Photo: Gnerk/Flickr

Fight against HIV has been the one of the best-funded health issues

NAIROBI,  – The large amount of donor funding that has gone into Rwanda’s fight against HIV has not affected efforts to prevent and treat unrelated diseases, such as malaria and measles, and may in fact have improved overall healthcare, a six-year study has found.

Researchers at Brandeis University in the US compared the performance of health clinics providing HIV services with those that did not by collecting data on the number of vaccines administered, visits to register child growth, and non-HIV/AIDS hospitalizations to monitor the attention given to non-HIV health issues.

“We wanted to examine how AIDS funding interacts with the rest of the health sector in Rwanda,” Dr Donald Shepard, a professor at the Schneider Institute for Health Policy at Brandeis and the study’s lead author, told IRIN/PlusNews. “There are conflicting views – some thought AIDS funding impacted the wider health system favourably, while others thought it worked the other way.”

The fight against HIV has been the one of the best-funded health issues in recent times. A study in 2009 by the UN World Health Organization (WHO) found that funding for HIV/AIDS accounted for almost one-third of total health overseas development assistance between 2002 and 2006.

There has been a backlash against the large amount spent on AIDS, with critics suggesting that funding for HIV is disproportionate to the global disease burden and is using vital resources that could be spent on other diseases.

The proponents of AIDS funding argue that the devastating impact of HIV justifies the high funding to fight the disease, and that the money has been used to strengthen health systems through improvements in infrastructure and functioning. The authors felt that Rwanda was a good case study because it has received strong HIV funding and has been used to support arguments on both sides.

“What we found in Rwanda was that large amounts of AIDS funding had not had an adverse impact, as some feared – there is no evidence that it detracted from the rest of the health system,” Shepard said. “On the contrary, the evidence suggests that the benefits have spun off into the rest of the health system. In health centres providing HIV services, for example, BCG [Bacillus Calmette-Guérin, a vaccine against tuberculosis] vaccinations increased at a higher rate than at those health centres that didn’t provide HIV services.”

The authors found that while there were neither “prominent diversions nor enhancement effects” after introducing HIV services to health centres, there was evidence that the health centres offering HIV services provided better preventive care than those that did not, including better immunization programmes.

According to Shepard, the fact that AIDS funding had been able to work well within the wider health system was no accident, but the result of a deliberate policy by the Rwandan government. “Rwanda made a thoughtful effort to integrate AIDS services into the general health system – staff who treated HIV patients also treated other patients, and systems set up using HIV funds supported other health issues in a systematic way,” he said.

Rwanda’s community-based health insurance, known as Mutuelle, and its performance-based financing for health centres, contributed significantly to the overall smooth and efficient running of the health system.

Shepard noted that the findings, while specific to Rwanda, meant that donors should continue their funding for HIV.

He suggested that “Other countries should look at Rwanda and adapt its systems to their own settings, using funding for HIV to broadly support the health system and strengthen the response to other diseases.”

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JOHANNESBURG,  – The Global Fund to fight AIDS, Tuberculosis (TB) and Malaria has announced that it will have US$1.6 billion more to invest in life-saving programmes between 2012 and 2014.

The new funds are a result of “strategic decisions made by the Board, freeing up funds that can be invested in countries where there is the most pressing demand”, a statement by the Fund said. Organizational changes have brought “improved financial supervision and overall efficiency”; for instance, the Fund has cut its staff by 7.4 percent. In addition, it has received new donations recently, including $750 from the Bill and Melinda Gates Foundation and $340 million from Japan.

Poor funding in 2011 forced the Fund to make an unprecedented decision to cancel its 11th round of funding, raising fears that gains made in the fight HIV would be lost. Some $616 million in grant requests is now being considered by the Technical Review Panel.

UNAIDS said the money would allow countries and communities to take the lead in determining their priorities to meet the targets of the 2011 UN Political Declaration on AIDS.

“This ushers in a new era for the Global Fund and I am pleased to see that it is opening the door to new partnerships,” Michel Sidibé, executive director of UNAIDS, said in a statement. “The Global Fund must keep firmly focused on country successes, and continue to leverage resources to ensure that countries can reach their goals and that more lives are saved.”

The international NGO, Médecins Sans Frontières (MSF), welcomed the new money but cautioned that the Fund must stick to country-driven, needs-driven and demand-driven programming. Sharonann Lynch, HIV policy advisor to MSF International, urged the Global Fund, which will have its 26th board meeting in Geneva, Switzerland, on 10 and 11 May, to adhere to its founding principle of saving lives.

“The Global Fund will deliberate on whether it can afford to open a new funding window this year [2012]. MSF demands that it does so as quickly as possible – we can’t afford to waste more time and squander the opportunity to save lives and prevent new infections,” Lynch told IRIN/PlusNews.

We can’t afford to waste more time and squander the opportunity to save lives and prevent new infections

“The funding window must be made available to all poor countries affected – the fear is that rushed reform within the Global Fund could lead to new strategies where it cherry-picks countries and interventions under the guise of poor funding.”

