Kenyans may have to dig into their pockets to help fund Aids treatment following a huge deficit caused by the country’s failure to get cash from the Global Fund.
The government is agonising on how to bridge a Sh16 billion shortfall over the next three years.
Now a team of experts is recommending new ways to raise money to save an increasing number of Kenyans needing anti-retroviral treatment.
Among the options being explored is putting an extra tax on mobile phone air-time and flight tickets.
Individual Kenyans and companies may also be asked to contribute to the treatment by, for example, adopting a patient(s). Managing one patient in a year costs about Sh15,000.
There are also plans to enter into public-private partnerships with local pharmaceutical companies to produce drugs and sell to the government at a cheaper price.
The experts looking into these alternative sources of funding are expected to come up with a concept paper detailing the way forward.
A recent meeting called to discuss Kenya’s failure to get round 9 funding from the Global Fund and attended by officials from the Ministry of Medical Services, National Aids Control Council and National Aids/STD Control Programme is said to have concluded the country can no longer depend on the Global Fund.
Dr Nicholas Muraguri, the director of the National Aids and STD Control programme, said the “dedicated tax” was also likely to be imposed on alcohol and cigarettes.
“At the same time, the Government plans to increase its budgetary allocation to the HIV and Aids component to ensure that the provision of ARVs is sustained,” Dr Muraguri said.
Currently, out of the 1.4 million people infected by Aids, the Government is providing ARVs to 360,000 of them.
Dr Muraguri also said corporate organisations will be asked to provide ARVs to infected employees through their medical insurance cover.
“This will reduce reliance on the Government providing the drugs to employees in the private sector,” he added.
Another strategy would involve the National Hospital Insurance Fund being asked to support the HIV and Aids programme as it is transformed into providing universal medical insurance cover to all Kenyans especially the needy.
A dossier prepared by the experts and presented to senior officials in the ministries of Health and Finance says the future of ARV treatment hangs in the balance unless alternative sources of funds are found.
The situation is being complicated by the fact that funding for paediatric treatment, which is done mainly by the Clinton HIV/Aids Initiative, is ending in December.
The foundation has committed close to a billion shillings this year on treatment and care of HIV positive children. More than 25,000 children are on ARV treatment, with more than 50,000 still waiting to receive the life prolonging drugs.
With this funding ending, the government is under pressure to get a new donor or provide budgetary allocation to take over the children’s treatment plan.
In the dossier to the Ministries of Medical Services and Finance, the experts warn that in view of the fact that PEPFAR funding will remain the same for the next five years and the Clinton HIV/Aids Initiative is ending, the government needs to urgently bridge the gap.
The cash situation does not look good even with all the funding from the approved Round 7 of the Global Fund, PEPFAR and Clinton initiative put together.
In the year 2010/2011, Kenya needs Sh7.8 billion to manage more than 540,000 adults and children on ARV treatment.
Yet it can raise only Sh5 billion from the three sources, leaving a gap of about Sh2.8 billion. In the year 2011/2012, the ARV treatment programme is projected to cost more than Sh10 billion to manage about 680,000 patients.
Only Sh4.5 billion is assured from development partners, leaving a gap of about Sh5.5 billion. For the year 2012/2013, the projected ARV cost for 770,000 people is Sh12 billion, but only Sh4.5 billion is assured from Round 7, PEPFAR and the Clinton initiative put together meaning new sources need to be found to bridge the gap of Sh7.5 billion.
The committee that came up with this costing now wants the government to fill the gap for the next three years, which total Sh16 billion.
The number of those needing treatment is set to increase as new World Health Organisation’s guidelines are effected in July.
The new guidelines say that HIV positive persons should be put on treatment once their CD4 count — the measure of the immune strength— falls below 350 instead of the current 200.
They will also see Kenya shift drugs from Stavudine to the less toxic Tenofovir and start therapy in HIV positive patients who have active TB and chronic active hepatitis B irrespective of their CD4 cell counts.
Funding problems are emerging at a time when Kenya has lost an appeal for Round 9 funding totalling $75 million.
The only money the government is assured of from the Global Fund is about Sh6.5 billion, the remaining disbursements for Round 7.
Failure to get Round 9 may have other implications. It is likely to affect the enthusiasm to apply for Round 10, which Global Fund is expected to start calling for proposals from May.
Morale among some of the key ministry officials involved in preparing the proposal is said to be low.
But last Tuesday, members of the Country Coordinating Mechanism who give directions on the applications for the Global Fund, decided that the country applies for Round 10 funding for HIV/Aids and Malaria.
This funding crisis is bound to have serious consequences on the treatment programme if it is not resolved.
More than 100,000 current patients receiving drugs and new ones who benefit from Global Fund may be forced to interrupt treatment if the medicines are not forth-coming. If this happens, chances for the development of resistant strains, which cost 10 times more to treat, are high.
HIV experts also fear any disruptions in treatment programmes will dampen the interest of people to get tested.
Studies have shown that ARVs are an incentive to get tested as many people believe they will receive treatment and continue leading productive lives even if found to be HIV positive.
Did not know
According to Kenya Aids Indicator Survey, 2007, 83 percent of those who participated in the study did not know their HIV status. More than half of the women and 75 percent of the men, had not had an HIV test by the time of the study.
Bringing these people out to get tested depends on the availability of drugs, care and reduced stigma and discrimination.
About three months ago, Kenya launched an ambitious four-year HIV programme, The Kenya National Aids Strategic Plan 2009 – 2013, which includes all aspects of the disease control at an estimated cost of Sh267 billion.
The success of this project was mainly pegged on the Global Fund’s continued support especially for the next two years.
— Additional reporting by Mike Mwaniki