Wednesday, September 23, 2020

Is the ARV Programme financially sustainable?

Official statistics indicate that last year alone, the Botswana Government spent close to P1.5 billion on Anti Retroviral drugs alone.

By any measure, this is a huge amount.
Recent economic developments ÔÇô here at home and abroad, have compelled us to ask the question of just how sustainable the ARV Programme is.
While Botswana has been lucky in that we have been able to get support from our cooperating partners, the truth of the matter is that proportionate to the overall expenditure, money from such external sources accounts for only 10%.
This should in no way be interpreted as a lack of appreciation on our part for the external benefaction Botswana has over the years received to bankroll her HIV/AIDS expenditure.

We remain deeply indebted to such organisations as the Bill and Melinda Gates Foundation.

We will forever remain grateful for far reaching assistance rendered this country by such institutions like the Baylour Children’s Clinic.
We remain indebted to the United States Government who, through PEPFAR, contributed immensely and generously towards Botswana’s war against HIV/AIDS.
In the same breadth Botswana has benefited kindly from the United Nations who, through their multi billion Dollar HIV & Tuberculosis Fund, have also in the past assisted us.

Due to their generosity and kindness, many of Batswana’s lives have been saved. The resources extended to Botswana government from such quarters have also infused a great deal of dignity among many citizens infected with HIV/AIDS who otherwise could not afford the drugs were it not for the subsidies from such Samaritans.

But still, the ground truth that we are trying to drive home is that for all the generosity from outside, Botswana Government has still had to foot the bulk of the bill ÔÇô 90% of the total.
As a matter of fact, this has meant diverting a significant share of resources that would otherwise have been used to advance our national development agenda. Talk of opportunity cost!

More importantly, there is no guarantee that going forward our hitherto generous international cooperating partners will continue to be on our side when it comes to financing our programmes of fighting HIV/AIDS.
These are hard realities we have to face as a nation.

There is also the backdrop of the difficulties that Botswana’s diamond industry is facing.

Even worse, the whole world is today reeling from an economic meltdown, the end of which cannot be adequately or confidently predicted.

While in the past it was relatively easy to juggle our national budget, going forward it is going to be much tougher because of the economic difficulties that are still unfolding.
“You will recall that we have been basing our plans on an estimate that 110, 000 patients were in need of treatment. This is an estimate that was more relevant for 2001. We now estimate the number of people in need of treatment to be 145 000. As at the end of September this year we have treated over 111,000 patients. We have not achieved universal treatment to date,” said President Ian Khama last year as he made a key note address on World AIDS Day in Selibe Phikwe.

The President went on to say that the programme had thus far averted 50,000 adult deaths, adding that government projected to save up to 130,000 lives by 2016.

With more people expected to join in the therapy, we, and with the economy at the same time undergoing stress, need as a nation to start debating the long-term sustainability of the ARV therapy.

Over the years, HIV/AIDS has evolved from being a purely health problem to become a developmental challenge.
We are happy this transition has long been recognized by both Government and political level and at operational level in the form of NACA (National AIDS Coordinating Agency).”

But still, as President Khama so succinctly put it in his first State of the Nation Address, “no amount of money can compensate for the need for greater commitment. This is especially so since the level of response is unsustainable in the face of other competing development imperatives. At this rate, continued progress cannot be guaranteed. This must be a concern for every citizen.”

It is on this note that, as Sunday Standard, we want to kick-start a public debate on just how sustainable the ARV programme is in the long run, not least because of the rough patch that our national economy is going through.

Our hope is that such a debate would compliment the other efforts by such institutions like NACA who are investing a lot of resources in preaching behavioral change ÔÇô or, in the parlance of Ian Khama, Discipline as the best saviour for this country!

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The Telegraph September 23

Digital edition of The Telegraph, September 23, 2020.