Photo: Anthony Morland/IRIN

Over US$2 million has allegedly been embezzled from the health ministry

LUSAKA,- Foreign aid for government health projects in Zambia, where most of the national health budget is donor- funded, was frozen last week after allegations of corruption.

The governments of the Netherlands and Sweden announced they had suspended aid after a whistleblower alerted Zambia’s Anti-Corruption Commission [ACC] to the embezzlement of over US$2 million from the health ministry by top government officials.

“The misuse of Dutch taxpayers’ money is unacceptable,” said Development Cooperation Minister Bert Koenders in a statement, adding that Dutch aid would be put on hold until the ACC and Zambia’s Auditor General released the findings from their investigations.

Donors fund 55 percent of the country’s health budget. The Dutch government, the largest supporter of Zambia’s tuberculosis (TB) programme, contributes about 13 million euros (US$18 million) annually to rural healthcare, preventing malaria, TB and HIV, and training medical staff.

The Swedish International Development Cooperation Agency (SIDA) had earmarked 88 million kroner (about $12 million) for Zambia’s health ministry before the scandal broke, but will now await the ACC’s findings before releasing the funds. “SIDA will not accept any abuse of development money,” Charlotta Norrby, head of SIDA in Zambia, told local media.

Nkandu Luo, a former health minister, told IRIN/PlusNews that the suspension of funding could compromise the health of many Zambians: “This decision by donors is a crisis and it’s important [to] address the concerns of the donors … and restore support to the Ministry of Health.”

But government spokesperson Ronnie Shikapwasha said it was still not clear whether the money in question included donor funds. “Government is currently engaging donors on the revelations concerning the plunder of public resources in the Ministry of Health,” he told IRIN/PlusNews. “We want to ensure that operations go on smoothly and the poor people, for whom that aid is meant, do not suffer.”

He said the government was working hard to make certain that all the culprits were brought to book and the stolen money recovered, and urged the donor community to “help us to make our system more transparent … to ensure that this sad development does not repeat itself in the future.”

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About 14 percent of Zambia’s 11.7 million people are HIV positive, and about half the estimated 300,000 people in need of antiretroviral (ARV) medication obtain it from government clinics and hospitals.

“HIV/AIDS is one of the biggest challenges that we have in the country, and the programmes will be affected – there is very little money coming from our government,” said Luo.

“The suspension of donor aid … will affect service delivery,” agreed Swebby Macha, president of the Zambia Medical Association. “Especially in the areas of drug supply and equipment, preventive programmes of HIV/AIDS, malaria, TB, and the rural retention scheme for our health workers. As things stand … the government will have to run the health sector with 45 percent funding.”

Shikapwasha said it was too soon to say what impact the suspension of donor funding would have on the health sector, but Georgina Mutila, an HIV-positive widow in the capital, Lusaka, said she was “very much afraid” that the supply of free ARV and TB drugs would be affected. “Our friends who have money might afford to buy ARVs, but for some of us that will be a problem.”

President Rupiah Banda, who was voted into office in October 2008 after the death of his predecessor, Levy Mwanawasa, has repeatedly been accused of being soft on corruption.

Mwanawasa’s anti-corruption drive endeared him to Western donors and in 2005 Zambia’s $7.2 billion external debt was slashed to barely $500 million after his government achieved the benchmarks for fiscal discipline and good governance set by the World Bank and the International Monetary Fund.

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Photo: UNDP Angola

Few prevention programmes are evidence-based

JOHANNESBURG,� – In at least five African countries, scarce resources are being spent on national HIV prevention campaigns that do not reach the people most at risk of infection, new research has found.

Between 2007 and 2008, UNAIDS and the World Bank partnered with the national AIDS authorities of Kenya, Lesotho, Swaziland, Uganda and Mozambique to find out how and where most HIV infections were occurring in each country, and whether existing prevention efforts and expenditure matched these findings.

The recently released reports reveal that few prevention programmes are based on existing evidence of what drives HIV/AIDS epidemics in the five countries surveyed.

