fund that negatively impact on health service delivery.

Said Kwataine: “For instance, the independence of Central Medical Stores and capacity constraints remain outstanding. The Global Fund has been supporting interventions towards health systems strengthening, including the 52 percent salary top-ups for health-care workers.

NAC executive director  Thomas Bisika admitted that since the government started implementing the National Response to HIV and Aids, there has always been a gap between budgeted resources and the money that is made available.

But Bisika said the figures in the NSP are preliminary and still being refined and that the costing of such strategies aims to help government have an idea about the ideal case and engage partners in effective resource mobilisation efforts and prioritise interventions.

He said once the NSP has been officially approved, government will engage funding and development partners in round-table discussions to secure financial commitments from its own resources as well as those of other funding partners.

Bisika said the country has two HIV and Aids grants with the Global Fund which have been consolidated into one grant called Single Stream Funding which is yet to be negotiated and signed for before the end of the current financial year.