Sh42bHIV/Aids money uncollected as millions suffer

By DANN OKOTH

Kenya may get up to $500 million in unspent HIV and Aids funding after all if negotiations with key partners bear fruit, we can reveal. The Sh42 billion can keep half a million people from dying from Aids-related complications.

The money is part of a record backlog that has been caused by confusion within the Grand Coalition Government, which provides health services through two warring ministries.

There were fears the Government would lose the money, which is provided through the United States President’s Emergency Plan for Aids Relief (Pepfar), following a row over accountability for previous amounts. 

Ministry of Health officials met Pepfar officials and Aids activists on Monday in a last ditch effort to secure the country’s allocation as intrigues and uncertainty continued to shroud the Pepfar unspent billions. There are fears the Government may leave most of the money on the table because it cannot get the Medical Services and Public Health ministries to work out how to use it all. 

“We met Pepfar and civil society groups to find a common ground on the way forward on how the money being held can be released and used,” said Peter Cherutich, the acting head of National Aids and Sexually Transmitted Infections Control Programme (Nascop) at the Ministry of Public Health and Sanitation.

“Another meeting has been planned next week to iron out the finer details of the funds roll-out.”

Our efforts to contact Pepfar country coordinator Katherine Perry to comment on the matter were fruitless after she failed to respond to our e-mails and phone calls.

Financial pipeline

Nearly $1.5 billion has accumulated unspent in the US’s global Aids programme financial pipeline. About Sh42 billion of this is allocated to Kenya but has not been disbursed even as people continue to die. It is estimated that Kenya has 1.5 million people living with HIV. Only 500,000 are already receiving life-sustaining HIV treatment. Treatment coverage is even lower for children, currently standing at a mere 34 per cent of those in need.

Kenya faces large gaps in treatment coverage to meet its national target of one million on ARVs by 2015.

Nonetheless, when Pepfar’s Kenya office submitted its proposed work plan for the coming year, US officials in Kenya did not plan to use the billions of unspent shillings to increase the pace of HIV treatment next year.

“It is a tragedy that money goes unused while Kenyans living with HIV get sick and die because they do not receive treatment,” says Jacque Wambui of Health GAP Kenya. “The US has billion of shillings unspent, and the Treasury has not kept its obligations to annually increase domestic budgets for the ARV drugs we need to stay alive.”  On World Aids Day in December last year, Minister for Special Programmes Esther Mirugi and US President Barack Obama made historic, complementary announcements that they would greatly step up the pace of enrolling people on Aids treatment.

The Special Programmes Minister promised that the Government would commit to more than double the numbers on Anti-retroviral treatments (ART) by 2015, while US President Obama pledged to support six million people on HIV treatment globally by 2013 through Pepfar. However, stagnating HIV treatment enrolments threaten both of these promises.

Dr Cherutich confirmed the country was experiencing severe gaps in HIV treatment and prevention saying there was need to inject more cash into treatment and prevention programmes to meet the country targets.

“Our target is to put a million people on treatment by 2015,” he says. “We need the money in the pipeline to bridge these gaps.” In the eight years of US funding of Aids globally, Congress has appropriated $37.9 billion, amounting to the largest Government programme ever to fight a single disease, an initiative started by President George W Bush known as the President’s Emergency Plan for Aids Relief, or Pepfar.

Bipartisan support

It has won wide bipartisan support from the start because of its success in saving millions of lives of Africans with Aids and helped shore up dysfunctional health systems in some of the poorest parts of the world.

However, pundits now believe the continued goodwill from the US could be running out amidst policy priority changes and lingering bureaucracies and inefficiencies in African governments. Any wonder that the Obama administration submitted a 2013 budget that called for a $550 million reduction — an 11 per cent cut — in its global Aids programme even after the US declared that an “Aids-free generation” was possible.

Speaking to the Global Post recently, Ambassador Eric Goosby, global Aids coordinator, explained that $1.46 billion designated to fight Aids hasn’t been used because of bureaucracies; major reductions in the cost of Aids treatment; delays due to long negotiations on realigning programmes with recipient country priorities and a slowdown in a few countries because the Aids problem was smaller than estimated. “What we’re doing is defining what money is available, and what resources we will put back into Aids-free generation type activities,” Goosby said. “Things that will not require continued yearly funding could be a one-time funding effort.”

Unexpected windfall

While this could create an unexpected windfall for some programmes, it also means that several countries that have not spent the funds will lose tens or hundreds of millions of dollars.

The key loser appears to be Kenya, which has had a half-billion dollars — roughly one-third the total amount in the pipeline — that has been accumulating in the US Treasury unspent for more than 18 months after Congress appropriated the money.

Goosby said his office has been aware of a growing pipeline of unspent money for the last two years, and he ordered investigations into why the money was building up in certain countries, notably Kenya, Ethiopia, Mozambique and Tanzania.

His office has not spoken publicly about the backlog until now in part because of internal concerns that Congress could cut future budgets because such a large amount was being delayed in the pipeline.

State Department officials argue though, that many foreign assistance programmes build up a pipeline of 12 to 18 months of funding. The difference with the Pepfar backlog is its sheer size — Pepfar accounts for roughly 20 per cent of the US foreign assistance budget. In the Pepfar pipeline, some country backlogs are substantial.

Countries’ allocations

Kenya alone has roughly one-third the entire amount, with $502 million in unspent funds. Tanzania ($149 million), Ethiopia ($138 million), Mozambique ($130 million) and Zambia ($91 million) are next on the list, which names 22 countries and two regions.

Kenya, the US notes, has had trouble spending the money because of inefficiencies in its two ministries of health, which were set up as part of a negotiated settlement following post-election violence in 2008, according to several US officials in Washington and Nairobi. The large amount of unspent money, officials says, was the major reason why the administration asked for a reduction in funds for the next fiscal year.

He said his office asked for what it would need to meet goals under US-supported programmes, and because of the cut it also saw an opportunity to seek a 57 per cent increase for the Global Fund to Fight Aids, Tuberculosis and Malaria, to $1.65 billion next year.in front of Tripoli’s newly built Grand Hotel, where dignitaries were staying, only 16 of Africa’s heads of state were present. That was less than half the necessary OAU quorum of 34 leaders. One of those who did not attend was Moi, the outgoing OAU chairman.

In the end, Moi refused to hand over to Gaddafi and continued for one more year as chairman until 1983, when he handed over to Ethiopia.

According to a former Moi official, Gaddafi never forgave Moi for refusing to handover the OAU chairmanship.