The US President’s Emergency Plan for Aids Relief (Pepfar) is to be spared a $400m funding cut that formed part of President Donald Trump’s plan to slash billions in spending on foreign aid, but local experts are unsure how this will affect South Africa.
They all believe, however, that any restoration of the funding would need to be accompanied by new and sustainable measures to prevent “potential shocks of future funding cuts”, among other priorities, reports Daily Maverick.
The “rescissions package” planned to cancel $9.4bn in previously approved – and unspent – federal funds, but after objections from lawmakers, Pepfar is being exempted from the cuts, bringing the size of the package to $9bn.
National Department of Health spokesperson Foster Mohale said the department did not believe this translated into an immediate decision to revive the Pepfar funding programme for countries which previously benefited from it, and that the department would “continue with efforts for self-funding”.
Trump initially signed the order imposing a 90-day freeze on almost all foreign development assistance in January and in late February, USAid issued notices to Pepfar-funded HIV organisations worldwide terminating their funding for good.
Dr Kate Rees, public health medicine specialist with the Anova Health Institute, said it was difficult to predict how the decision would affect South Africa’s HIV programmes.
Although Anova lost its Pepfar funding during the cuts, it continues to run its other programmes.
“There’s still a lot of work to do to decide how that (Pepfar) money is going to be dispersed and we can’t really say yet what’s going to happen with it,” Rees said. “It’s likely that some of it will come to South Africa. We know for sure though, that the programmes, as they were before, are not going to be reinstated.”
She added that even if Pepfar funding were restored to South Africa, it would be in a different format.
“It’s going to be (at) different levels, and implemented very differently from how it was before. There’s going to have to be a different relationship between the Department of Health and Pepfar, and the NGOs that were implementing some of the programmes.”
Professor Linda-Gail Bekker, CEO of the Desmond Tutu HIV Foundation and director of the Desmond Tutu HIV Centre at the University of Cape Town, echoed Rees’ sentiments, noting that it was “too soon to say” how the restoration of the funding would play out in South Africa.
“I think we all need to advocate for urgency. Pepfar isn’t yet through, as such, and so I think we still need to advocate for how, where and when (it’ll be reinstated),” she said.
Sustainable solutions
Bekker said that beyond establishing a “transitional, emergency bridge” to get South Africa back on the road to reaching the 2030 targets for ending the Aids epidemic, there was also a need to rethink priorities and increase efficiency in the response to HIV.
“Restoring the (HIV) projects… that’s not going to happen, so the question is, what do we prioritise and what is Pepfar going to prioritise to make sure we protect the most vulnerable and allow the health system to operate in the best possible way?
“It’s generally accepted that key populations and community organisations rely heavily on external funding, and need that … because if they’re pushed into the overall system, they can often get lost and missed. I would like to think there will be Pepfar funding coming into South Africa for some of these programmes.”
Both Rees and Bekker said that a restoration of Pepfar funding would need to be accompanied by new measures to ensure the HIV programmes were not vulnerable to potential shocks caused by future funding cuts.
Bekker called for “sustainable” solutions that took into consideration the need to place more people on to ARVs, eliminate vertical transmission, prioritise primary prevention methods and incorporate innovations for HIV care and prevention.
The Treatment Action Campaign has welcomed the decision to preserve $400m for Pepfar, saying it was evidence that bipartisan support for the programme still existed, according to Sibongile Tshabalala, national chairperson.
“However, the executive orders, restrictions and programmatic cuts are still in force – nothing has changed in terms of the current implementation.
“It does not mean that services will re-open, (nor that) implementing partners with terminated grants will return to clinics. We desperately await the return of all funding for the healthcare workers and services that was cut in January,” she said.
See more from MedicalBrief archives:
Treasury bails out HIV/Aids projects blindsided by Pepfar cuts
No extra funding in Budget for Pepfar gaps