This guest blog was written by Jeanette Strydom, the communications officer at Africa Health Placements, a member organization of GHC based in Johannesburg.
JOHANNESBURG, South Africa — The President’s Emergency Fund for AIDS Relief (PEPFAR), which was started in 2003, is an American-run initiative that aims to help save the lives of those suffering from HIV/AIDS. A large portion of PEPFAR’s resources go to sub-Saharan Africa, and South Africa is one of the largest of those recipients. The PEPFAR model operates through and is driven by partnerships with recipient nations, NGOs and healthcare facilities. PEPFAR is by far the largest global health initiative.
Funding in 2008-2013
Currently in South Africa there are 140 prime implementing PEPFAR partners and more than 650 sub-partners working throughout the nine provinces. PEPFAR’s primary programme in South Africa was intended to run for five years until 2008; however, when the time came to reduce funding, the South African government was not ready to carry the hefty financial and administrative burden thereof. The South Africa Department of Health had not taken the necessary steps to be able to manage what PEPFAR had built with their private partners. PEPFAR subsequently took the decision to extend funding for another five years until the end of 2013 in order to finish what they initially intended whilst strategically re-aligning funding to encourage partners to move from treatment activities to prevention.
Funding in 2013-2017
With its new funding strategy over the next five years, PEPFAR will work to achieve five overarching goals:
1. Transition from an emergency response to promotion of sustainable country programs.
2. Strengthen partner government capacity to lead the response to the epidemic and other health demands.
3. Expand prevention, care, and treatment in concentrated and generalized epidemics.
4. Integrate and coordinate HIV/AIDS programs with broader global health and development programs to maximize impact on health systems.
5. Invest in innovation and operations research to evaluate impact, improve service delivery and maximize outcomes.
The new PEPFAR five-year strategy shifts away from an emergency response and prioritises capacity building and systems strengthening. Funding will therefore shift from treatment to prevention. From the end of 2012 until the end of 2017, PEPFAR will be working with the South African public sector as well as other health-related organisations to support the implementation of their HIV and tuberculosis responses. The expected result will be a reduction in HIV and TB transmission, expanded and sustained national services and the strengthening of the systems that bolster South Africa’s national response.
According to PEPFAR, South Africa represents a tiny 0.7% of the world’s population but is responsible for 17% of its HIV prevalence. This is roughly 5.7 million people living with HIV. PEPFAR estimates that South Africa has the fourth highest incidence of TB – approximately 31% of all TB in Africa occurs in South Africa. They have reported that South Africa is only one of 12 countries worldwide where the mortality rate of children under the age of five has increased since 1990. These sobering statistics mean that the government, the South African National AIDS Council and other organisations have a profound challenge on their hands, even though the pandemic has stabilised in recent years.
Apart from stop-gap measures, South Africa must find a way to strengthen permanently the efficiency of HIV and TB interventions along with finding ways to streamline costs to ensure available funds are used to maximum benefit. PEPFAR partners will continue to serve as a supportive structure offering technical assistance.
This will mean that organisations implementing interventions need to collaborate in order to find areas of synergy, as well as share costs and resources to stretch funds. Health systems need to be strengthened to have both the ability to deliver basic services and to function efficiently with minimal resources.
As well, behavioural interventions focused on challenging social norms, minimising stigma and eliminating gender inequality are cost effective but are also potentially powerful ways of fighting key drivers of HIV infection, and these can be scaled up. Improved monitoring and evaluation frameworks with more accountability and transparency will assist in meeting these ends.
The fight against HIV/AIDS and TB is not over and South Africa must be prepared to take appropriate measures to ensure that the hard work of previous years is not wasted, but instead continued even more strongly going forward. This will require commitment and a coordinated effort from government, civil society, academia and healthcare professionals, as well as finding innovative ways to use the resources available in the most beneficial ways. The ultimate goal is as it has always been: to protect and treat those most vulnerable to the ravages of HIV/AIDS and TB.