It is still not clear whether people living with HIV/AIDS in KwaZulu-Natal will ever see any of the $72-million granted to the province in April by the Global Fund to Fight HIV/AIDS, TB and Malaria (GFATM).

The Global Fund has indicated that from this week it will start to disburse money to projects approved in its first round of applications ‘€“ but unless procedural problems surrounding the KZN grant are cleared up, this province’€™s money will not come through.

According to Sibani Mngadi, the Health Minister’€™s spokesperson, “only part of the consultation process on the KZN grant has taken place, and no final decision can be taken until that is complete”.

At last month’€™s meeting between Health Minister Dr Manto Tshabalala- Msimang and Global Fund executive director Richard Feachem, the fund indicated that its board could not alter grants once they had been awarded.

Tshabalala-Msimang, who wants the $72-million to be distributed to all nine provinces, was asked to consult further then advise the Fund on how to proceed with the KZN grant.

Deputy President Jacob Zuma has since been drawn into the saga, and the hopes of the KZN HIV/AIDS sector now rest on his problem-solving ability.

The root of the problem, according to the National Department of Health, is that the Global Fund violated its own rules by awarding the money directly to the KZN consortium, the Enhancing Care Initiative, when the application should have gone through the SA National AIDS Council (SANAC).

Global Fund rules stipulate that, unless there are exceptional circumstances, country applications need to be routed to it via multi-sectoral “county co-ordinating mechanisms”.

However, the department only decided to declare SANAC as the “country co-ordinating mechanism” a few days before the closing date for applications to the Fund.

By that time KZN had already submitted its proposal. The KZN consortium, which includes the provincial health department and the University of Natal, then wrote to the Fund to formally withdraw its application as it had been instructed to submit this via SANAC.

But the Fund had already approved the KZN grant to cover a range of services including voluntary counselling and testing, treatment of opportunistic infections, home-based care, anti-retroviral treatment and orphan care.

Legally, SANAC’€™s term of office had expired at the time that it was supposed to approve funds and none of the members’€™ terms of office had been officially extended.

This was done at a SANAC meeting last month, which also approved South Africa’€™s second round of applications to the Fund. This meeting could also have approved KZN’€™s application in retrospect, but this was not done.

Government officials say Tshabalala-Msimang wants to teach the Global Fund a lesson for snubbing SANAC. However, she is also known to be under pressure from SADC countries that failed to get grants from the Global Fund.

She is also said to be stung by the fact that Uganda was chosen to represent Eastern and Southern Africa on the Fund’€™s board, instead of South Africa.

In the meantime, there is a real danger that the Global Fund might run out of cash as, according to Feachem, it needs double the money pledged to it in order to address the health crisis.