Ensure targets in malaria, HIV and TB fight are met

It is just under three months to the end of 2020, when global targets in the fight against HIV and tuberculosis (TB) — the three 90s and reducing TB-related deaths, including among people living with HIV, by 75 per cent — are due. But recent data indicates that responses in many countries, Kenya included, are veering off the track, which risks reversing the lifesaving gains so far.

In 2018, funding for HIV programmes plummeted by $1 billion (Sh1 trillion) in low and middle-income countries while for TB ballooned to $3.5 billion annually. In 2017-2018, donor funding for HIV and TB fell by nine and 12 per cent, respectively.

Although the domestic funding for HIV has increased gradually over the past decade, the combined resources for countries like Kenya has woefully lagged. The annual global investment of $26 billion required to meet the 2030 HIV target reached just $19 billion in 2018. While the spending in TB programmes was estimated at $10.4 billion in 2018, just $6.9 billion was expended.

The Global Fund aims to mobilise at least $14 billion of the $101 billion needed to supported HIV, TB and malaria programmes in 2021-23. An additional $46 billion from domestic funds and $23 billion from other external funders is expected to only cover 82 per cent of the needs, leaving a deficit of $10 billion for TB, $4.4 billion for HIV and $3.4 billion for malaria. That could, however, be complemented by a contribution from domestic funds.

Dwindling donor funding

The dwindling donor funding has prompted calls for an increase in domestic funding against these diseases. But that may not be achievable soon. Kenya is unlikely to replace even 10 per cent of the Global Fund’s HIV/Aids care and treatment funding.

Besides funding, stumbling blocks in public health response include legal and cultural barriers and restrictive policies. Most disease programmes compete with national goals of revamping the health system and achieving universal health coverage (UHC). These, the Global Fund warns, may lead to a rebound in HIV, TB and malaria cases and deaths.

There is a need to scale up responses based on a realistic assessment of epidemiological status, availability of funding and communities’ needs, including acknowledgment of the gaps and funding shifts, along with the urgent need for measures to correct them. Investments in reducing transmission, illness and deaths should be prioritised.

The national and county governments must establish the fiscal capacities to reverse the decline in domestic funding, continuously engage in comprehensive HIV and TB services and re-engineer the terms of engagement with global partners.  Importantly, within UHC, financial protection for patients, equitable access to patient-centred and community-oriented services, like those for people living with HIV and/or TB, should be imperative.

Mr Onyango is a Global Impact Fellow at Moving Worlds Institute (MWI). [email protected].