Business and Policy Annual Review: A year of much progress
By JONATHAN MUNDELL (1)
Another year passes by in the fight against the HIV & AIDS epidemic, and it is becoming ever more important to look back and reflect on the progress, and also the shortcomings of efforts in combating the African continents most terrifying scourge. Africa’s endeavour to stabilise the effects of the epidemic, and international efforts to assist the continent in this regard, have been the focus of much debate and discussion over the past several years, and while there have been a handful of drawbacks and failures, 2007 has been a year full of positive strides and much success. While this newsletter focuses its attention primarily on the political and business related progress in Africa’s fight against the epidemic, it is important to remember that this is not where it ends, or in fact even begins. Community efforts are often neglected; breakthroughs in research are often overlooked, and issues such as violence, stigmatisation and the psychological impact of the virus are often ignored. This said, however, the aim of this newsletter is to review the past years major successes, from a business and policy perspective, in the African continents attempts to address the issue of “HIV & AIDS in Africa”.
GLOBAL FUND, PEPFAR FUNDING CLIMBS
International funding of HIV & AIDS initiatives are obviously an extremely important step in stemming the tide of the epidemic in Africa, and this year has seen numerous positive strides in upgrading such attempts. The United States Senate approved a Bill that will see the US foreign aid budget rise to US$ 34 billion. US$ 590 million will go towards the “Global Fund to fight AIDS, Tuberculosis and Malaria”, whilst over US$ 5 billion will go towards combating HIV & AIDS worldwide. In May, United States President, George W. Bush announced an increase of funding under the US President’s Emergency Plan for Aids Relief (PEPFAR) to US$ 30 billion in an address at the Rose Garden, in Washington DC. Bush stated that the increased funding is intended to support treatment for nearly 2.5 million people, to prevent more than 12 million new infections, and to support care for 12 million people, including more than 5 million orphans and vulnerable children. Although this funding increase will have a significantly positive impact on Africa, it must be remembered that there is still much needed to be done, both on the ground, and in the political arena.
While South Africa continues to receive the largest portion of PEPFAR funding in Africa, countries such as Kenya and Zambia have felt the positive impact of the Presidents attempts to scale up the initiative this year. PEPFAR has increased their funding to Kenya, which received US$ 367 million during 2007. Beyond funding, PEPFAR provides advice, technical assistance and monitors 275 treatment centres in Kenya. They also supply antiretroviral (ARV) treatment to an estimated 126,000 people. The Zambian Ministry of Health received an increase to US$ 216 million towards fighting HIV & AIDS, with the funds being used for such projects as mobile testing and treatment centres, purchasing condoms, and improving paediatric and family ARV treatment in rural areas.
In April this year, during a meeting in Geneva, the Board of the Global Fund stated that between US$ 6 billion and US$ 8 billion would be required each year between 2008 and 2010, in order to meet the demands of developing nations. These figures will at least triple the size of the Global Fund, and will allow these countries a much more realistic chance of meeting G8 and UN goals. The Board does realise that this significant increase in funding will require increased contributions, and the Board has thus made a plea to all stakeholders to assist in this regard. Amongst the various contributions from the Global Fund, 2007 saw the Government of Rwanda sign a grant agreement to the sum of US$ 58 million with the Fund. The grant, which will fund a new five-year project, will primarily aim at the prevention of HIV & AIDS. This will be done through outreach programmes, mass media campaigns, the increased coverage of Voluntary Counselling and Testing (VCT), the Prevention of Mother to Child Transmission (PMTCT), the expansion of ARVs, improving care and support of individuals already living with the virus, improving the linkages between HIV and other health services, and strengthening the health system in general.
Funding is however wasted if effective strategies have not been planned, and are properly implemented. In June, the World Health Organisation (WHO) and representatives from PEPFAR met in Kigali, Rwanda to discuss the development of a new strategy that could greatly increase health service provision on the African continent. The strategy is termed “Task Shifting” and consists of three elements. The first is “Treat” which provides treatment and prevention support for those health workers who may be exposed to HIV themselves. “Train” is the next facet, which will enhance the training of health workers across all levels to facilitate better treatment for the infected. The “Retain” aspect of the plan will provide a variety of incentives to existing staff so that their expertise and experience is not lost. It is estimated by the WHO that another 4 million health workers are required for the effort.
UGANDA…LOCAL ROLE MODEL
With regards to local HIV & AIDS initiatives, Uganda continues to be a role model for the rest of the African continent, and in fact the international community, having reduced prevalence from around 30% in the early 1990s, to about 6% to date. Ministry of Health Commissioner for Planning, Dr Francis Runumi, has stated that funding in the Ugandan health sector is still low. Uganda, together with other African states committed to The Abuja Declaration of 2001, have agreed to prioritise the fight against HIV & AIDS by devoting 15% of national budgets to their respective health sectors. Currently, Uganda’s commitment of 8.3% is still below the agreed upon amount, but Dr Emmanuel Otaala, State Minister of Primary Healthcare, says the Government is ready and willing to fulfil its commitment to the declaration. In addition, Chairperson for the Parliamentary Budget Committee, William Okecho, said the framework for the 2007/2008 budget shows an increase to US$ 246 million (UGX 386 billion), up from the US$ 243 million (UGX 381 billion) allocated in 2006/2007.