The Global Fund is one of the largest contributors to the fight against HIV, TB and malaria, and by 2010 was disbursing $3.5 billion annually. It has supported about 40 percent of all HIV treatment in developing countries and much of the care in middle-income nations such as China and India. More than two-thirds of the world’s malaria prevention and treatment, and three-quarters of all tuberculosis efforts, now depend on it.

“Countries that implement our grants are saving more and more people, but demand for services is still enormous,” said Gabriel Jaramillo, who became General Manager of the Global Fund in February 2012. “With more money, we can save more lives.”

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Photo: Kristy Siegfried/IRIN

Nsanje Port officially opened in 2010, but has yet to become operational

NSANJE,  – Visitors arriving in Nsanje, the sleepy capital of Malawi’s southernmost district, are greeted by a large yellowing billboard announcing: “The dream becomes reality. Nsanje Port opens October 2010.” But those who go to the port will find little more than a concrete quay with a couple of dozen mooring posts, and a few fishermen manoeuvring crude dug-out canoes through the murky brown waters of the Shire River.

For former President Bingu wa Mutharika, the construction of an inland port at Nsanje meant linking land-locked Malawi with the Indian Ocean port of Chinde, 238 kilometres away in neighbouring Mozambique, through the Shire-Zambezi Waterway project. The aim was to reduce the high costs of importing and exporting goods by road via Malawi’s commercial capital, Blantyre and the Mozambican port city of Beria – a round trip of about 1,200 kilometres.

But Mutharika’s enthusiasm for the project was not matched by his counterpart in Mozambique. As Mutharika presided over the official opening of the port in October 2010, flanked by former Zambian president Rupiah Banda and Zimbabwean president Robert Mugabe, he had to admit to the crowd gathered to witness the arrival of the first barge that the Mozambican government had called for environmental and feasibility studies before it would allow any barges to navigate the Zambezi River portion of the waterway, which flows through its territory.

There’s no evidence that Nsanje will ever be a big port city

Since then, the port has sat idle, gradually shedding nuts and bolts to vandals and becoming the focus of increasing resentment from local people promised jobs and development. Nsanje resident Rose Samuel, 32, said the only improvement to the town has been the paving of a 50-km stretch of road linking Nsanje with Bangula, the next town. Much of the remaining 130km of road between Nsanje and Blantyre has yet to be tarred.

“There’s no evidence that Nsanje will ever be a big port city,” said Samuel. “We’ve heard that down the river it’s so narrow that a ship can’t pass, so we don’t think [the port] will be in use anytime soon.”

Land grabbed

Samuel has more reason to be bitter than most. Her family was among about 300 that used to farm land now occupied by the port. In early 2010 the government communicated through the local Traditional Authority [the chief], that the land was needed for the port and families would be compensated according to the size of their plot.

“Those families affected had to uproot maize that was already planted,” said Samuel. “Some were old people who left crying – that was their only source of income.”

Photo: Kristy Siegfried/IRIN

Rose Samuel’s family was among about 300 displaced by construction of the port

Samuel’s family received a mere 5,000 kwacha (US$20) for one hectare of ancestral land, for which they had no title deeds. Her family now survive by doing piece-work and renting a small plot of land to grow food. “The weather here is bad always, and most of the time we live on potatoes. By the river it was wetter and the soil was better,” she said.

Many others have yet to receive anything. “People are worried that if they can grab land without paying, what will stop them removing more people from the area.”

Her concern is justified. Townspeople have been told by the Traditional Authority not to build any new houses because the land has been earmarked for development, and Nsanje’s District Commissioner, Rodney Simwaka, told IRIN that his office has received 4,000 applications for land from developers who are banking on the port eventually becoming operational.

Simwaka said the applications had not yet been processed but village headman Black Richman Khembo told IRIN, “Lots of land has been bought by rich people hoping to make money. So far they are letting people remain on the land, but someday they will probably kick them off.”

Project shelved

Simwaka declined to comment on recent statements by Jerry Jana, Director of Economic Affairs for the People’s Party, Malawi’s new ruling party following Mutharika’s unexpected death in April 2012, that long-term projects like the Nsanje port would be shelved for the time being while the government focused on issues of immediate concern like the country’s crippling shortages of fuel and foreign exchange.

“We need full support of the Mozambican authorities to go ahead,” Jana told IRIN, adding that the requested environmental impact and feasibility studies had yet to be carried out.

The African Development Bank (AfDB) has agreed to fund the feasibility study that formed part of the Memorandum of Understanding (MoU) on the Shire-Zambezi Waterway project signed by Malawi, Mozambique and Zambia in April 2007.

Responding by email to questions from IRIN, AfDB’s resident representative for Malawi, Andrew Mwaba, said the Southern African Development Community (SADC), the executing agency for the project, is “working on fulfilling conditions precedent to the first disbursement [of funding for the feasibility study],” and that the study was proceeding. “The project is in the interest of three governments and shelving [it] will be against the MoU the three governments signed.”

Village headman Khembo was among those who lost land when the port was built, but unlike Samuel, he holds on to the hope that the port will eventually open and provide opportunities and employment, “if not for me then maybe my children”. Lack of jobs has already pushed two of his eight children to leave Nsanje, one for South Africa and the other for Mozambique.

“If the port starts operating, Nsanje will change for the better,” he said. “Then I won’t mind about my land.”

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