Hundreds of Kenyan AIDS activists held a protest on 18 May in the capital, Nairobi to demand that the government meet its commitment to increase annual health and HIV funding.
"The Minister of Finance promised an annual budgetary allocation increase of 10 percent to health and HIV - we demand that this promise be kept," Davis Njuguna, an AIDS activist with the National Empowerment of People living with HIV/AIDS in Kenya (NEPHAK), told IRIN/PlusNews during the rally. "We cannot pledge to end AIDS without increasing funding to it. Access to HIV treatment is a right and we are not accepting lip service any more."
Marching along Nairobi's busy Thika Road, protesters waved posters urging Finance Minister Uhuru Kenyatta and US President Barack Obama - who pledged during his presidential campaign to provide US$50 billion to fight HIV globally by 2013 - to keep their promises. Other placards read, "You Talk, You Talk, We Die!" and "Broken Promises Kill!"
Demonstrators cited recent groundbreaking research showing that antiretroviral (ARV) treatment drastically reduced HIV transmission among discordant couples as justification for more funding for the pandemic. An estimated 44 percent of new infections in Kenya occur among married or cohabiting couples.
"It is not enough to say putting people on treatment reduces their chances of infecting others, yet you are not providing the money to offer people the treatment," said Emily Onyango, a 31-year-old living with HIV, who participated in the protest. "People will not come forward to accept they have HIV when they know that a number of others who have the disease are dying because they can't access treatment."
Two consecutive rejections by the Global Fund to fight AIDS, Tuberculosis and Malaria, flat-lined funding from the US President's Emergency Plan for AIDS Relief and an end to funding for paediatric ARVs from the Clinton HIV/AIDS Initiative have significantly dented Kenya's ability to fund its AIDS fight.
The country has put more than 400,000 people on ARVs, but another 600,000 need the drugs and have no access to them; an estimated 1.5 million Kenyans are infected with HIV.
In 2010, the national budget set aside an unprecedented 900 million Kenya shillings - about $10.5 million - for the purchase of ARVs, and the activists said the government's most recent application for $340 million for HIV from the Global Fund had been successful. However, this will still not cover Kenya's funding gap for HIV, which is estimated at $1.67 billion up to 2013.
Civil society organizations are calling on the government to find ways to reduce the over-reliance on donors and ensure sustainable funding for HIV programmes. In 2010, the National AIDS Control Council (NACC) developed a raft of proposals for consideration by the Ministry of Finance which, if adopted, could go some way to offset the funding gap; however, few of these have been acted on.
|Access to HIV treatment is a right and we are not accepting lip service anymore|
Among the ideas proposed was implementing international funding mechanism UNITAID's air ticket funding scheme, whereby a small levy on airline tickets and cargo goes towards HIV programmes, and enforcing a 2 percent tax on mobile-phone airtime. More recently, a taskforce formed by NACC suggested the government could collect millions in unclaimed assets lying in various financial and social welfare institutions and use them to pay for HIV treatment.
Government officials say it has not yet formed the partnerships required to implement these ideas.
"We have as a government received very smart ideas from different stakeholders on how we can fund our HIV and AIDS programmes, but we can't rush to implement them because we need discussions on them from other players," Peter Anyang' Nyong'o, Minister of Medical Services, told IRIN/PlusNews. "If you say, for instance, that imposing some tax on air tickets is one of the ways, we need to discuss this with airlines because that might translate into them increasing their airfares.
"We have made proposals to the Ministry of Finance to increase funding - not just for HIV - but also to other health programmes, [for instance] increased contributions to the National Hospital Insurance Fund," he added. "We can't keep talking yet our people are dying, so let's push on with what needs only government approval."
Photo: Nic McPhee/Flickr
|Kenya faces a funding shortfall of US$1.67 billion up to 2013|
According to Eugene Wandere, an economics lecturer at the University of Nairobi, the government must work harder to involve the private sector in public health programmes. "For instance, if you say you are going to increase tax on a particular commodity to fund HIV, then you must involve the producer on how you will cushion their profits and what benefits they stand to gain," he said. "But the government appears to be engaging in lone-ranger tactics and they hit a brick wall every time they make a move."
Wandere further noted that funding gaps could also be addressed by prioritizing HIV funding so that funds were redistributed to the areas that needed them most.
Ultimately, however, the responsibility of funding health and HIV lies with the government, says Catherine Mumma, a local human rights lawyer.
"The government has the ability to, and it must, increase its funding to healthcare while these other ways of getting funds are looked into," she said. "Only sustained increases in government funding to cover healthcare programmes remain most sustainable."