A tussle over the control of resources, overlapping tasks, and a budget that did not match with the activities, might have cost the country the much needed Global Fund money for the purchase of the life prolonging anti-retro viral drugs.
The country’s appeal to the Global Fund for HIV/AIDS, Tuberculosis, and Malaria for Round 9 funds totalling 73 million for HIV/AIDS programmes was rejected, sending the country into a serious funding crisis for its ARV programme.
By end of Friday (19th February 2010), the Fund was expected to have communicated to the government the reasons behind its decision to deny the country the much needed funds. But our investigations point to three reasons that might be the basis of the rejection of the appeal of Round 9, which also included money for Malaria programmes.
Sources within the National Aids Control Council says the turf of war of who should control the Global Funds money might be one of the reasons why the Fund is apprehensive funding the country in such an environment.
Under the current arrangement, the principal recipient of the Global Fund money is the treasury. In 2008, with the formation of the coalition government and the splitting of the Ministry of Health into Medical Services and the Public Health and Sanitations, the latter was chosen as the sub-recipient of the Funds once the money was in the country.
There are feelings in some quarters that this decision was informed by the ODM and PNU politics, and the intense lobbying of who should control the HIV/AIDS money. There is one school of thought which argues that ordinarily, money for procurement of ARVs should go to the Ministry of Medical Services which is in-charge of treatment and care, while Public Health handles prevention programmes.
Another school of thought argues that since the Ministry Public Health and Sanitation is in-charge of many of the health facilities at the low level, then it has the right to control the way the funds are used.
While Global Fund is said not to dictate to government’s who should receive the money, a source within the NGO sector say they would have wished the Ministry in-charge of the medical services handle all the roles to do with the treatment and care.
As things stand now, the Ministry of Medical Services prepares a plan and budget of the drugs they require and then hand it over to the Ministry of Public Health and Sanitation to finalize the lucrative procurement process.
Such a situation has not augured well with Medical Ministry, with some of its very senior official said to express openly their dissatisfaction with the way the treatment programme is being handled.
“When things go wrong with the procurement the way they have done with the matter ending in court, it is the Ministry of Medical Services that it is blamed and not the Public Health,” complained one senior official at the Ministry of Medical Services.
“Now everybody is coming to us asking about the fate of patients and the procurement, matters we have no idea how they were handled. If we are the ones doing treatment and care, let us also do the procurement,” said the officer.
This explains why while the Ministry of Medical services headed by Prof Anyang Nyong’o of ODM party has expressed its frustration with the Global Fund which it describes as problematic; the Ministry of Public Health and Sanitation, headed by Beth Mugo of PNU, says the working relationship with the Fund is cordial. And they are assured a better working relationship and future funding.
The ministry is even optimistic of winning Round 10, to which it says it will submit a proposal as the Ministry of Public Health. As an officer in this ministry expressed optimism about future funding, those within the Ministry of Medical services are talking a different language.
They say they are not enthusiastic about applying for Round 10, since the morale is too low after the appeal failed to go through. They accuse their counterparts in the Ministry of Public Health of not doing a lot on preparing the proposal for treatment and care, and yet they are the ones who decide on the how money is spent and from whom the drugs are bought.
Who controls HIV/AIDS money is a war that dates back as far as 2003, when the Ministry of Special Programmes in the office of the President was assigned the HIV/AIDS docket. Then, some medics argued HIV/AIDS would be well tackled in the ministry of Health and hence it was misplaced under the office of the president.
In addition to the tussle over the control of resources, overlap of functions between various agencies tasked with managing HIV/AIDS programme in the country is another area of concern to the Global Fund. Of particular concern by the Fund is the overlap of tasks between the National Aids Control Council (NACC) and the Ministry of Public Health and Sanitation.
The two run preventive programmes, some of which are very similar, but each present its own budget for approval. NACC, which in the office of the president, for instance, has an activity on Information, Education and Communication, the same as the Ministry of Public Health.
The two also have programmes around testing and advocacy. NACC argues that they have been doing all these things before the split of the Ministry of Health, and the tasks should not be taken away from them.
The Global Fund would have wished these functions be tackled by one agency for uniformity, reduction in duplication of tasks and minimization of wastages. In fact, the Fund is said to have expressed serious reservations with how the roles of NACC, the Ministry of Medical Services and that of the Public Health and Sanitation are defined. In some cases, the roles are either overlapping or misplaced.
The other issue that the Fund might have based its decision to reject Kenyan’s appeal for Round 9 is the failure by the country’s proposed activities to synchronize with the budgeted figures.
It seems these issues were not fully addressed when the government presented its appeal to the Fund, hence the failure to win Round 9 and the funding crisis the country might find itself in if the government and new donors do not respond.
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