Monday, February 04, 2013

When the foreign funded HIV programs pull out

For those who were not fans of the former President George W. Bush's tenure, The President's Emergency Plan for AIDS Relief or PEPFAR was his only positive contribution to global affairs, a successful utilization of 'soft power' if there ever was one. When access to antiretroviral therapy was almost impossible for your average person in the developing world, PEPFAR provided entree to HIV drugs and services, at least in the selected PEPFAR countries. The program by now can boast of many achievements, particularly the sharply increased access to AIDS drugs even in the most disadvantaged settings. Millions of lives have been saved. But as I mentioned in an earlier post a couple of years ago, this is a fragile, dubious, and non-sustainable relationship in the long term. HIV requires lifelong treatment, and it is not healthy to have your existence depend on the decisions of a foreign government, especially an economically sputtering and lurching superpower.

Now it seems that the chickens are coming to roost. PEPFAR has announced that it will no longer be funding health NGOs in South Africa that provide HIV/AIDS services. HIV positive patients are stranded and scrambling to find alternative sources of care. This generally means joining the long lines in the highly challenged public health care sector. The potential for treatment interruptions abounds. This unwelcome development has not gathered much attention in the international press, although the AIDS Healthcare Foundation has weighed in, launching a press release stating that President Obama's cutting of Global AIDS Funding is 'shameful.' Well, yes and no. The shame should at least be shared by the South African government, in particular the Department of Health, whose ultimate responsibility it is to provide reasonable access to HIV/AIDS services for citizens who need them. It is not the sort of responsibility you can outsource to foreigners in perpetuity.

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It's a bit more complicated. The South African government already covers ARVs and much of the laboratory testing for ART services covered by such NGOs. Challenges in the public service are largely the result of insufficient HRH -- a problem that the South African government should have started addressing more efficiently years ago, but one that few countries have successfully resolved.

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