The Sunday News
FORTY-THREE-YEAR-OLD Mr Chirenje (not real name), is a widower who is living with HIV and was recently diagnosed with tuberculosis (TB).
He has just read, with despair, an article in a local weekly on dwindling donor support for HIV and Aids, TB and malaria programmes in developing countries, Zimbabwe included.
The article further paints a depressing picture by hinting at possible complete drying up of donor funding for the fight against the three ailments, two of which afflict him.
“It is inevitable that one day donor funding for the fight against killer diseases like HIV and Aids, tuberculosis and malaria, for developing countries will dry up.
“And when that happens, countries like Zimbabwe will face disastrous consequences if the day catches them unprepared?”
A grim faced Mr Chirenje ponders on the harsh reality of a predicament he shares with hordes of others in his circumstance, should predictions by the local weekly newspaper come to pass.
Being conversant with current affairs has allowed Mr Chirenje, a Mathematics teacher in Chirumanzu in the Midlands Province, to conceptualise with ease the gravity of the matter at hand.
He quizzes, “I understand the country’s health system heavily relies on donor funding, what is our Government doing to prevent a total collapse of the health sector, in the event that donors do indeed pull out?”
“There is a need for us as a country to come up with home-grown funding mechanism for our health programmes,” Mr Chirenje points out.
Four months into his TB treatment course, Mr Chirenje may have escaped the catastrophe that may come with the imminent withdrawal of donors, but he feels for those that may be struck by the gauntlet when the time comes.
His concerns come at a time when the donor countries have also been going through recession, presumably leading to the dwindling of donor funding.
Bulk of the TB funding in the country comes from international partners, with the Global Fund providing the largest chunk.
However, trends show that financial support from the donor partners has been dwindling over the years, a development that worries Mr Chirenje, among other stakeholders in the fight against TB.
According to UNAids, international donor contributions dropped from a peak of $9,7 billion in 2013 to 8,1 billion in 2015.
A Global Fund report of 2015 shows that for the period January 2010 and December 2014 Zimbabwe was allocated about $ 51 million for its TB programme, and for the period January 2015 to December 2017 the grant was reduced to $ 38 million.
In 2011, for the first time in about a decade, the Global Fund cancelled pending funding rounds for countries, suspending new grants due to lack of funding from donors, most Western, who are facing recession in their own backyards.
Last year UNAids executive director Dr Michel Sidibe urged countries to devise ways of mobilising domestic funding of HIV and TB programmes as 13 out of 14 funding partners had reduced their financial assistance.
The above developments attest to a looming funding challenge for TB programmes in Africa and countries like Zimbabwe need to be proactive and devise means of harnessing local resources for sustainable funding of health programmes.
The number of TB cases being detected in Zimbabwe remains very high at a time when general funding is dwindling and little effort is being made to improve domestic funding.
Zimbabwe is categorised by the World Health Organisation (WHO) as one of the world’s TB hot spots, being one of the eight countries in Africa appearing in all the top 30 high-burden lists of TB, TB/HIV and Drug Resistant-TB in the world.
Zimbabwe has one of the highest estimated TB incidence per capita (603/100 000 population) in the world.
Given this scenario of dwindling foreign support and a high TB burden, the need for the country to move with haste towards improving domestic funding of HIV and TB cannot be overstated.
The Parliamentary Portfolio Committee on Health and Child Care conceded, in a report last year, that it was high time TB was placed high on the political agenda in order to ensure there is political will to fund TB treatment and interventions in the country.
Zimbabwe and many other Third World countries that heavily depend on donor support for their health sector are sitting on a time bomb, whose explosion can be prevented by proactive interventions.
An outline of treatment of TB in Zimbabwe and its costs shows drug susceptible TB costs about $31 for a course of six to nine months. Multi-drug resistant TB, treated with a course of medication of 20 to 24 months costs about $2 571 to treat, while extensive drug resistant TB takes 24 to 36 months to be treated at a cost of $31 000 per person.
Should the country fail to devise localised means of funding TB programmes and wait until donor funding dries up, with the expenses outlined above, a disaster is in the making.
Country Director for The international Union Against Tuberculosis and Lung Disease (The Union), Dr Christopher Zishiri underscored the importance of harnessing more local resources towards funding TB programmes.
The Union is already supporting the Ministry of Health and Child Care’s TB programmes through Challenge TB, a USAid funding mechanism.
He proposed a raft of strategies that the Government can employ to improve domestic funding of TB programmes.
“There are local players (companies and institutions) in the country who can all contribute to supporting the programme.
“There are a number of options to improve domestic funding. For example, inclusion of sin tax on tobacco companies. That money can then be channelled towards TB among other health programmes. Introduction of a 1 percent tax on telecommunication companies, getting a percentage of the minerals (diamonds, gold) to support TB programmes,” he said.
Dr Zishiri said fulfilment of the Abuja declaration was an important step for African countries towards achieving sustainable funding of their health sectors.
He said his organisation was working with the Parliament of Zimbabwe to lobby the Government to allocate more funding towards the health sector.
“We believe a healthy nation is the backbone of any strong economy hence the need to invest more in health. For starters fulfilment of the Abuja declaration will go a long way in making sure service provision is always there and fully functional,” he said.
With a high HIV and TB co-infection rate of about 70 percent and TB being a major cause of death among HIV positive patients there is perhaps need for the National Aids Council (Nac) to relook into its priorities and allocate resources for TB.
Zimbabwe, in 1999, introduced the Aids Levy which became effective in January 2000. Introduction of the levy somehow ushered a new dimension to funding of HIV and Aids programme.
However the Aids Levy accounts for only 25 percent of funding for all HIV programmes, with the remainder being funded by donors.
With the high rate of HIV and TB co-infection, there is perhaps need for further strengthening and boosting of the Aids Levy by expanding its catchment base.
This way the fund may be able to cater for TB and in a way allow the country to carry its own disease burden looking forward.
Director of the Aids and TB Unit in the Ministry of Health and Child Care Dr Owen Mugurungi conceded that the country was indeed over reliant on foreign donor support for its HIV/Aids and TB programmes.
He however attributed the development to the poor economic conditions prevailing in the country due to economic embargoes placed on Zimbabwe by Britain and its allies.
Dr Mugurungi said the country will continue looking for donors to support the entire health sector without giving priority to any particular disease.
“The issue is to look for donors or partners to support us. Since the country was hit with sanctions our economy has not been doing well and there hasn’t been enough money to fund our development programmes,” he said.
“Of course we have to increase funding for the health sector and the reasons are not selective to any particular disease. For me it’s about increasing funding for the whole sector, for all diseases priorities that afflict us and that’s why we always engage donors and partners to help us in that regard” added Dr Mugurungi.
Funding for TB is used for various purposes, among them treatment, case detection and awareness programmes, interventions which may come to naught if the funding base dries up.
While calls for the country to improve domestic funding for both HIV and TB programmes may start to sound like a broken record, they remain a tune that should be harped on until the relevant authorities start dancing to it.
@irielyan
