The Global Fund defended its decision to deny donor funding to Zimbabwe’s public health efforts early this year and encouraged the country to use the feedback provided by an independent panel of experts from the previous two years in applying for this year’s new round of funding.
The Global Fund is a nongovernmental organization, bankrolled by governments, international institutions and private donors, whose goal is to select the best programs for delivering treatment — primarily in sub-Saharan Africa, Latin America and Asia — and then to finance those programs under supervision.
According to the International Herald Tribune (IHT), the Global Fund has raised billions of dollars and millions of people are being treated but some experts still doubt whether a centralized financing mechanism is the best way to fight the three epidemic diseases.
In response to online questions submitted by people from around the world via the IHT, Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said the Global Fund had a good record in Zimbabwe.
"The Global Fund feels a strong and heavy responsibility for the welfare of the many people in Zimbabwe affected and infected by the three diseases and continues to support the country’s fight against them," said Kazatchkine.
"Paradoxically, given all the media criticism of us for not supporting Zimbabwe, the Global Fund is the largest — and almost only remaining — funder for health programs," he added.
In a positive move, the Washington-based Global Fund recently agreed to help pay salaries of Zimbabwean doctors and medical staff in a bid to stem a massive brain-drain that has seen the best qualified health professionals leave the country.
With a hyperinflation spiraling beyond economic description, and a crippled public health sector, there is no doubt that injection of donor funds can bolster local efforts to fight AIDS, TB and malaria in the country.
In total, the Global Fund has turned down Zimbabwean proposals in five of its seven funding rounds to date, each time citing technical shortcomings of proposals as the reason.
Zimbabwe currently also has access to very limited resources to tackle mounting humanitarian public health disasters. United Nations Children’s Fund (UNICEF) estimates average international HIV spending in southern Africa is about US$74 per person living with HIV per year.
In Zimbabwe, that figure is a paltry $4. Already, Zimbabwe has recorded progress, a key development on which the Global Fund can build upon. Zimbabwe is the first country in the southern Africa region to record a decline in levels of HIV.
The country has seen a steady decline in HIV prevalence rates, from over 26 percent of the population in 2001 to around 15 percent in 2006, according to reports from the United Nations Joint Program on HIV/AIDS (UNAIDS).
The rejection of the request from Zimbabwe for funds to fight particularly TB is seen as a critical setback to efforts aimed at addressing a disease on the surge in the country.
The limited funding that is finding its way to the country is specifically for AIDS programs. However, in the absence of funding, laboratory and diagnostic systems and technical support required to combat TB, the disease is threatening to unravel progress made in responding to HIV, especially Among all nations, Zimbabwe is one of those most heavily affected by tuberculosis (TB).
The 2007 Global Tuberculosis Control Report from the World Health Organization (WHO) ranks Zimbabwe among the 22 countries with the highest TB burden. TB has re-emerged as a leading killer, especially among people living with HIV. An estimated two-thirds of Zimbabweans with TB are also infected with HIV.
"Sources of support for civil society to undertake TB activities, particularly for community-based interventions, are non-existent," said Lindiwe Chaza-Jangira, executive director of the Zimbabwe AIDS Network (ZAN).
"Movement of people within SADC [South African Development Community] further threatens to increase MDR and XDR-TB in the region, and for Zimbabwe this is made worse by a weakened health system."
Zimbabwe’s proposal to the Global Fund, which was rejected, sought funding to put in place programs to respond to the rising problem of TB. However, it is not the issues that determine the success of a proposal but rather the soundness of approach to tackle the issue.
"Zimbabwe’s proposals to the Global Fund in the last two funding rounds have not been approved because the independent experts who review proposals were not satisfied with the technical and scientific merit of the country’s proposals (soundness of approach, feasibility and potential for sustainability)," said Kazatchkine.
He stated that the Global Fund was not pursuing an agenda to stifle funding to the country but that those responsible for drafting proposals at country level should make the proposals sound and concrete.
"The Global Fund is, however, in no way reducing its support to the country. The Global Fund strongly encourages Zimbabwe to use the feedback provided by the independent panel of experts from the previous two years and apply again for this year’s financing round, which opened on March 1," he said.
On the question of health financing, Kazatchkine said that the Global Fund was unique in that it is based on country ownership and the countries themselves set their priorities, design programs, implement them and are accountable for what is being achieved.
"The Global Fund bases its financing solely on performance. All funds are released incrementally, based on demonstrated results against targets we have jointly agreed with the countries.
While judgment, of course, always has to play some role, the system is designed to prevent political or any other considerations from influencing decisions on funding," he said.
"Donors and beneficiaries are equally represented on our board, contrasting with most financing institutions for development."
Responding to a question on the high price of the drugs for HIV, Kazatchkine said that since 2000, prices for antiretroviral treatment have been reduced from $15,000 to $20,000 per patient per year to less than $100 per patient per year in some countries.
"This incredible reduction is the result of the tireless work of AIDS activists and pressure groups, combined with the competitive market pressure by generic drugs manufacturers. Also, the buying-power of resources