In Lesotho, where nearly one in four are living with HIV, an analysis of national prevalence and behavioural data found that most new infections were occurring because people had more than one partner at a time, both before and during marriage. But Lesotho has no prevention strategies to address the problem of concurrent partnerships, or target couples who are married or in long-term relationships.

An evaluation of Mozambique’s prevention response found that an estimated 19 percent of new HIV infections resulted from sex work, 3 percent from injecting drug use, and 5 percent from men who have sex with men (MSM), yet there are very few programmes targeting sex workers, and none aimed at drug users and MSM.

The research also found that spending on HIV prevention was often simply too low: Lesotho spent just 13 percent of its national AIDS budget on prevention, whereas Uganda spent 34 percent, despite having an HIV infection rate of only 5.4 percent.

Debrework Zewdie, director of the World Bank’s Global HIV/AIDS Unit, noted that the current global economic downturn made it more important than ever to get the most impact out of investments in HIV prevention. “These syntheses use the growing amounts of data and information available to better understand each country’s epidemic and response, and identify how prevention might be more effective.”

The reports made recommendations on how the countries could move towards more evidence-based prevention strategies to make more efficient use of limited resources.

Lesotho was advised to revise the content of its prevention messages to address multiple concurrent partnerships and integrate partner reduction into all future policies. One of the recommendations to Mozambique was that condom promotion programmes be focused on high-risk groups such as sex workers.

The five-country project also aimed to build capacity to enable these nations to undertake similar studies in future, as part of their ongoing efforts to evaluate and plan HIV responses.

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Photo: Allan Gichigi/IRIN

The people most affected by the pandemic are often left out of the response to it

NAIROBI,� – The war against HIV/AIDS, which has too often been fought in plush offices and conference centres, needs to be reclaimed by people in developing countries, who are most affected, or it will continue to be a losing battle.

This was the message from the Global Citizens Summit in Nairobi, Kenya, organized by international anti-poverty agency ActionAid, and attended by a broad range of organisations in the field of HIV and AIDS to discuss using social mobilization to “repackage” the HIV response.

“The fight against HIV did not originate in boardrooms – in the US, the momentum came from gay activists propelling HIV onto the national agenda,” said Leonard Okello, head of ActionAid’s global HIV team.

“In Uganda it came from poor women forming TASO [The AIDS Support Organisation], which has since grown into a national model for community-based care, and in Senegal it came from community and religious leaders – it was citizens rising up to make their voices heard and to put AIDS on the agenda. We need to go back there.”

Participants pointed out that although community-based organizations did the lion’s share of HIV-care work, they received a fraction of global AIDS funding.

The Bungoma Orphans, HIV/AIDS and Poverty Organization (BOHAPO), in western Kenya, supports orphans and widows in the area with food, money for transport to the hospital, and school uniforms, but has never received any funding from the government or international NGOs; it relies on the local community and sporadic individual donations from abroad.

“A lot of HIV money goes to paying for offices and other administration costs,” said Edwin Walela, founder of BOHAPO. “It would be better if that money went straight to helping the widows and orphans – the government gives them ARVs [antiretrovirals], but then they have no money to buy food so they are still dying … they need more help.”

Brian Kagoro, ActionAid’s Pan African policy manager, said it was time donors started directing funds to where they actually worked and involved people living with HIV who were often left out of policy discussions about the pandemic.

“We need to stop chasing the money and let the money chase the people’s ideas. We talk about people being infected and affected by HIV, but we don’t think of them as people with ideas of their own about their condition.”

He called for a global mass movement, built on the resilience and determination of people living with HIV, to replace “this grasshopper movement that hops from conference to conference.”

Participants also highlighted the need to put more pressure on governments to make good on their commitments. “We’ve stopped expecting our governments to keep their promises, and so there is no reaction, no anger from us when they don’t,” said Salil Shetty, director of the UN Millennium Campaign. “We need to find that anger and channel it, not to politics, as we so often do, but to water, to education, to HIV.”

He cited the example of South Africa’s Treatment Action Campaign, which used legal advocacy and grassroots mass-mobilization to get the South African government to provide free ARV therapy, generic drugs and greater commitment to the needs of people living with HIV.

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