NATIONAL STRATEGIES INDICATE PROGESS
This year has also seen a number of African countries upgrade their national policies on HIV & AIDS. The new South African National Strategic Plan (NSP) has two main aims: to halve the amount of new infections by 2011 through a variety of new programmes, and to treat and provide support for 80% of those already infected. Some of the new recommendations include working against drug and alcohol abuse, for high profile people to be tested in order to set an example, and legalising of commercial sex work. One setback is the price-tag of such developments, which could run to about US$ 6.4 billion (ZAR 45 billion). However, beyond expected setbacks, there lies the denial of AIDS, which has plagued efforts in South Africa and made it a laughing stock on a number of occasions. Even South African President Thabo Mbeki has, in the past, argued that a virus (HIV) cannot lead to the development of a syndrome (AIDS). AIDS dissidents have undermined the distribution of antiretroviral drugs and their views have been lent credence due to the stance of Health Minister, Manto Tshabala-Msimang. The NSP is another step in the right direction however, and if nothing else, demonstrates how South Africa, who in November officially became the country with the highest HIV prevalence in the world, are finally taking their situation seriously.
A number of other African countries have also reviewed their national plans to combat HIV this year. Namibia, for example, has developed a new policy, which is based on several broad strategies, including: creating and strengthening a conducive environment for those infected and affected by HIV & AIDS; prevention to reduce new HIV and other sexually transmitted infections; and access to cost-effective and high-quality treatment care and support services to HIV positive people. The Mauritian Government also revealed its new national plan to prevent new HIV infections, while treating those already infected. The plan sets forth methods to meet goals set by the Government to combat the impact of HIV & AIDS on “at risk” groups. The Government stated that “Strategic goals were more defined to better respond to the constraints and needs of risk groups. A national coordination group comprising the various sectors concerned by the pandemic was instituted under the aegis of the Prime Minister's Office to successfully implement the projects and activities stipulated in the strategic plan". In keeping with their determined attempts to be the most successful country in addressing issues related to HIV & AIDS, Uganda unveiled an ambitious plan that aims to provide 80% of people living with HIV & AIDS in the country with access to ARV treatment, as well as care and support services, within the next five years. The proposal will partner with the ABC (Abstinence, Be faithful, Condomise) campaign as a means to support those already living with the virus, while reducing new infections at the same time.
WORKPLACE STRATEGIES IN THE SPOTLIGHT
National strategies are an obvious requirement if a country is to realistically address any issue, but the need for such strategies on a smaller level, such as within the workplace, has only recently become properly acknowledged. The majority of people living with HIV are in their working prime, and therefore the effect of the epidemic on business is profound, and this impact will continue to rise, if effective strategies are not developed. This year has seen the business sector taking large strides in addressing the issues of HIV & AIDS in the workplace. The Global Health Initiative of the World Economic Forum has developed a programme for small and medium sized businesses (SMEs), which aims to include customers and suppliers in HIV & AIDS programmes. SMEs are a key component of the economies of many Southern African countries and this initiative will help to combat the dangers to business faced by HIV & AIDS. Standard Chartered Bank will provide an example to other larger businesses by holding workshops throughout Africa to educate SMEs on how best to tackle HIV & AIDS in the workplace. Countries such as Malawi, Nigeria, South Africa and Zimbabwe have made numerous positive actions addressing this issue.
In Malawi, the International Labour Organisation’s (ILO) “HIV & AIDS Workplace Education Program” National Co-ordinator has warned the private sector on the risks involved in not developing workplace HIV & AIDS policies. In Nigeria, speaking at a “Nigerian Business Coalition against AIDS” (Nibucaa) seminar, the Organisation’s Executive Secretary, Olusina Falana, spoke of the need for Nigerian businesses to recognise, and engage in discussions about the enormous influence of HIV & AIDS on employees. He stressed the importance of non-discrimination and proper medical care for HIV infected employees, which would allow them to be productive and successful. The Nigerian, “National Workplace Policy on HIV & AIDS” has now been backed by the Federal Government and is designed to combat stigma and discrimination against people living with HIV & AIDS. The policy ensures that workers do not have to disclose their HIV status to employers, they will enjoy equal access to benefits and health insurance regardless of their status and that HIV screening is not required by employees. The South African Bureau of Standards (SABS) has launched a “South African National Standards” (SANS) system, which seeks to standardise HIV & AIDS workplace policies. By agreeing to comply with the system, companies will have to achieve certain basic standards, and will be internally and externally audited to achieve a certification, which must be continuously improved upon. Finally, in Zimbabwe, a private sector HIV & AIDS policy has been approved and was formulated with input from the Government, the private sector and the labour department, and focuses on five key areas. According to National AIDS Council Workplace Co-ordinator, Vimbai Mudenge, these include: “strengthening co-ordination of the private sector, strengthening leadership commitment in the private sector, standardisation of programmes”, and “creating one monitoring and evaluation centre and resource mobilisation”. In addition, the Swedish International Development Agency has donated US$ 730,000 towards alleviating the effects of HIV & AIDS on the workplace in Zimbabwe. The ILO will work in conjunction with the Zimbabwean Congress of Trade Unions and the Employers’ Confederation of Zimbabwe in administering the initiative.
From the above, it is not difficult to feel at least somewhat positive about the strides that are being taken in addressing the issues related to HIV & AIDS in Africa. Although there is still a huge amount to be done if the epidemic is to ever be effectively managed, it needs to be seen as a process during which consistent evaluation and continuous planning is necessary. While it is incredibly important to assess failures and address setbacks, it is just as important to acknowledge the good work that is being done, as it is this positive area that will ultimately lead to success of the African, and international community in defeating the HIV & AIDS epidemic.
(1) Jonathan Mundell is Director: HIV & AIDS Unit at Consultancy Africa Intelligence (jonathan.mundell@consultancyafrica.com).
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