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ZIMBABWE: The politics of Zimbabwe's global fund rejection
Matilda Moyo
August 19, 2004

http://www.pambazuka.org/index.php?id=23954

Zimbabwean activism for access to life-saving HIV-treatment has been thrown into a quandary following the rejection of the country’s proposal in the fourth round of funding by the Global Fund on AIDS, Tuberculosis and Malaria.

Treatment activism efforts have been flustered after the decision, which was made at the eighth meeting of the GFTAM board, held in Geneva late last June.

Zimbabwe had requested US$218million from the GFTAM in order to combat HIV/AIDS over a five-year period. The country is among the worst-hit by the AIDS pandemic, with an estimated 25 percent of its adult population living with HIV, which causes AIDS. Estimates of weekly AIDS-related deaths range from 1 800 to 3 000, depending on the source of statistics, which is high regardless of the figures one chooses to use.

The GFTAM was established in 2002 to fund activities aimed at combating the three killer diseases and was a welcome relief to cash-strapped governments, particularly in the third world. Since then, it has become the world’s premier financing mechanism in the fight against the three deadly diseases, which reportedly kill more than six million people annually.

Zimbabwe was no exception and had therefore anchored its hopes on the fund. Media reports indicated that the country intended to use the bulk of the fund for its AIDS treatment programme, which is already underway, albeit at a snail’s pace.

According to the Minister of Health and Child Welfare, Dr David Parirenyatwa, government planned to place at least 171 000 people on life-saving antiretroviral treatment (ART) within the next two years. The programme had begun at referral hospitals in the country’s two major cities, Harare and Bulawayo, while plans to scale up rapidly were on the cards.

Although this target fell short of activists’ expectations as it is estimated that at least 600 000 people living with HIV/AIDS (PLWHA) are in need of ARV treatment in Zimbabwe, most were coming to terms with the fact that half a loaf is better than nothing and were reserving that battle to enroll more people on ART for a later stage.

However, the rejection of Zimbabwe’s proposal comes as a blow to AIDS activists, who do not have many sources of funding for treatment programmes and hoped that the Global Fund would tide over the cash-strapped government.

Although most were trying to digest the implications of the non-approval of the grant, many activists could not hide their disappointment and pain as they realized that their last hope had been dashed.

"So much work went into developing the proposal, and we had so much hope that it was going to be funded. For all treatment activists, this is definitely bad news as it means that the country will have to go back to the drawing board. There is no way the country can achieve its stated goal of treating 171 000 people by the end of 2005 at the current levels of funding," said lawyer-turned- activist, Tapiwanashe Kujinga, who is also an advocate for access to HIV-treatment.

This was supported by yet another activist, Martha Tholana, who described the GFTAM decision as disastrous and a major blow to the proposed Government-led ARV roll-out plan.

"I do not know if the roll-out is going to be successful with that (decision) and what the future for the treatment programme in Zimbabwe is. I am confused and devastated, really," she said, summing up the general sentiment.

There was, however, concurrence that the failure of the proposal pointed to the need for alternative sources of funding to sustain not only treatment, but other programmes instead of depending on donor funds as many lives were at stake.

"We need to see if we can have alternative ways of sustaining the treatment programme in Zimbabwe. What makes me so mad is we could have benefited a lot from the Global fund. This issue needs to be sorted out otherwise we are in danger of loosing yet a lot more thousands of people," said Believe Dhliwayo, an activist living with HIV.

Some activists are particularly despaired because they perceive the rejection as part of sanctions against the present leadership, which is responsible for the current crisis in governance.

While a significant number of citizens support sanctions against the ruling party leadership, they believe that it should not affect ordinary people who are also victims of the prevailing system.

"When two elephants fight, the grass suffers and we are the grass that is caught in between," said an activist who declined to be named.

Tonderayi Chiduku, who sits on the Country Co-ordinating Mechanism (CCM), the national structure through which the fund operates, as a representative of civil society and PLWHAs, said they had reason to believe the rejection was on political grounds, given the current situation in the country.

Under the circumstances, the government-established National AIDS Council (NAC), was not the best channel for funds, he said without elaborating.

However, the GFTAM Technical Review Panel (TRP), in its report placed the Zimbabwe application under the third category, which means that while the proposal was not approved, the country may incorporate the panel’s recommendations and reapply in the fifth round.

Proposals are first screened for eligibility by the Secretariat and then forwarded to an independent TRP of experts in the diseases, who assess proposals for technical merit and consistency according to proven best practices.

"While this proposal aims to address a critical and urgent need in Zimbabwe, it has several weaknesses which make it impossible to evaluate adequately, and is therefore not recommended for funding and is classified in Category 3. The CCM is encouraged to submit a new proposal that takes all of these comments into account," said comments on the TRP’s review form.

Among the reasons cited for the non-approval were that "the budget is too ambitious, and not justified by the proposal." Further to this, the document states that there is no implementation plan, in addition to a number of other technical weaknesses. This, sadly, outweighs the proposal’s strengths.

Zimbabwe won a GFATM grant in the first round amounting to $ 8,877,500, out of which only $ 1, 415,000 has been disbursed, the TRP report noted.

According to information on the fund, in Round four, seven approved projects had five-year budgets in excess of $100 million. These were Ethiopia $405 m.; Tanzania $293 m; Zambia $254 m.; Kenya $186 m.; India $165 m.; Uganda $158 m and Russia $121 m. Kenya’s proposal to combat malaria was approved while the AIDS proposal was not approved. Overall, the fund approved US$ 968 million worth of grants to various countries.

Zimbabwe’s request was not the only one that was rejected. Other non-approved projects that had five-year budgets in excess of $100 million included Ghana $305 m, South Africa $243 m, Cote d'Ivoire $169 m, Nigeria $166 m, Kenya $142 m, Burkina Faso $104 m. All of these were HIV/AIDS proposals.

According to a press release by the GFTAM secretariat, the Global Fund provides grants to locally-developed programs to prevent and treat AIDS, TB and malaria. Countries and organizations may apply for funding by submitting proposals in ongoing funding rounds. In January, the Global Fund issued its fourth call for proposals for grant funding with an application deadline of early April.

The Global Fund is an independent private foundation under Swiss law, governed by an international Board. Apart from a high standard of technical quality, the Global Fund attaches no conditions to any of its grants. It is not an implementing agency. It relies on local ownership and planning to ensure that new resources are directed to programs on the frontline of this global effort, reaching those most in need. Its performance-based approach to grant-making – where grants are only disbursed if progress has been measured and verified – is designed to ensure that funds are used efficiently and create lasting change for people and communities.

Matilda Moyo is a Zimbabwean free-lance journalist.

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