Government senior officials returned empty handed last month after failing the United States President’s Emergency Plan For Aids Relief(PEPFAR)’s Thirteen Points Test for funding.
Botswana failed the PEPFAR funding test at an international planning meeting in Johannesburg, held on the 11th-15th March this year, under the auspices of the Country Operating Plan 19(COP 19).
Key among the reasons cited for PAPFAR’s refusal to sign up Botswana, alongside Mozambique and South Africa was serious lack of performance in several areas, including increasing figures of new infections, poor data management and patient tracking systems despite continued funding from international donors.
The delegation which included, officials from the Ministry of Health and Wellness, and National AIDS and Health Promotion Agency (NAHPA) Coordinator, Richard Matlhare, were advised that unless they demonstrated how the resources provided by donors were distributed among stakeholders, they would first have to put their house in order.
John Payne, Communications Specialist at PEPFAR Botswana, acknowledged after clearance with the US Public Affairs Department thus, “During the course of the week, US Global AIDS Coordinator (OGAC)-PEPFAR asked the Botswana team to report on current progress towards achieving epidemic control. Based on this, the team was asked to boost implementation of current year programs and to work to remove structural barriers that may be holding Botswana back from achieving the 95-95-95 UNAIDS targets.”
When asked whether, the decision to withhold the funding was based on non compliance or some diplomatic considerations, Payne was blunt, “The reason PEPFAR put COP19 on hold was to allow the Botswana team to reboot efforts now ÔÇô in the current fiscal year ÔÇô towards reaching epidemic control.”
According to Payne, Botswana was once an international leader in the response to HIV/AIDS, and has also been a world leader in HIV and TB research. He lamented that despite these many strengths, the collective response to HIV in Botswana has now stalled.
Another tough measure emanating from the meeting was the US Global AIDS Coordinator’s Directive that testing in community settings be stopped with immediate effect at least until a clear link between testing, treatment and retention as opposed to escalation of figures in HIV infections is demonstrated.
To qualify the decision, Payne pointed out, “PEPFAR has noted a need to immediately focus on linking HIV-positive clients to treatment and retaining new and current anti-retroviral therapy (ART) patients in care programs, which include receiving at least one viral load test every year.”
Again, the PEPFAR Specialist contended, “While efforts to link and retain people living with HIV are emphasized, the need for testing in community settings is being de-emphasized ÔÇô at least until linkage and retention rates improve.”
On whether funding for Tebelopele’s Counselling and Testing Community testing Centre has been stopped as well, it was stated, “This is incorrect. Funding for Tebelopele has not been stopped. Tebelopele will continue to receive funding as a sub-partner in PEPFAR under FHI360 activities (APC and LINKAGES).”
“Perhaps what you are referring to is a directive to stop PEPFAR support for HIV Testing in community settings with immediate effect. This was a directive given to the team by PEPFAR and it affects our community testing partners, but does not stop the government and others from continuing to test for HIV in the community, nor does it stop our partners from testing in facilities,” he bared PEPFAR’s stern posture.
Programs aimed to help infected people to remain virally suppressed are said to lag behind those of neighboring countries like Namibia. Men, in particular, are pointed as failing to access care and treatment services and continue to spread the virus at alarming rates.
Botswana has also fallen behind other southern African countries in adopting policies and World Health Organization (WHO) normative guidance that would have prevented new HIV infections and TB cases, and helped to identify, retain and virally suppress people living with HIV.
As to what conditions would what the conditions that the three countries including Botswana need to observe before they could be reconsidered for funding.
The position was that every country responding to a nation-wide HIV epidemic should have practices and policies that meet the needs of clients and result in effective programs, of which Botswana is found wanting.
Elimination of structural barriers through adoption of policies, normative guidance and practices will clear the path to reaching epidemic control.
Matlhare, admitted some of the observations made by OGAC-PEPFAR but took exception to the criticism that the increase in infections to bring down Botswana’s track record have been statistically qualified.
“Our team will be going to Washington D.C April end but we trust that most of the concerns would have been taken care of, so that even some of those that relate to policy would most probably have been responded to,” reassured NAHPA Coordinator.