Interview by Phyllis Kachere | The Herald
The National AIDS Council has been accused of abusing the AIDS levy by spending more of the collected revenue on administration instead of drug procurement. For clear answers on these and other questions, Deputy News Editor Phyllis Kachere spoke to the council’s chief executive, Dr. Tapuwa Magure.
Phyllis Kachere : Dr. Magure, may you please explain what the National AIDS Council is all about and what its mandate is?
Dr. Tapuwa Magure: National AIDS Council is a parastatal established under the Ministry of Health and Child Welfare through an Act of Parliament (the National Aids Council Act Chapter 15:14 of 2000). Its mandate is to co-ordinate HIV and AIDS programmes in Zimbabwe as well as administer the National AIDS Trust Fund.
Phyllis Kachere: I have gone through your website. Some of your core values are transparency and accountability. What are you doing to ensure that your organisation realises these values?
Dr. Tapuwa Magure: These values were set on the basis that NAC was established to serve the public and that it receives and administers public funds. In order to ensure that NAC remains accountable and transparent we have put many measures in place.
The co-ordination of HIV and AIDS programmes through a multi-sectoral approach where stakeholders across the divide come together to plan, implement, monitor and evaluate HIV and AIDS programmes. This is done through our co-ordination structures and mechanism which goes down to the grass-roots level.
NAC financial accounts are audited every year by internal and external auditors and the results are made public through publishing them in the print and electronic media. We also put them on our website www.nac.org.zw. The results are also disseminated to key stakeholders.
NAC is governed by a multi-sectoral board. This board constitutes of representatives of People Living with HIV, workers, Government ministries, faith-based organisations, arts, youths, etc. These people ensure that the needs of the constituencies they represent are met.
Phyllis Kachere: Since NAC’s establishment, what have been your major successes?
Dr. Tapuwa Magure: We have scored a lot of success. I will touch on the major successes which have brought change to the public we are serving. These successes have been recorded in the areas of policy, funding, HIV prevention, treatment and management.
In the area of policy, the establishment of NAC through an Act of Parliament has enabled the organisation to be the sole co-ordinator of HIV and AIDS in the country. This has enabled the national response to HIV to be guided and focused. This has been achieved through the 3 ONES principle where we have one co-ordinating authority, which is NAC, as it has been mandated to do so by the NAC Act, one strategic framework, which we develop through a multi-sectoral and evidence based approach to guide HIV and AIDS interventions.
This strategic framework is produced in the form of five-year periodic plans (Zimbabwe National HIV and AIDS Strategic Plan) and one monitoring and evaluation framework. This is one standardised tool which we have developed to monitor and evaluate our efforts so that we remain focused and guided.
We have undoubtedly done very well in the area of mobilising resources to fund the HIV and AIDS interventions in the country. We have also done well in the area of domestically funding the national response to HIV and AIDS.
Our AIDS levy collections continue to rise year by year. In 2009 when the economy was dollarised we collected US$5,7 million, the following year the figure rose to US$20,5 million, US$26,4 million in 2011 and US$32,5 million last year. We have, however, managed to instil donor confidence in our work. We have managed to attract external funding over the years and this external funding continue to come on the basis that we are co-ordinating and managing the national response well.
The guided and funded HIV and AIDS response has directly resulted in successes being recorded in the area of service delivery to the public. We have managed to bring down HIV prevalence from as high as 27 percent in late 90s to 15 percent in 2011.
Apart from the fall of prevalence rate we have managed to put more people on treatment. As the funding is improving more people are also being put on ART. The AIDS levy used to support around 20 percent of people on ART, the support has risen to around 40 percent.
In order to create an enabling environment and promote ART uptake we have gone a step further to equip our laboratories in central, provincial and district hospitals as well as clinics with the necessary equipment such as CD4 count machines, chemistry analysers, haematology machines and viral load machines and related reagents. This support has not only been confined to public health institutions, we have extended the same to the health institutions in the uniformed forces and National Blood Transfusion Services which has received blood test kits.
Phyllis Kachere: Late last year PLWHIV demonstrated against you citing shortage of ARVs, maladministration and lack of transparency in the administration of the AIDS levy. So who benefited from all these successes?
Dr. Tapuwa Magure: It is true that the people did demonstrate. They handed over a petition to NAC outlining their grievances. The grievances included shortage of drugs, user fees and lack of transparency in the administering of AIDS levy. As I have said earlier NAC contributes a certain percentage towards the procurement of ARVs and other partners such as Global Fund and USAID also contribute.
There was a delay in disbursement of funding from Global Fund and this resulted in the drug stock levels going down, not running out. It resulted in people being given one to two months drug supply instead of the three months drug supply they were used to. As we speak, the situation has returned to normal. The issue of user fees is really an issue affecting ART adherence. People are being charged user fees to cater for administration costs of clinics and hospital, our mandate does not, however, allow us to determine user fees of clinics or health service institutions. As NAC we will lobby with necessary Government departments to ensure that PLWHIV access treatment and care services.
On lack of transparency being put on the petition I think that is purely due to limited understanding on how NAC functions. As highlighted earlier the NAC board has multi-sectoral representation and that NAC accounts are audited every year and the audited financial accounts are made public.
Phyllis Kachere: As an organisation what did you do to ensure that such demonstrations do not happen in future?
