The government is putting on a brave face over reports that it has lost significant financing from the Global Fund to Fight Aids, Tuberculosis and Malaria but behind the scenes is a picture of growing unease.
In a dossier prepared by a team of technical experts and presented to senior officials in the ministries of health and finance, the future of ARV treatment hangs in the balance unless the government comes to bridge a huge gap or scouts for new donors.
Funding for paediatric treatment, which is done mainly by the Clinton HIV/AIDS Initiative, will not happen after the end of this year. The Foundation is going to use close to one billion shillings this year on treatment and care of HIV positive children. Over 25,000 children are on ARV treatment, with more than 50,000 still waiting to get access to this life prolonging drugs.
With this funding coming to an end, the government is expected to have scouted for a new donor or provided budgetary allocation to take over the children treatment programme.
In recent communication to the Ministries of Medical Services and Finance, the experts warn that in view of the fact that PEPFAR funding will remain the same for the next five years and the Clinton HIV/AIDS Initiative is coming to an end in 2010, the government needs to come in urgently to bridge the gap in funding.
Overall, the situation of funding does not look good for the country with a huge funding gap remaining even after all the funding from the approved Round 7 of the Global Fund, PEPFAR and Clinton HIV/AIDS initiative, put together.
In the year 2010/2011, the country needs Sh 7.8 billion to manage over 540,000 adult and children on ARV treatment. It can raise only Sh 5 billion from the three sources, leaving a funding gap of about Sh 2.5 billion. In the year 2011/2012, the ARV treatment programme is projected to cost over Sh 10 billion to manage about 680,000 patients.
Only Sh 4.5 billion is assured from development partners, leaving a gap of about Sh 6 billion. For the year 2012/2013, the projected ARV cost for 770,000 people is Sh 12 billion, but only Sh 4.5 billion is assured from Round 7, PEPFAR and Clinton initiative put together. Meaning new sources need to be found to bridge the gap of Sh 7.5 billion.
The committee that came up with this costing now wants the government to fill the gap for the next three years, which totals to Sh 16 billion. By the end of last year, 360,000 people were actively on antiretroviral treatment.
These increased costs take into consideration the new World Health Organizations guidelines and recommendations of the technical committee whose membership was drawn from the two key Ministries of Health, World Health Organization, Universities and other key stakeholders.
In their recommendations, the committee agreed that HIV positive persons should be put on antiretroviral treatment once their CD4 count-the measure of the immune strength-falls below 350 instead of the current 200. The new rule is expected to start July this year.
Shifting from the Stavudine to less toxic drug tenofovir; aggressive use laboratory to monitor CD4 count and viral load and initiating antiretroviral therapy in HIV positive patients who have active TB and chronic active hepatitis B irrespective of their CD4 cell count; are the other recommendations of the technical committee which are going to push up cost of managing the disease.
Funding problems are emerging at time when the country has lost an appeal for Round 9 funding totaling 75 million US dollars, making life very difficult for the patients and those in charge of running ARV treatment programme.
The only money the government is assured of from the Global Fund is about Sh 6.5 billion, the remaining disbursements for Round 7.
Government functionaries are said to be mad with the loss of appeal of round 9, terming Global Fund funding as problematic and very competitive.
During a recent meeting to discuss the round 9 outcome, official from the Ministry of Medical Services, National AIDS Control Council and National AIDS/STD Control Program are said to have tasked a team to look into other sources of funding to avoid the nasty encounters with the Global Fund.
“There are serious considerations to look for other sources funding from China, World Bank and other bilateral arrangements since Global Fund funding can no longer be assured,” says one of the officers who attended the meeting.
Also being explored is putting an extra tax on air-time and flight tickets, which will go towards financing HIV/AIDS programme. This is one of the innovative ways the Clinton Foundation raises its funds through what is referred to as French airline ticket solidarity levy.
Government is also towing with the idea of renegotiating with PEPFAR to support more patients on its programme. Individual Kenyans and companies may also be asked to contribute to the treatment of the patients in the manner they are comfortable with such as adopting a patient(s). Managing one patient in a year costs about Sh 15,000.
There further plans to enter into public-private partnerships with pharmaceutical companies, especially the locally based, for them to produce and sell to the government antiretroviral drugs at a cheaper price. The team tasked with looking at these alternative sources of funding is expected to come up with a concept paper detailing the way forward.
Failure to get Round 9 may have other implications. It is likely to affect the enthusiasm to apply for Round 10, which Global Fund is expected to start calling for proposals from May. Morale among some of the key ministry officials involved in preparing the proposal is said to very low.
But on Tuesday (23rd March 2010), members of the Country Coordinating Mechanism who give directions on the applications for the Global Fund, decided that the country is going to apply for Round 10 for HIV/AIDS and Malaria.
This sorry funding state the country finds itself in is bound to have serious consequences on the treatment programme if nothing happens.
More than 100,000 current patients on treatment and new ones who benefit from Global Fund may be forced to interrupt treatment if drugs are not forth-coming. If this happens, then the chances for the development of resistance strains, which cost 10 times more to treat, is very high.
HIV experts fear problems with funding and any disruptions in treatment programmes will dampen the interest of people to get tested. Studies have shown that ARVs are an incentive to get tested as many people belief they will receive treatment and continue leading productive lives even if found to be HIV positive.
According to Kenya Aids Indicator Survey, 2007, 83 percent of those who participated in the study did not know their HIV status. More than half of the women and 75 percent of the men, had not had an HIV test by the time of the study. Bringing these people out to get tested depends on the availability of drugs, care and reduced stigma and discrimination.
About three months ago, the country launched an ambitious four year HIV programme, The Kenya National Aids Strategic Plan 2009 – 2013, which includes all aspects of the disease control at an estimated cost of Sh267 billion.
The success of this project was hugely pegged on the Global Fund’s continued support especially for the next two years.
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