DOMESTIC FUNDING FOR HIV & AIDS RESPONSE

The AIDS Levy in ZIMBABWEBy Dr. T. Magure

NAC Chief Executive Officer

Background…NAC established1999 was perhaps the year of turning of the tide

in HIV and AIDS where in the following happened:The 1st National HIV and AIDS Policy was

developed in 1999; supported by the National HIV and AIDS Strategic Framework -

The National AIDS Council was established in 1999 and operationalised in 2000 to inter-alia: coordinate, facilitate, mobilize, support and monitor a decentralized national Multi-Sectoral response to HIV and AIDS

NAC Mandate

• MANDATE: To provide for measures to combat the spread of Human Immuno Deficiency Virus (HIV) and management, coordination and implementation of programmes that reduce the impact of HIV and AIDS. (The National AIDS Council Act Chapter 15:14 of 2000)

Zimbabwe HIV Situation

• Population: 12.7 million (2011)

• HIV Prevalence: 15%• HIV Incidence: 0.98%• ART: 747, 200

Source: UNDP data

Percent HIV positive men and women age 15-49

HIV Prevalence by Province

Mashonaland West15%

Mashonaland Central

14%

Mashonaland East16%

Manicaland14%

Masvingo14%

Midlands15%

Matabeleland North18%

Matabeleland South21%

Bulawayo19%

Harare13%

Zimbabwe:15%ZDHS 2010/11

6Source: 2008 Report on the Global Epidemic (UNAIDS)

Zimbabwe The Sharpest HIV Decline in Southern Africa

• Home-grown resource mobilisation initiative meant to raise resources for the national response to HIV and AIDS

• Established by an ACT of Parliament• Stipulates that formally employed individuals

and corporates be levied 3% of their taxable income towards the National AIDS Trust Fund

• ZIMRA directly deposits the funds into a NAC account

• NAC administers the fund

The National Aids Trust Fund

The idea was conceived in late 1990s, in response to worsening HIV and AIDS situation – in the face of limited government funding

Various institutions, including PLHIV implemented a sustained lobbying campaign

A bill was thus developed and presented to Parliament

The Government presented the idea as a means of self sufficiency in responding to HIV and AIDS

Also as a basis on which donor funds can be attracted

Parliament passed the bill, resulting in the AIDS Levy as we know it today

Establishment Process

• To pursue objectives of the National AIDS Strategic Plan

• To provide support for HIV and AIDS programmes in the community

• To assist in the procurement of drugs for infected• To undertake prevention measures• To cater for HIV and AIDS OVC• To facilitate training of people engaged in HIV and

AIDS activities• To promote, M&E and research• To establish a secretariat for the pursuit of the

objectives

NATF Objectives,

• The NAC Board has produced detailed instructions on administration of fund

• Fund has been decentralized through NAC structures at PAAC, DAAC and WAAC level, wherein NAC has established AIDS Action Committees to stand in for the Board at those levels

• DAAC is the most active element of the decentralized structures – In 2015, each of the 10 provincial offices will receive $500, 000.00 for provincial non-health programmes

• 50% of the estimated $38 million will go for procurement of ARVs

Administration of fund

• 50% Treatment• 10% prevention• 3% Advocacy• 3% M&E• 3% Coordination• 4% Mitigation• 3% CHBC• 1% Communication• 10% Capital Items• 13% Admin

Thematic allocations…

AIDS Levy successes• US$150 million has been raised since 2009• HIV Prevalence reduction from over 30% before 2000 to

15% in 2011• 30% of all ART clients supported through AIDS Levy• Procurement of ART Commodities – drugs and equipment• Health and sector workers support and retention• Has given birth to the new PPP arrangement – called

Increased Access to Treatment• Supported development and implementation of sector

policies• Flexible fund – supports cancer and TB, and covers gaps

during Global Fund shortages

ART Coverage

• ART coverage has continued to rise in Zimbabwe, spurred by both national and donor investment

• Coverage now stands at 747 000 clients out of estimated 1,2 million in need

• What is significant to note is that all HIV positive people are targeted for treatment – at a CD4 count of 500

• Previously, Zimbabwe had achieved universal access – ie. The expressed need for ART had been met at CD4 count of 350

AIDS Levy successes: Diagnostic EquipmentEquipment Quantity

CD4 Count High Throughput Machines

4

CD4 Count Medium Throughput Machines

12

Chemistry Analysers High 4

Chemistry Analysers Medium Throughput

12

Haematology Machines High throughput

4

Haematology Machines- medium throughput

12

Gene- Experts Machines 12

General Purchases

• ARVs• Anti TB Medicines• Anti Cancer Medicines• Laboratory Equipment & Reagents• HIV & Syphilis Test Kits• NBSZ Blood bags & Blood Test Kits & Reagents• CHBC Kits• Male Circumcision kits

Donor % Support

Global Fund 35

NATF 30

USG 18

Other 16

CHAI 1

Funding Partners Distribution for ART

AIDS Levy Build On: Improved Access to Treatment

• NAC in partnership with other public sector entities and private sector players recently established an Improved access to treatment plan - more on the lines of a public private partnership arrangement

• The scheme is meant to benefit employees on medical aid – especially public service workers – who may detest queuing at public ART outlet centres

• In the Plan, NAC procures ARVs worth millions per year at cheaper prices and through the National Pharmaceutical Company, distributes some of them to private pharmacies

PPP

• Private pharmacies sell to people on medical aid at $17.00 per month instead of the previously at least $55.00

• The National Pharmaceuticals charges a handling fee, while the private pharmacies levy their own mark-up

• NAC recovers the money invested in procuring ARVs and ploughs it back in the procurement chain

• Close to US$ 1 million already been raised so far in 2014

• The arrangement has a potential for NAC to raise additional US$5 million per year in two years

THANK YOU