HIV/AIDS funding reality check: Tanzanias of the world can’t do it alone

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Dr. Faustine Ndugulile (second from left) at a presentation at the International AIDS Conference in Washington Thursday.

In Tanzania, an east African country home to 46.2 million people where the national HIV/AIDS prevalence rate is 5.7 percent, the domestic HIV/AIDS response accounts for 10 percent of the national budget, or about $20 million per year. Sixty-five percent of government funding finances antiretroviral therapy (ART).

Still, there is a gap of financing of about 50 percent, and the HIV/AIDS program depends on donors for about 97 percent of its funding.

Dr. Faustine Ndugulile, a Member of the Tanzanian Parliament, painted this picture – one in which a country’s response to the AIDS epidemic is so greatly dependent on international donors – at the International AIDS Conference in Washington Thursday, reinforcing the message that international funding for HIV/AIDS is still critical in many of the countries hardest hit by HIV/AIDS.

In April of last year, Tanzanian representatives told UNAIDS that more than half of those in need of ART in the country were receiving it – up from virtually zero coverage in 2004. Prevention of mother-to-child transmission services of HIV reached 70 percent in 2010, up from 10 percent coverage in 2004. Ninety-one percent of all foreign funding in Tanzania comes from two donors, Ndugulile said, 71 percent from the U.S. President’s Plan for AIDS Relief (PEPFAR) program, and 20 percent from the Global Fund to Fight AIDS, Tuberculosis and Malaria. The remaining nine percent comes from eight other multilateral and bilateral donors.

The private sector is the smallest contributor to the country’s HIV/AIDS response – accounting for around four percent of spending compared to multilaterals, he said. In order to address this disparity, the government of Tanzania is intending to establish a mechanism to involve the private sector to increase their contributions to the HIV/AIDS response, beyond what is typically support for employees living with HIV/AIDS.

“The government needs to take ownership,” Ndugulile said. While he understands that there are competing interests, across the health setting even apart from HIV/AIDS there is much going on – a huge burden of malaria, tuberculosis, and now an emerging burden of non-communicable diseases, he said.

The Tanzanian government is also in the process of establishing an AIDS Trust Fund to tax certain products and use that money for HIV/AIDS activities, Ndugulile said, and it is expected that this initiative will reduce the funding gap by 40 percent.

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