US HIV aid cuts create R4bn shortfall in NGO sector

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JEREMY MAGGS: Global donor funding for HIV (human immunodeficiency virus), I read, is shifting fast and South Africa is feeling the impact, with major cuts to US aid and a R4 billion funding gap here at home.

The pressure is now squarely back on our public health system. I think the question, though, is whether it can absorb the shock without losing decades of progress.

Read: US funding cuts have crippled our HIV work – Professor Glenda Gray

Someone who’s applied their mind to that is healthcare systems advisor and the CEO of the EndlessLife Group, Zohakiy Mbi-Njifor, who joins me on the programme now. Zohakiy, welcome.

This is a very important issue and you say that the aid cuts signal that Africa is no longer a priority. That in itself is very disturbing. Do you think South Africa needs to treat this as a temporary shock, or is this now a permanent reset that we’re looking at?

ZOHAKIY MBI-NJIFOR: I think we should treat this as a permanent fixture. I don’t see us going back to the status quo to how aid was distributed in the past.

I don’t see the US government completely reversing back to large donor funding to Africa, especially South Africa.

I think this is a call for the South African government to begin to allocate resources to all the programmes that the US government was funding in this country.

This is not going to be a temporary shock. We do see that policies don’t shift significantly overnight. I do foresee that this is going to be a lingering issue for a while.

JEREMY MAGGS: It’s all very well to suggest, Zohakiy, allocating or reallocating resources, but those resources cost money. Government could very well argue that the funds just don’t exist.

ZOHAKIY MBI-NJIFOR: That’s true. But we see historically, Jeremy, that the government has always cut the healthcare budget in this country.

We do know that we have a serious health issue with HIV, with TB (Tuberculosis). We have severe diseases in the country. For the last five years, the budget year 2021 through 2022, we’ve seen from R64.5 billion, reduced R4 billion.

I think it’s time that the South African government takes health funding extremely seriously.

I don’t see the R4 billion that was invested in this country from the US government coming back anytime soon. I do think that needs to come back from the government of (South Africa).

JEREMY MAGGS: Well, at this point, if I understand this correctly, government has stepped in with around R750 million, but that only covers a fifth of the gap. So what happens practically on the ground when that once-off money runs out? What kind of landscape are we looking at?

ZOHAKIY MBI-NJIFOR: Jeremy, it is dismal. I can tell you many NGOs (non-profit organisations), grassroots organisations, community-based organisations, local organisations, NGOs that were providing services across several district provinces have closed shop.

Those programmes have ceased to do work and some of them have handed over that work to the government, to clinics, to other government departments, to try and intervene.

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It looks like this, so NGOs that will provide educational services to schools, educating young girls and young boys around HIV infection prevention activities, some of those have ceased. NGOs that provide support to the government, by providing Prep, which is pre-exposure prophylaxis or post-exposure prophylaxis, have ceased.

NGOs that will support the government in providing antiretroviral treatments in the communities to patients, some of them have had to close shop.

The effect of some of these funding cuts are real, let alone the amount of labour loss, loss of jobs both in the public sector and in the NGO sector, because a lot of this funding supported the employment of nurses within public facilities.

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It does not only affect the NGO sector, even the public sector itself, that depended on this funding to have some staff seconded into their offices or into clinics, has seen a massive shock in that aspect.

There is a definite need to look at alternative financing and to do some reforms around healthcare financing in the country.

JEREMY MAGGS: Zohakiy, I want to come back to jobs in just a moment.

But if I understand this correctly, around three quarters of Pepfar-supported (US President’s Emergency Plan for Aids Relief) programmes were shuttered as a result of the closure of funds.

It does, though, raise the question about whether our health system was too over-reliant on donors to begin with.

ZOHAKIY MBI-NJIFOR: Well, that’s a very good question.

Our health system was reliant on donor funding, but I wouldn’t say over-reliant. So without the donor funding, we still have people on treatment.

The government is at the forefront of treating the South African patients and communities on ARVs (antiretrovirals). That is the fact.

The funding that the government puts forth for these far outweighs what the donor community has invested – the R4 billion – government spends way more, almost R10 billion or more on ARV investment in the country.

Listen/read: SA approves long-acting HIV jab set to curb new infections

The donor funding is significant, but it’s not massive, it’s not the key driver for the provision of health services in the country. However, the gap is still significant to be breached because, as we see with the provisional of resources of R754 million, it does not in any way come close to what the gap is, which is about R4 billion.

Therefore, we see that there is a need for us to begin to rethink, especially the government and also the NGOs, rethink of alternative ways of investing in this work because the work is necessary. We have the biggest population of ARV patients in the world.

JEREMY MAGGS: Let me ask you this question. When we had the money, when the funding was there, I wonder whether it was being spent efficiently. There was surely resource drain and wastage, and a lot of that money was probably not being spent or allocated correctly. Am I right?

ZOHAKIY MBI-NJIFOR: Well, yes, you could say that. I think part of the issue is that we have a problem of allocation and spending.

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It’s not only allocation, I think it’s more spending because we have a difficulty through our PFMA (Public Finance Management Act) processes in spending money correctly, we have a challenge with spending the money in the right areas and with recruiting the right skills.

It takes a while for government to fill a vacancy, for reasons you and I might not know. Why does it take so long to fill a vacancy?

I think there’s a need for us to challenge not only the allocation of resources in the government departments, but also the ability to spend those resources efficiently in the right areas.

The same thing applies for the public, for the NGO sector, we find a lot of spending in travel, a lot of spending in workshops, a lot of spending in recruiting the wrong skills. All of that leads to inefficiency and waste of resources.

JEREMY MAGGS: Well, a R4 billion funding gap is immense. Healthcare systems advisor and CEO of the EndlessLife Group, Zohakiy Mbi-Njifor, thank you very much for joining me.

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