DOMESTIC FUNDING FOR HIV &
AIDS RESPONSE
The AIDS Levy in ZIMBABWE
By Dr. T. Magure
NAC Chief Executive Officer
Background…NAC established
1999 was perhaps the year of turning of the tide
in HIV and AIDS where in the following happened:
The 1st National HIV and AIDS Policy was
developed in 1999; supported by the National HIV
and AIDS Strategic Framework The National AIDS Council was established in 1999
and operationalised in 2000 to inter-alia:
coordinate, facilitate, mobilize, support and
monitor a decentralized national Multi-Sectoral
response to HIV and AIDS
NAC Mandate
• MANDATE: To provide for measures to combat
the spread of Human Immuno Deficiency
Virus (HIV) and management, coordination
and implementation of programmes that
reduce the impact of HIV and AIDS. (The
National AIDS Council Act Chapter 15:14 of
2000)
Zimbabwe HIV Situation
• Population: 12.7
million (2011)
• HIV Prevalence: 15%
• HIV Incidence: 0.98%
• ART: 747, 200
Source: UNDP data
HIV Prevalence by Province
Percent HIV positive men and women age 15-49
Mashonaland
Mashonaland Central
14%
West
15%
Matabeleland North
18%
Bulawayo
19%
ZDHS 2010/11
Harare
13%
Midlands
15%
Matabeleland
South
21%
Mashonaland
East
16%
Manicaland
14%
Masvingo
14%
Zimbabwe:
15%
Zimbabwe The Sharpest HIV Decline in Southern Africa
Source: 2008 Report on the Global Epidemic (UNAIDS)
6
The National Aids Trust Fund
• Home-grown resource mobilisation initiative
meant to raise resources for the national
response to HIV and AIDS
• Established by an ACT of Parliament
• Stipulates that formally employed individuals
and corporates be levied 3% of their taxable
income towards the National AIDS Trust Fund
• ZIMRA directly deposits the funds into a NAC
account
• NAC administers the fund
Establishment Process
 The idea was conceived in late 1990s, in response
to worsening HIV and AIDS situation – in the face
of limited government funding
 Various institutions, including PLHIV implemented
a sustained lobbying campaign
 A bill was thus developed and presented to
Parliament
 The Government presented the idea as a means of
self sufficiency in responding to HIV and AIDS
 Also as a basis on which donor funds can be
attracted
 Parliament passed the bill, resulting in the AIDS
Levy as we know it today
NATF Objectives,
• To pursue objectives of the National AIDS Strategic
Plan
• To provide support for HIV and AIDS programmes in
the community
• To assist in the procurement of drugs for infected
• To undertake prevention measures
• To cater for HIV and AIDS OVC
• To facilitate training of people engaged in HIV and
AIDS activities
• To promote, M&E and research
• To establish a secretariat for the pursuit of the
objectives
Administration of fund
• The NAC Board has produced detailed instructions on
administration of fund
• Fund has been decentralized through NAC structures at
PAAC, DAAC and WAAC level, wherein NAC has
established AIDS Action Committees to stand in for the
Board at those levels
• DAAC is the most active element of the decentralized
structures – In 2015, each of the 10 provincial offices
will receive $500, 000.00 for provincial non-health
programmes
• 50% of the estimated $38 million will go for
procurement of ARVs
Thematic allocations…
•
•
•
•
•
•
•
•
•
•
50% Treatment
10% prevention
3% Advocacy
3% M&E
3% Coordination
4% Mitigation
3% CHBC
1% Communication
10% Capital Items
13% Admin
AIDS Levy successes
• US$150 million has been raised since 2009
• HIV Prevalence reduction from over 30% before 2000 to
15% in 2011
• 30% of all ART clients supported through AIDS Levy
• Procurement of ART Commodities – drugs and equipment
• Health and sector workers support and retention
• Has given birth to the new PPP arrangement – called
Increased Access to Treatment
• Supported development and implementation of sector
policies
• Flexible fund – supports cancer and TB, and covers gaps
during Global Fund shortages
ART Coverage
• ART coverage has continued to rise in Zimbabwe,
spurred by both national and donor investment
• Coverage now stands at 747 000 clients out of
estimated 1,2 million in need
• What is significant to note is that all HIV positive
people are targeted for treatment – at a CD4
count of 500
• Previously, Zimbabwe had achieved universal
access – ie. The expressed need for ART had
been met at CD4 count of 350
AIDS Levy successes: Diagnostic Equipment
Equipment
Quantity
CD4 Count High Throughput
Machines
4
CD4 Count Medium Throughput
Machines
12
Chemistry Analysers High
4
Chemistry Analysers Medium
Throughput
12
Haematology Machines High
throughput
4
Haematology Machines- medium
throughput
12
Gene- Experts Machines
12
General Purchases
•
•
•
•
•
•
•
•
ARVs
Anti TB Medicines
Anti Cancer Medicines
Laboratory Equipment & Reagents
HIV & Syphilis Test Kits
NBSZ Blood bags & Blood Test Kits & Reagents
CHBC Kits
Male Circumcision kits
Funding Partners Distribution for ART
Donor
% Support
Global Fund
35
NATF
30
USG
18
Other
16
CHAI
1
AIDS Levy Build On: Improved
Access to Treatment
• NAC in partnership with other public sector entities
and private sector players recently established an
Improved access to treatment plan - more on the
lines of a public private partnership arrangement
• The scheme is meant to benefit employees on
medical aid – especially public service workers – who
may detest queuing at public ART outlet centres
• In the Plan, NAC procures ARVs worth millions per
year at cheaper prices and through the National
Pharmaceutical Company, distributes some of them
to private pharmacies
PPP
• Private pharmacies sell to people on medical aid at
$17.00 per month instead of the previously at least
$55.00
• The National Pharmaceuticals charges a handling fee,
while the private pharmacies levy their own mark-up
• NAC recovers the money invested in procuring ARVs
and ploughs it back in the procurement chain
• Close to US$ 1 million already been raised so far in
2014
• The arrangement has a potential for NAC to raise
additional US$5 million per year in two years
THANK YOU