Dr. Tapuwa Magure: We gave the petition the attention it deserves. We increased the level of involvement of People Living with HIV in the implementation, monitoring and evaluation of HIV and AIDS interventions. Through our MIPA unit we have established a Community Monitoring Team which goes out in the community to monitor and really see if people are accessing HIV-related health services in the public health institutions. This team is constituted by PLWHIV. From last year the team visited at least four provinces. We use their independent findings to review and strengthen our systems.
Phyllis Kachere: How is the AIDS levy collected?
Dr. Tapuwa Magure: In accordance to the provision of Section 14 subsection 14 and 15 of the Finance Act, Chapter 23:04, the AIDS levy is charged on individuals, companies and trusts at a rate of 3 percent of the amount of income tax assessed. In case of individuals, the tax is levied on the income tax assessed after deducting any credits accruing to the individual pay as you earn tax.
Phyllis Kachere: How then is it administered?
Dr. Tapuwa Magure: The allocation of funds from the AIDS levy to different programme areas is done through the NAC board guided annual work plan and budget which is approved by the Minister of Health and Child Welfare. Of the total funds collected, 55 percent goes towards the Antiretroviral Therapy Programme, 10 percent prevention, 6 percent M&E and co-ordination, enabling environment takes 4 percent, programme logistics support and assets accounts 23 percent and 4 percent respectively.
Phyllis Kachere: How about those people who are in the informal sector, how is it collected?
Dr. Tapuwa Magure: We are not collecting AIDS levy from the people in the informal sector as there are no mechanisms in place to collect from them. We have, however, proposals on the table on how best we can have them contributing to the Aids levy. It is my hope that if everyone contributes, domestic funding will be able to sustain the national response to HIV.
Phyllis Kachere: Apart from the informal sector is it true that mining companies have been exempted from paying the tax?
Dr. Tapuwa Magure: It’s true but we are engaging the relevant authorities so that these companies can contribute towards the levy. With the discovery of a lot of minerals in Zimbabwe and the increase in the number of mining firms their contribution will make a difference. More people will be put on ART and equipment for health institutions will be purchased.
Phyllis Kachere: There has been a suggestion of having one funding mechanism in Zimbabwe, how viable is this suggestion?
Dr. Tapuwa Magure: Yes, there is really need to have one funding mechanism in Zimbabwe in addition to the three highlighted before. This will go a long way in improving the HIV and AIDS funding situation in Zimbabwe. Firstly, from an economic point of view we will be able to benefit from economies of scale principles. If we are buying ARVs from one funding basket we will be able to purchase more and put more people on ARVs. One funding source will make it possible to account for all HIV and AIDS funding coming into the country.
Phyllis Kachere: All these are policy issues, to what extent are you involving the lawmakers?
Dr. Tapuwa Magure: We have been engaging the lawmakers formally and informally. We have presented these issues to the Parliamentary Portfolio Committee on Health and the thematic committee on HIV and AIDS. We also routinely conduct HIV and AIDS capacity building workshops for the parliamentarians. We will continue to use various avenues to see to it that these issues are addressed.
Phyllis Kachere: This discussion has brought to light some of your achievements and challenges. Are there any other challenges affecting the national response to HIV and AIDSand what are you doing about it?
Dr. Tapuwa Magure: Although NAC was established through an Act of Parliament and mandated to co-ordinate HIV and AIDS programmes in Zimbabwe as well as administer the National AIDS Trust Fund, this Act does not give enough powers to duly exercise its mandate. We are again in the process of reviewing the Act although it might take long. Funding still remains a major challenge. Our vision is “No HIV transmission, universal access to HIV and AIDS services”. In order to realise this, we need more funding internally and externally to ensure that prevention, treatment and care service are accessible to all.
Phyllis Kachere: How are human rights issues being addressed in the implementation of the HIV and AIDS programme?
Dr. Tapuwa Magure: We strongly uphold all human rights in the implementation of HIV and AIDS services. Zimbabwe is party to and has ratified the Universal Declaration on Human Rights, the 2001 UNGASS Declaration on HIV and AIDS, the 2001 Abuja Declaration on HIV and the 2006 Political Declaration on HIV and AIDS which are key legal instruments that address issues on HIV and AIDS and human rights.
These rights are to do with principles of confidentiality, the right to information, stigma and discrimination, accessibility and affordability. HIV and AIDS services are being offered to people non-discriminatory to ensure that we realize our vision of zero HIV new infections, zero HIV related deaths and zero HIV-related deaths. We are working with organisations such as Zimbabwe Lawyers for Human Rights on these issues.
Phyllis Kachere: Lastly, Zimbabwe has been hailed regionally and internationally for its good work in the national response to HIV/AIDS. How has Zimbabwe benefited from this?
Dr. Tapuwa Magure: Zimbabwe’s good work has benefited Zimbabwe, regional and international countries. Locally, we have managed to attract funding for various programmes. For example, the last World AIDS Conference held in Washington, USA, saw Zimbabwe receiving a lot of support towards male circumcision.
Regionally and internationally, countries have come to learn of how we are managing the response. The AIDS levy has been documented as the best practice worldwide.
Countries such as Zambia, Botswana have come to Zimbabwe for a look and learn tour. This month we had the Ugandan delegation led by the parliamentary chairperson on health coming to Zimbabwe to look and learn on how we have managed to come with domestic funding of HIV and AIDS and how we were managing it.