Govt needs Sh830bn for ambitious HIV plan

Dar es Salaam. The government needs over $382 million (about Sh830 billion) until December, 2017 to fund its ambitious plan of putting over 1.4 million Tanzanians living with HIV on life-long ARVs regardless of their CD4 cell count.

As the country joins the rest of the world in marking World Aids Day today, only about 839,00 people known to be infected are currently receiving ARVs, according to the Tanzania Commission for Aids (Tacaids).

The rest are yet to be put on treatment in line with the new World Health Organisation’s (WHO) best practices unveiled in the form of the new guidelines which campaign for the ‘test and treat’ all approach—released early this year.

This happens at a time when the government is contendng with a budget shortfall of over $50 million in funding the initiative, although Health minister Ummy Mwalimu maintained yesterday that it was highly unlikely the gap would compromise the government’s new HIV/Aids targets.

Speaking in an exclusive interview, Ms Mwalimu told The Citizen that all HIV-positive individuals eligible for the ARVs but were not receiving the drugs are now being targeted for enrolment into the treatment schedules at various centres across the country.

“The funding gap will not affect the implementation of the Test and Treat project,’’ she noted and added: “Rather, it will only affect the attainment of the maximum stock levels to a certain extent. Nevertheless the ministry of health is working hand in hand with partners and donors to find possibilities of covering the remaining funding gaps for 2018 going forwards.’’

The World Aids Day theme: ‘Let’s join hands to prevent new HIV Infections,’ is in line with the global targets of cutting down new HIV infections, improving the quality of life of people infected and reducing mortality, according to National Aids Control Programme (NACP) manager, Dr Angella Shayo.

Various stakeholders who spoke to The Citizen have raised their concerns about the government’s donor dependency in securing funding for People Living with HIV (PLWH). Some have gone ahead to advise the government against the ambitious move.

Sikika executive director Irenei Kiria is, however, urging the government not to embark on the project as early as now, terming it as “unrealistic.”

He says, “It is impossible under current levels of resources and capacities to enrol more than 2.5 million people on ART.” He adds, “The government could postpone implementation of WHO’s new policy but monitor closely those who have tested positive to ensure they enrol on treatment once their CD4 counts drops below 250.’’

He Adds: “If that won’t be happening, the more sustainable option would be to step up prevention to ensure zero infection.”

“The current ART programmes are largely supported by foreign funding by over 95 per cent. This support is declining while the new policy requires the government to triple the number of individuals on ART,” Mr Kiria observed.

“In addition to the challenges of funding, there have been other problems associated with the health system generally,’’ he noted. Member of Parliament for Kigamboni, Dr Faustine Ndungulile, said it was too “risky” to put an HIV-positive patient on life-long ARVs, and then stop in the middle of the course of treatment due to lack of funding.

As chairperson of the Inter Parliamentary Union (IPU) Advisory Group on HIV/Aids, and a public health expert, Dr Ndungulile suggested that the government must now focus on local sources for sustainable HIV/Aids funding instead of relying heavily on donor support.

His suggestions seem to find an answer today as Tacaids launches the Aids Trust Fund (ATF) as part of the plans to raise domestic revenues for boosting HIV/Aids programmes in the country.

Tacaids Policy and Planning director Richard Ngilwa told The Citizen yesterday that Sh2 billion has been set aside as a starting deposit for the fund, whose board is yet to be established.

When the ATF is in place, he said, it will oversee and monitor all the procurement of ARVs and strategise all domestic resource mobilisation programmes in the country.

Health minister Mwalimu, for her part, told The Citizen that the government was now in discussions with a major donor—the Global Fund, in preparations for a new three-year grant.

She, however, expressed fears about lack of sustainable funding but was confident about the measures being undertaken by the government in ensuring domestic resources mobilisation for health.

Global Fund Programme officer Akjagul (Akja) Karajakulova told The Citizen yesterday that there is currently one Global Fund grant in Tanzania Mainland (TZA-H-MOF) and one Global Fund grant in Zanzibar (QNB-C-MOH) that include funding for ARVs.

He said, “Please note that these amounts only include the cost of drugs. Apart from that, the grants also include related Procurement and Supply Management costs.”

Countries around the world are grappling with challenges related to funding for health, with various studies warning of the gaps in raising money to fight HIV/Aids.

A study published last year in the Plos Medicine Journal, titled: ‘The HIV Treatment Gap: Estimates of the Financial Resources Needed versus Available for Scale-Up of Antiretroviral Therapy in 97 Countries from 2015 to 2020’ revealed that there were funding gaps in many countries including Tanzania. The study recommended: “….future resource needs for ART scale-up are smaller than stated elsewhere but still significantly threaten the sustainability of the global HIV response without additional resource mobilization from domestic or innovative financing sources or efficiency gains.”