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Calling for transparency and accountability in HIV/AIDS related work
Transparency International – Zimbabwe (TI-Z)
May 22, 2007

The people of Zimbabwe are suffering. More and more people are now within the poverty bracket, even those who had seemed to be doing reasonably well under the prevailing economic circumstances. The reasons for this are many, but bad governance and corruption top the list. The situation is increasing the vulnerability of people living with HIV/AIDS and also those affected by the pandemic.

HIV/AIDS is claiming 8,000 lives a day with 12,000 new infections every day. UNAIDS reports that 3 out of 4 HIV positive people are denied treatment due to various reasons. Huge amounts of money are being channelled towards fighting the epidemic. However, the donor funds and government budget allocations for combating HIV/AIDS seem to have presented both an 'enormous opportunity' and a 'great temptation' as there are growing allegations of misuse of these funds by institutions and individuals administering them. Transparency International-Zimbabwe is concerned by the lack of accountability and transparency in:

1. The administration of HIV/AIDS funds
2. The distribution of ARVs.
3. The worsening plight of the people living with HIV/AIDS under the declining economic conditions where corruption is fast becoming a norm.

While the effects of corruption in HIV/AIDS prevention and treatment is not very different from corruption found in other areas of the health sector, the scale of the pandemic, the stigma attached to the disease and the high cost of drugs to treat it magnify the problem. The response to HIV/AIDS has been an increase in funds available to purchase drugs, treat the infected, assist the affected, prevent new infections and help HIV/AIDS orphans. But scaling up budgets without paying due regard to the anti-corruption mechanisms needed to ensure their proper use provides further opportunity for corruption. An examination of the Global Fund finds that including all stakeholders in the design of programmes, from governments and NGOs to the sufferers themselves could help provide and safeguard against corruption.

While it is difficult to draw a casual link between corruption and the spread of HIV, there is ample evidence that suggests that corruption impedes efforts to prevent infection and treat people living with AIDS in many parts of the world. The mechanics of corruption affecting the prevention and treatment of HIV/AIDS are not substantively different from those affecting the health sector more generally: opaque procurement processes, the misappropriation of funds earmarked for health expenditure and informal payments demanded for services that are supposed to be delivered free. (www.transparency.org) What is different is the scale of the problem and the nature of the disease - a chronic, usually fatal and often-stigmatized disease that can be contained only with expensive drugs. Moreover, the individuals responsible for tackling corruption may themselves be severely affected by AIDS. These factors create particular vulnerabilities to corruption.

There are multiple opportunities for corruption in the prevention and treatment of AIDS. In prevention programmes, corruption occurs when false claims are presented for awareness-raising activities that never took place, or for materials that were never purchased. It also occurs in programmes aimed at alleviating the socio-economic effects of the disease on victims and their families, such as feeding programmes or support for school fees.
But it is treatment programmes that are most vulnerable. Money for high-value drugs can be embezzled at any number of points in the procurement and distribution chain. At the grand end of the scale is theft by ministries and national AIDS councils of funds allocated for treatment, and the misappropriation or counterfeiting of medicine. At the petty end are doctors who extort 'tips' for medicines and patients who sell their own medication because it is the only valuable commodity they have.

Corruption in Treatment

Treatment is not available to all who need it. This is no different from other health services in Africa and the rest of the developing world where many are excluded through financial or cultural constraints, or because of the distance to health facilities. Access to ARV sharpens these issues, however. Demand frequently exceeds supply even when there is an official policy to determine who gets treatment, such as a cut-off point based on blood test results (the CD4 count). Those whose results are 'not bad enough' may try to use financial, political or other inducements to get onto treatment programmes. Corruption contributes to the extent of the problem when regulatory authorities turn a blind eye to counterfeiting or public officials receiving inducements to procure from less reputable suppliers.

In Zimbabwe the government has imposed an 'AIDS levy' since 2000 whereby employees contribute 3 per cent of their gross salaries towards a fund administered by the National AIDS Council (NAC). It is estimated that the government collects about US $20 million per year through this fund, but no information about how the fund is used and who benefits from it has ever been made public. In March 2005, the health ministry ordered an audit of the NAC but the report has not been published. Civil society organizations (CSOs) are increasingly seen as important providers of services and receive substantial grants to do so, but the transaction costs of processing and monitoring CSO applications are very high. An attendant risk is that CSO directors will siphon off their funding. For example, the director and senior staff at the Zimbabwe National Network for People Living with HIV/AIDS were suspended after allegations of corruption. The network received more than US $1.8 million from the NAC between 2003 and 2004.

What can be done to minimize Corruption?

As with attempts to tackle corruption in the health sector generally, the terms and conditions of health workers should be improved in parallel with the introduction of mechanisms to increase their accountability to the communities they serve. However, paying health workers and civil servants more is necessary, it is not enough to limit corruption.

Increasing transparency is vitally important in health services. The public needs to be more aware of the eligibility criteria for ARV programmes, which should ideally become more consistent within and across countries. They need to be aware of what they have to pay and what they will receive. The quantities and values of drugs supplied at each level of the system should be well publicized, and health workers should account for them. There also needs to be a mechanism whereby people can complain without fear of victimization.

To this end, Transparency International-Zimbabwe has conducted out a Multi-country Study on Corruption in public service delivery focusing on HIV/AIDS programmes. The study covers Zambia, Zimbabwe, Botswana, Malawi, Swaziland and South Africa and the report is going to be launched soon. Corruption exacerbates the suffering of the HIV/AIDS infected and those affected by the epidemic, as such TI-Z calls upon Zimbabweans from all walks of life to expose corruption and condemn the vice at all levels society as we commemorate the Global AIDS Week.

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