Source: Zim’s donor dependency syndrome shocker –Newsday Zimbabwe
ZIMBABWE’S heavy reliance on non-governmental organisations (NGOs) for many years could see the country losing out on the latest ground-breaking HIV and Aids intervention by the United States’ President’s Emergency Plan for Aids Relief (PEPFAR), with the Trump administration indicating that it will not be distributed through non-profit entities.
PEPFAR is supporting an initiative by the Global Fund to Fight Aids, TB and Malaria to provide lenacapavir to up to two million people in countries with high burdens of HIV.
According to UNAids, lenacapavir, is one of the most promising new HIV prevention tools that has emerged in HIV response, offering protection against the virus with just twice-yearly injections.
And in Zimbabwe, NGOs have been at the forefront of fighting the pandemic, with PEPFAR implementingcomprehensive HIV programmes since 2006 through the United States Agency for International Development and the Centers for Disease Control and Prevention.
However, announcing the latest developments in partnership with Gilead Sciences and the Global Fund on the PEPFAR Initiative recently, US State Department senior official for Foreign Assistance, Humanitarian Affairs and Religious Freedom, Jeremy Lewin, said the programme would not be implemented through NGOs.
“For too long, PEPFAR’s budget has been drained by sort of NGO implementing partners that are charging very high indirect cost rates and has been sort of focused on non-core activities,” Lewin said.
“But the core of PEPFAR, what’s made it so effective for so many years, has been the delivery at scale, the procurement and purchasing of medications, whether that’s sort of conventional antiretrovirals, prevention medication or sort of medical breakthroughs like lenacapavir.
“As we think about it, there’s been a lot of sort of media attention on some of the programmes that we have cut because they’re no longer aligned with our priorities.”
Gilead scientists have spent 17 years researching and developing what would become lenacapavir.
The medicine has been approved in the FDA and the European Commission, and in clinical trials, nearly a 100% of people taking lenacapavir remained free of HIV.
However, Lewin underscored that there are no NGOs involved in this.
“We are making a deal to help purchase a tremendously innovative medication and get it to the countries,” he said.
“And it’s those countries that are going to be responsible for distributing it through their national healthcare systems.”
He said the US government would be helping countries with the tools to fight the epidemic and building their own national capacity, their own national healthcare systems, “rather than distributing medication through NGOs that were operating as a shadow healthcare system”.
“So this is where we see a lot more of our resources going and so we’re really excited. This is only the beginning,” Lewin said.
However, health experts yesterday told NewsDay that the US government stance could cost Zimbabwe, which has over the years relied on NGOs as partners in fighting diseases.
United States-based health economist Fungisai Nota said lenacapavir was a global blessing in the development of the long-lasting HIV preventative drug.
“But this blessing is limited to those countries that have developed efficient distribution systems within their public health infrastructure,” Nota said.
“For Zimbabwe, I know efforts are in place to (develop efficient distribution systems), but we are still too far behind in the development of our local health infrastructure to fully benefit from this new model of medication distribution.
“For far too long, our government took a back seat to its own country’s provision of public health and took a free ride from local NGOs.”
Nota said the sidelining of NGOs in the new paradigm severely harmed the HIV fight and limited the benefits of the new innovative preventative medication.
Public health economist Tendayi Chipango said Zimbabwe should explore opportunities for local or regional manufacturing of medicines like lenacapavir under licensing agreements.
“This would reduce costs, secure supply chains and build long-term self-sufficiency,” she said.
“At the same time, strengthening domestic health financing, through tax-based funds or pooled insurance would make programmes more sustainable beyond donor cycles.
“As the global economy weakens, failing to address these burdens risks leaving Zimbabwe permanently stagnant.”
Chipango urged policymakers not to choose one disease over another, but to design an integrated health system that can respond to multiple threats while safeguarding long-term economic stability.
“The way forward is not exclusion but a weaning from dependency towards a resilient health system that is integrated, accountable and responsive to all our people’s needs,” she said.
“It’s definitely ‘all hands on board’ if we are to really reap this opportunity presented to us.”
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