The consummate diplomat, Global fund director Richard Feacham, failed to hide his disappointment last week when he told a media contingent that government had failed to sign agreements which would see millions of dollars flowing into South African Aids coffers.

‘€œThis is very disappointing. The work is urgent and the money needs to flow. The delay in money means a loss of human lives. These are life and death issues,’€ said Feacham.

Feachem and Deputy President Jacob Zuma were expected to sign the grant agreements at a Pretoria ceremony on Sunday (6 April), but this did not happen as there were still points of disagreement at that late stage. The signing ceremony was moved to Thursday, but this also failed to materialise.

After months of squabbling between the health minister and the GFATM about the process of how KwaZulu-Natal was awarded its five-year $72-million grant, one of the last outstanding points of agreement was who should be the “principal recipient” of the money.

Earlier in the year, after the SA National AIDS Council (SANAC) finally approved KZN’s proposal, government resolved to set up a trust under SANAC to control the money.

However, this was not acceptable to the Global Fund and government was finally forced to back down and designate the Treasury as “principal recipient”.

Government expressed its regret that it had not been possible to conclude matters due to ‘€œthe relatively complex legal processes’€.

It said in a statement that the process of completing arrangements to ensure formal accountability to all the South African stakeholders and to set the relationship with the global fund on an unambiguous legal foundation would take about four weeks.

Feachem said this week that the grant money for the first two years’ of the projects’ applications – amounting to some R328-million ($41 095 529) – would be transferred to South Africa within a month of both parties signing.

“It’s simply a matter of establishing bank accounts,” said Feachem.

The KwaZulu-Natal partnership, spearheaded by the Enhancing Care Initiative at the University of Natal, will get an initial R214-million to fund a whole spectrum of prevention, treatment and care projects in the province.

LoveLife will get R96-million to set up “adolescent-friendly clinics” countrywide, while Soul City will get almost R19-million for a year.

The grants are worth some 30% less than when they were first awarded 18 months ago due to the improved performance of the Rand.

The dispute around the KZN grant – which ironically was made by a partnership including the provincial health department – revolved around the fact that the proposal had not first been approved by SANAC before being sent to the fund.

According to Global Fund rules, every grant application has to have the support of a representative body of stakeholders – a Country Co-ordinating Mechanism – before it will be accepted by the fund.

However, the South African government decided that SANAC would be this Country Co-ordinating Mechanism after the KZN partnership had already sent its application to the Fund.

The KZN partnership then wrote to the fund to withdraw its application so it could send it via SANAC first, but found that its application had already been successful.

The health ministry and government believed it had been snubbed, and a row ensued with the global fund.

However, a global fund spokesperson said that the KZN grant process was not unique to South Africa. “A number of first-round applications did not first get the approval of their country co-ordinating mechanisms, as in many cases, these had not yet been set up. This approval was given subsequent to the proposal being received from the fund.”

Feachem added that the fund had “treated no one with disrespect”, and that “SANAC today endorses the KZN proposal”.

Feachem also said that it appeared to be “not a matter of if, but when and how” anti-retroviral drugs were made available in the public sector in South Africa.

“I say this on the basis of my knowledge of the provisions in the Budget and the Treasury and Health Department task team,” he said.

“But we couldn’t underestimate the policy difficulties, which are literally a matter of life and death. Where do you start, and how; equity issues which affect who lives and who dies.”