‘We have seen this coming long ago in South Africa’¦ Even when PEPFAR gave us R900 million in 2009, they warned us that: ‘Please, try to make sure that you are self-sufficient’,’ says Motsoaledi.
Over a year ago, PEPFAR, the American President’s Emergency Plan for AIDS Relief, decided not to increase its funding. A number of other funders have also decreased their support. But the biggest shock came last week when the board of the Global Fund to fight AIDS, TB and Malaria announced that it has decided to cancel Round 11 of new grants. This is because donor governments have not paid the money that they had promised into the Global Fund coffers. The Global Fund is the largest funder of AIDS treatment, supporting over 70 % of ARV programmes in the developing world. The Joint United Nations’ Agency for AIDS (UNAIDS), warns that lack of funding will have drastic consequences for AIDS treatment programmes that rely on foreign money.
‘It means most of the developing countries will not be able to sustain the treatment programmes, and we all know the disastrous effects on someone who has been on treatment’¦ If they have to stop taking treatment the implications are they might actually die a little faster, there might be a build-up of resistance – such that the drugs that we are using now might not work even if the funding is made available in two years’ time – and we are going to go back and use the same drugs. So, the build-up in resistance might even be much more harmful’, says Henry Damisoni, Senior Monitoring and Evaluation Officer for UNAIDS.
‘What I’m scared of and what I’m almost sure that that’s where we will go back to is we will go back to rationing. We might even go back to selecting some of the beneficiaries, patients will present again much sicker, the mortality will increase again’, adds Dr Eric Goemaere, head of the South African mission of humanitarian group Medecins Sans Frontieres (MSF) or Doctors without Borders.
But Health Minister Dr Aaron Motsoaledi says it is wrong for Africa to depend on donors.
‘I raised this issue in Cote d’Ivoire when the Africa region of the World Health Organisation was discussing an Africa emergency fund. I, as a Minister and a participant in that, raised this issue and I raise it again today. It will be wrong for Africa to keep on depending on donor funding to fight this disease. We have to be self-sufficient. I said so because it’s very risky to say: ‘I’m going to depend on somebody else’,’ he says.
According to Motsoaledi, South Africa is able to support its own AIDS treatment programme.
‘In South Africa we can’t say we are rich, but we have started that programme of being self-sufficient for a long time. And I’m quite confident that you are not going to be hearing about any province or any area not getting ARVs because of this Global Fund money. There will be problems in other programmes, but not in ARVs. We have tried to be self-sufficient for a long time, especially with the buying of ARVs. We use very little donor money with the purchase of ARVs. The donors are helping us to run programmes of prevention, to fund NGOs’¦ but the ARVs’¦ most of the monies is ours’, the Health Minister says.
The country uses a little less than 10% of donor money to buy ARVs. But some countries are less fortunate. In Zimbabwe, for example, funding shortfalls threaten to interrupt treatment for more than 112 000 patients who are already taking ARVs by 2014. Mozambique expects to face shortages of first-line ARV drugs by the end of next year. Many developing nations rely on donor funding for up to 90% of their AIDS programmes. South Africa is the only African country that contributes to the Global Fund. The Treatment Action Campaign (TAC) has called on the South African government to take political leadership and ask wealthy nations to continue supporting the Fund.
‘We’re calling upon the South African government to take leadership in ensuring that it urges the other international countries to provide immediate funding for the Global Fund to ensure that countries in the sub-Saharan Africa or countries that are reliant on the Global Fund do not suffer because of the unavailability of funds’, says the TAC’s Nokhwezi Hoboyi.
The TAC says it’s morally and ethically important for South Africa to make this call, to which Health Minister, Dr Aaron Motsoaledi, responded:
‘We have always been lobbying. When the Global Fund was replenishing last year, we have lobbied. We have lobbied all the time and we’ll continue lobbying’.