Southern Africa is easily the region most profoundly impacted by HIV and AIDS. It is for this reason, according to Dr Norbert Foster, Namibia’s Deputy Permanent Secretary in the Ministry of Health and Social Services that it was fitting that his country should host this year’s HIV and AIDS Implementers Meeting. The gathering took place in Windhoek from 10-14 June and was themed ‘Optimising the Response: Partnerships for Sustainability’. It attracted over 1,500 HIV and AIDS programme implementers from 55 countries and was co-sponsored by the US President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNAIDS, UNICEF, the World Bank, the World Health Organisation (WHO) and the Global Network of People Living with HIV.
Over four days of discussions, more than 300 abstracts were presented by delegates from their respective Governments, non-governmental organisations (NGOs), multilateral organisations, the private sector, and groups of people living with HIV and AIDS. In line with the theme, the meeting reflected on successes and failures of the past, in an attempt to outline ways in which the impact of HIV and AIDS programmes can be optimised in the future. Another key aim of the meeting was to emphasise that while optimising the impact of programmes is critical, it is equally important that these programmes produce sustainable outcomes. A point that echoed throughout the meeting was if such outcomes are to be achieved; these programmes require sound and balanced partnerships and leadership, which have, to a large degree, been lacking in the past. The increasing need for effective leadership and working partnerships in the fight against the epidemic in Africa is an explicit prerequisite in the wake of the current financial turmoil.
Maintaining the momentum
During the opening of the meeting, Namibian President Hifikepunye Pohamba stressed the need for continued funding if the momentum that has been gained in the fight against HIV and AIDS is to be maintained. He said the meeting was important as it brought together and showcased successful programmes that have been developed in various countries over the years. He added that, “This meeting represents a renewed call to all partners to continue working together to fight the AIDS pandemic”. The need to recognise which programmes are effective and the need for an increased sense of partnership have been augmented by the global financial crisis, which was a topic of much discussion during the meeting.
Various speakers urged the world’s prominent HIV and AIDS funders to sustain their support, despite the global economic situation, and a number of presentations revealed the possible effects of decreased financial commitment to fighting the epidemic. Professor Rifat Atun, the Director of Strategy at the Global Fund, said that while the extent of the aversive effects of the economic crisis is still not clear, the successes achieved so far would be undermined if they are not sustained through continued and increased funding. This is similarly true for the need for the sustainable impact of programmes. Atun concluded his talk on a pragmatic note by stating, “We must optimise the use of our resources to achieve value for money and ensure mutual accountability in this unfavourable economic environment."
Optimising the use of our resources is a key point, and one that was alluded to throughout the meeting. It is now more important than ever that the available money is spent wisely, and that the implementation of programmes to combat HIV and AIDS - whether from a prevention or treatment perspective - is led through effective partnerships and based on the experience of the large of amount of research that has been conducted over the past quarter of a century.
Utilising funds with purpose and direction
During the meeting, the leaders of PEPFAR, the Global Fund, UNAIDS, UNICEF, the World Bank, and governments receiving AIDS funds were challenged to stop spending money on unproven interventions. With funding pools quickly drying up, it is now essential that all funding is directed and utilised efficiently and with purpose. A study undertaken by the United Nations (UN) has revealed the grave effects that the economic crisis has already had on the fight against HIV and AIDS. Eight out of 69 countries already face shortages of antiretroviral (ARV) drugs or other disruptions to AIDS treatment. The UN projects a similar scenario for a further 22 countries across the globe in the coming year. Despite global treatment of HIV and AIDS having been stepped up, the current economic crisis could worsen the situation for the two-thirds of people still not receiving treatment.
These financing problems have been further complicated by the recent finding that the early initiation of ARV treatment can lead to significantly quicker patient recovery and also the substantial decrease in tuberculosis mortality (1). While the results of this clinical trial provide the basis of an important new guideline that needs to be implemented globally over the coming few years, the current budgetary crises experienced throughout the developing world will have a significant restrictive effect on how this finding can be utilised. In South Africa, for example, increasing the CD4 count treatment trigger from the current 200 cells/mm3 to the now suggested 350 cells/mm3 will more than triple the number of eligible HIV-infected patients - which will certainly be out of reach of a budget that is already stretched. Commenting on this situation, Fareed Abdullah, Director of the Africa Unit for the Global Fund, said: “In a world where cash is short, we need to ask for more money for ARV treatment now. I know it’s a big ask, but we must ask.” This is definitely the case. The focus now more than ever needs to be on funding programmes and initiatives that have been assessed successfully.
Moving away from “wasteful spending”
In the past, far too much money has been spent on ineffective programmes - and this needs to change. In addition, as has been discussed in previous newsletters, good leadership is critical in all attempts to address the HIV and AIDS epidemic. During this years’ Implementers Meeting, Stefano Bertozzi, the Executive Director of the Centre for Evaluation Research and Surveys at the Mexican National Institute of Public Health, commented on the fact that HIV and AIDS programmes have been plagued by “wasteful spending.” He went on to say that, “We need to stop implementing large-scale interventions of uncertain values without measuring their effectiveness.’’
This call was echoed by Paul de Lay of UNAIDS, who agreed that many HIV and AIDS programmes have been extremely inefficient. De Lay emphasised the fact that the economic crisis should be viewed as an opportunity to improve the efficiency of programmes, correctly stating that: “When times are tough, the importance of investing wisely become even more important.”
The HIV and AIDS Implementers Meeting certainly gave everyone something to think about. We all hope that governments, civil society and international partners around the African continent will respond positively to the various calls for more effective leadership and spending, in the pursuit of more sustainable results. The current economic turmoil is undoubtedly going to have (and has already had) an impact on the availability of funds, and while it is important that the calls for increased funding persist, those of us working on the front lines need to ensure that the funds that are made available are not wasted.
Jonathan Mundell is Director: HIV & AIDS Unit at Consultancy Africa Intelligence. The June edition of the HIV & AIDS in Africa Newsletter is republished here with permission from Consultancy Africa Intelligence (CAI), a South African-based research and strategy firm with a focus on social, health, political, and economic happenings in Africa. For more information see http://www.consultancyafrica.com or http://www.ngopulse.org/press-release/consultancy-africa-intelligence. Alternatively, visit http://www.consultancyafrica.com/promo2 to take advantage of CAI’s free, no obligation, 3-month trial to the company’s Standard Report Series.
(1) See http://www.nih.gov/news/health/jun2009/niaid-08a.htm