HDN Key Correspondent, Zimbabwe
The shock decision this week by the Global Fund to Fight AIDS, Tuberculosis and Malaria to (GFATM) to reject another request from Zimbabwe for funds deals a critical setback to efforts aimed at addressing major health issues in the country.
The Global Fund has now turned down Zimbabwean proposals in five of its seven funding rounds to date, each time citing technical shortcomings of proposals as the reason. Zimbabwe’s failure to secure backing in this latest round of funding seriously undermines the country’s struggle to build its capacity to effectively respond to the three epidemics.
"Proposals submitted by Zimbabwe sought a total of US$48.5 million to address malaria and US$25.5 million to tackle tuberculosis over a five-year period,” according to a Voice of America interview with Nicolas Demey, of the GFATM. Demey was quoted as stating that the proposals were turned down for “technical weaknesses”.
“The limited funding that is finding its way to Zimbabwe is specifically for AIDS programmes. 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 further threatens to increase MDR and XDR-TB in the region, and for Zimbabwe this is made worse by a weakened health system.”
“We therefore feel this news is a terrible blow and will continue to advocate for resources to support the work of NGOs in response to this dual TB/HIV epidemic," she added.
The GFATM proposal could not have been declined because of inadequate need. 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.
For the past 20 years, Zimbabwe has fought TB fairly successfully, providing free access to WHO-recommended treatments. But in the past few years, TB disease has re-emerged as a leading killer, especially among people living with HIV (PLHIV). An estimated two-thirds of Zimbabweans with TB are also infected with HIV.
At the epicentre of the HIV epidemic, Zimbabwe now has a staggering six times more TB cases than it did two decades ago. Funding, laboratory and diagnostic systems and technical support need to be directed towards fighting TB in the country to prevent the epidemic worsening even further.
Zimbabwe currently also has access to very limited resources to tackle other mounting humanitarian health disasters. For example, the United Nations Children’s Fund (UNICEF) estimates average international HIV spending in southern Africa is about US$74 per PLHIV per year.
In Zimbabwe, that figure is a paltry US$4. Without essential international support, the deadly combination of TB and HIV epidemics is likely igniting a silent and uncontrollable epidemic of drug-resistant TB that could negate previous national health gains. Malaria is also a serious health threat in Zimbabwe. “After HIV and AIDS, it is the biggest killer of children under five in Zimbabwe,” says UNICEF.
“The estimated one million cases of malaria each year in Zimbabwe are also a serious threat to pregnant women and newborns, the leading cause of work-absence due to illness, and a severe brake on economic growth.”
Combined with a high prevalence of HIV infection, the overall immunity against TB and malaria is considerably reduced, making mortality rates in the country very high.
"There is an immense need for the funds to address TB and Malaria which are compounding the nation’s response to HIV,” said Sara Page, Deputy Director of Southern Africa AIDS Information Dissemination Services (SAfAIDS), a non-governmental organization based in Zimbabwe.
“Zimbabwe has demonstrated exceptional efforts and commitment to HIV prevention and behaviour change, which has translated into a substantial reduction in HIV prevalence and incidence,” she added.
“However, there is an ongoing need to strengthen and support national efforts in care and treatment of HIV and TB."
There can be no question that the longer the delay in funding responses to the three major epidemics in Zimbabwe, the greater the cost will be in terms of human suffering and loss of life, but also in future economic terms as the cost of medical care and support also escalates.
Despite these numerous challenges, real progress has been made in addressing health issues. 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 recent reports from the United Nations Joint Programme on HIV/AIDS (UNAIDS).
In light of country’s achievements, and the scale and intensity of its people’s need, the Global Fund has moral and humanitarian responsibility to reconsider its decision to reject Zimbabwe’s latest request for support to tackle TB and malaria. According to its own reports, the Global Fund was created to “finance a dramatic turn-around in the fight against AIDS, tuberculosis and malaria.”
In the five years since it was created, the fund has awarded over US$8 billion in grants to recipient countries. In that period, the fund has committed US$85 million to Zimbabwe – around US$6.5 per citizen. About 40% of the committed funding has actually been received by Harare.