Mozambique is set to receive million of dollars in aid this year to fund its new HIV/AIDS strategy. Non-governmental players could ensure the money reaches villages and other needy areas.
Millions of dollars in aid are expected to be pumped into Mozambique's new national AIDS strategy this year – a move which may mark a turning point in Mozambique's battle against HIV/AIDS.
The strategy's success depends on how much of the funds are disbursed in the neediest areas, a challenging proposition in a country with limited infrastructure, warn some experts. But donors are confident: they praise the government for its transparent use of aid money in the past and its determination to tackle the epidemic.
In 2001 almost 68,000 people died of AIDS in Mozambique, and 500 became infected every day. UNAIDS, the United Nations body fighting the global pandemic, says unless things change quickly HIV/AIDS will reduce life expectancy from 50 to 36 years by 2010.
After years of colonial rule, civil war, floods and famine, Mozambique is now one of the world's poorest countries with one of the highest HIV infection rates – 13.6 per cent of 15-49 year olds are HIV positive. One of Africa's few fast-growing economies, with an average annual growth rate of 6.4 per cent a year, this epidemic is something Mozambique can ill afford.
Under its new coordinated approach, all the money for HIV/AIDS programmes will be pooled into a common fund, set up in January 2004. Many welcome the new strategy – in the past donors gave money to different ministries and non-governmental organisations on a piecemeal basis, and each donor demanded a separate report on how the funds were spent.
HIV/AIDS prevention and treatment programmes are still almost entirely run by NGOs in co-operation with the ministry of health. Some areas of greatest need, like Beira, Mozambique's second city with an infection rate of 26.5 per cent, were often left out as many NGOs chose to work in those places where they were already active.
Beira has always suffered setbacks, but the HIV/AIDS epidemic is the worst. During the 16-year civil war between the ruling FRELIMO government and the opposition RENAMO which ended in October 1992, residents went without electricity for months on end, and chronic water and sanitation problems have still to be resolved.
Beira's residents are vulnerable to diarrhoea and cholera outbreaks – especially dangerous for people living with HIV/AIDS. Beira port has also suffered lost business after the virtual collapse of neighbouring Zimbabwe's economy. As people become poorer, many young girls have turned to sex work, which further increases the spread of HIV.
Twentyseven-year-old Tiago Franca, a hotel receptionist in Beira, commented just before the local elections in November 2003 – in which RENAMO gained control of Beira municipality – that "political power is centralised in [the capital] Maputo. Beira is left behind. We need more business, the city has a water problem, unemployment is high, we have a lot of layabouts and our women are going into prostitution openly now."
It has been difficult to find the money and staff to run AIDS programmes in Beira. One aid worker in Maputo, who did not want to be named, said: "There is more money in Maputo. Lots of people (aid workers) want to stay in Maputo. It is hard to get people to go up to Beira."
Experts hope the new five-year AIDS strategy, written by the government in consultation with NGOs and donors, will change that. Not only does it cover all sectors, including health, education and business, it also plans to fund all provinces equally.
As a result some large contracts have just been approved – the Clinton Foundation is giving $350 million over five years for treatment and support to the whole health sector. And in March the Geneva-based Global Fund on AIDS, Tuberculosis and Malaria is expected to approve an amount of $109 million – to be spent over two years on prevention, support for affected families and treatment.
Both the Global Fund and the Clinton Foundation are part of a huge international push to raise funds for AIDS programmes in developing countries. Last year's $4.7 billion was a 20 per cent increase over 2002, but UNAIDS says at least twice that amount will be needed in 2005.
When the money arrives, Mozambique will face a double challenge: the government lacks the infrastructure and staff to administer the funds, and right now only 40 per cent of Mozambique's 19 million people have access to any kind of health care.
"One of the biggest challenges is whether they have the capacity for all this and to manage it in a transparent way, having recently come out of 16 years of civil war," says Aida Girma, country co-ordinator for UNAIDS.
Even basic financial information is not yet widely available. "Many are struggling to monitor the aid flows – even the National AIDS Council, set up in 2000 to oversee the strategy, is still trying to get this information [on aid flows] from donors," says Girma.
While funds for the health service will be disbursed by the health ministry, those for NGOs working on other areas will be disbursed by provincial and national committees made up of government officials and NGOs.
Alfiado Zunguza, executive director of Justa Paz, a national NGO which will sit on some of the provincial committees, is happy with the set-up, saying: "It is a way of making the government accountable at the provincial level – community based organisations will know how much money there is at the provincial level and who used the money. In six months' time we will see if what's been on paper is being implemented. If there are problems, these will come up in the national and provincial committees."
But this part of the strategy has ignored rural NGOs and Zunguza says this means infection rates are set to rise in villages, where 77 per cent of the population lives.
The majority of small, village-based NGOs cannot afford to send staff to present their views to the city-based provincial committees, and they will find it difficult to receive funding under the new system – they lack the capacity to design proposals and provide the necessary financial reports. "A lot of people in rural areas are dying and they don't know exactly what killed them. So the infection rate will grow because they lack information about how it's spread and how to prevent it," says Zunguza.
There are no official figures for rural infection rates. Zunguza says "because villagers go to traditional doctors who use unsterilised instruments, we think the spread is very high."
"There are times when it seems overwhelming and the speed – or lack of it – is cause for pessimism," says David Melody of the NGO Médecins Sans Frontières in Mozambique. "But in 2001 the big issue was funding. Then came the Global Fund and the Clinton Foundation with the promise of many millions – a scenario hardly dreamt of two years ago."
Ruth Ayisi is a freelance journalist based in Mozambique. Alex Whiting is a British journalist working for Panos Features.