[DEBATE] : (Fwd) Global financial crisis = less AIDS subsidies

[Patrick Bond]

HEALTH-AFRICA: Global Financial Crisis Leads to HIV Budget Cuts
By Kristin Palitza

CAPE TOWN, May 18 (IPS) - International donors and African governments 
are likely to cut health budgets due to the global financial crisis. 
Health experts fear that increasing unemployment and poverty will lead 
to less food security and quality of nutrition, which will in turn put 
more stress on already weak health systems.

The implications, warns a newly-released World Bank report, could be grave.

"We need to ensure that African lives do not become a silent casualty of 
the global financial downturn," demanded Paula Akugizibwe, regional 
treatment literacy and advocacy coordinator of Windhoek-based AIDS and 
Rights Alliance for Southern Africa (ARASA) in Namibia.

"Our lives are not cheap or expendable. We expect health to be 
prioritised over weapons, sports and lavish politics," she added.

Tanzania was the first sub-Saharan country to announce a 25 percent cut 
of its annual HIV/AIDS budget.

"This will have a significant impact on human resources in the sector 
and on health service delivery," explained Akugizibwe. "Long-term health 
planning will become completely unpredictable."

The situation is not much better in neighbouring countries. The South 
African government has indicated that large private firms, especially 
mining companies, are likely to cut their HIV prevention programmes 
affecting thousands of employees and their families.

Even worse, Botswana’s presidential spokesperson Jeff Ramsay recently 
announced government will not be able to include new patients in its 
free antiretroviral (ARV) treatment programme from 2016 onwards, because 
it doesn’t have sufficient funds to expand the programme.

Smaller budgets

All this stands in direct contradiction to a commitment to set aside 15 
percent of their national expenditure towards health made by African 
heads of state during a meeting in Abuja, Nigeria, in 2001.

"Very few countries have met this goal. The money is there. It’s all 
about prioritisation of resources," Akugizibwe told IPS. "The situation 
is very frightening, because governments cut back on already 
insufficient HIV treatment and care programmes," she warned.

Even international donor organisations have started to feel the 
financial crunch. The Global Fund to Fight AIDS, Tuberculosis and 
Malaria recently announced it is at least $4 billion short of the money 
it will need to continue funding essential HIV, TB and malaria services 
in 2010. The coalition believes there is a $10.7 billion funding gap for 
regional implementation of the Global Plan to Stop TB alone.

To mitigate the impact of the financial crisis on HIV health service 
provision, a number of AIDS and tuberculosis (TB) activists from across 
Sub-Saharan Africa – including ARASA, the South African Treatment Action 
Campaign (TAC) and the Kenyan Collaborative Fund for HIV Treatment 
Preparedness – have now come together to lobby for continued health 
financing.

The right to health and treatment are non-negotiable, the activists say. 
They now want to hold the heads of state and international aid 
organisations to their commitments made to increase and improve HIV 
treatment and care.

"Broken promises and skewed priorities of governments and donors have 
reduced the right to health and access to treatment to unattainable 
rhetoric," lamented TAC women’s health programme coordinator Nonkosi 
Khumalo.

The activist coalition demands that African governments and 
international funders close the gap on health financing and warn that 
the lives of millions of people in Sub-Saharan Africa are in jeopardy 
because of the lack of political will and investment to realise the 
right of access to life-saving treatment.

"In the last few months, we have seen trillions of dollars spent on 
financial bailouts to stimulate economic recovery. A tiny portion of 
this sum could have bought quality, sustainable healthcare for millions 
of people," Khumalo further explained.

Broken promises

According to the 2009 World Bank "Averting a Human Crisis During the 
Global Downturn" report, countries in Eastern and Southern Africa are 
the most vulnerable. Researchers estimate the negative impact of this 
crisis will affect 70 percent of people on ARV treatment in Africa 
within the next twelve months.

With a few exceptions, such as Botswana and South Africa, most countries 
have limited fiscal space they can use to cushion the impact of a 
decline in international aid, World Bank says.

Already, large percentages of households in Sub-Saharan Africa are poor, 
and the large number of people on treatment means ever-increasing 
treatment programme costs.

Yet, Sub-Saharan Africa only accounts for one percent of global health 
expenditure and two percent of the global health workforce. Currently, 
only one third of HIV-positive Africans in need of antiretroviral (ARV) 
treatment can access it, according to TAC.

Failure to meet the commitment to bringing universal access to treatment 
for people with HIV who need it, the World Bank report notes, will call 
into question the legitimacy of development assistance for health, 
threaten the gains in health system capacity delivered through HIV 
treatment programmes.

It will ultimately result in greater long-term costs due to higher rates 
of transmission, more TB cases and larger numbers requiring expensive 
second-line drugs for both HIV and TB.

Dr Bactrin Killingo, chairperson of the Nairobi-based Collaborative Fund 
for HIV Treatment Preparedness agrees.

"If current cost constraints faced by HIV treatment programmes are not 
addressed, while the demand for expensive second-line treatment 
increases, we will soon find ourselves in a situation similar to the 
1990s, where millions of lives were lost unnecessarily because people 
could not afford the treatment they needed to stay alive".