THE HISTORICAL CONTEXT OF HIV AND AIDS IN ZIMBABWE
2.4. Overview of the State’s Responses to HIV and AIDS in Zimbabwe
2.4.2. The State’s Funding of HIV and AIDS Interventions
The capacity of the Government of Zimbabwe to make resources available for HIV prevention and AIDS mitigation programmes was affected by economic downturn that hit the nation from the mid-1980s through to the 1990s and peaked in the years 2000-2007. For example, the gross national income per capita in Zimbabwe dropped from US$10, 523 in 1985 to US$395 in 2000.334 Poverty among ordinary citizens escalated and was exacerbated by rapid unemployment. Van Donk observed: ―By the end of 2002, an estimated three out of four (74%) people were expected to live on less than US$2 a day. Unemployment has also increased phenomenally over the years from 18% in 1982 to 60% by 1999.‖335 Meanwhile, the Government of Zimbabwe‘s foreign bred economic reforms launched in 1991 had negative effects on the State‘s funding of the public sector and led to cuts in healthcare service provision. A report issued by Irish Aid made the observation that the new economic policy led to:
…the introduction of cost recovery measures, which meant that hospitals were expected to charge market related tariffs for their services to all people. The cumulative impact of the resulting neglect of non-productive sectors such as health, was a serious decline in the quality of health services and shortages of essential drugs.336
The poor, including PLHIV were left with limited options and thus resorted to using church healthcare centres whose rates were generally affordable.337 The churches could also access essential drugs through external funding and contacts.
After the controversial economic reform policies of the 1990s, worse was yet to come.
The Government‘s land invasions from 1999 and the rise in political intolerance gave
333 NAC, Zimbabwe national behavioural change strategy, 9, 13.
334 Van Donk, ―Development planning and HIV/AIDS in sub-Saharan Africa,‖ 132-133.
335 Van Donk, ―Development planning and HIV/AIDS in sub-Saharan Africa,‖ 133.
336 Irish Aid, Looking back, mapping forwards, 30. See also Van Donk, ―Development planning and HIV/AIDS in sub-Saharan Africa,‖ 138.
337 V. Chitimbire, same interview.
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way to ―economic contraction, disintegrating public services, runaway inflation, and widespread public discontent.‖338 Furthermore, the redistribution of land by the State might have been of benefit to some local emerging black farmers but the initiative appears to have yielded more economic challenges than benefits.339 The withdrawal of international donors from the provision of financial support towards public infrastructure including healthcare services exposed PLHIV to untold hardships and misery. As Stephen O‘Brien observed:
As the post 1999 political and economic crisis progressively unravelled, the international donors withdrew funding or channelled development assistance through means other than the State.
…Certainly, overall AIDS funding to Zimbabwe decreased.340
Without foreign donor support, HIV and AIDS interventions under the State in Zimbabwe became quite minimal. As O‘Brien has shown, external support including the Global Fund remained the largest funding source for AIDS-related programmes.
In 2005, AIDS funding indicated that US$103,052,437 was obtained from external sources in comparison to US10 million raised from the local AIDS levy.341
While the Government committed itself to play a leading role in mobilisation of resources,342 the socio-political climate in Zimbabwe in the period 2000-2007 had negative consequences for HIV and AIDS interventions. The State had very limited options and therefore was forced to establish a local fund known as the National AIDS Trust Fund (NATF) in 1999. This AIDS levy was to be:
…the first of its kind in the region, a unique strategy under which all employed persons in Zimbabwe are levied an additional 3% tax on their taxable income. The fund was meant to finance the operations of the National AIDS Council and key HIV and AIDS interventions.343
338 M. Bratton and E. Masunungure, ―The anatomy of political predation: Leaders, elites and coalitions in Zimbabwe, 1980-2010,‖ iv. Research paper number 9 for the Developmental Leadership Programme (January 2011).
339 Rodriguez, ―AIDS in Zimbabwe,‖ 10.
340 O‘Brien, ―The prevalence and politics of HIV/AIDS in Zimbabwe,‖ 8.
341 O‘Brien, ―The prevalence and politics of HIV/AIDS in Zimbabwe,‖ 8.
342 O‘Brien, ―The prevalence and politics of HIV/AIDS in Zimbabwe,‖ 8.
343 N. Madzingira, ―The Zimbabwe National AIDS Levy Trust (The AIDS levy),‖ SADC HIV and AIDS best practice series (March 2008), 11,
<http://www.safaids.net/filesSADC_BestPracticeZimbabwe/> [Accessed 7 May 2012].
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Funds from the AIDS levy were prioritised for: (a) Purchase of ARVs by the National AIDS Council‘s and financially support the HIV and AIDS activities carried out by Zimbabwe National Family Planning and the MOHCW, (b) direct funding of the Basic Education Assistance Module (BEAM) for payment of school fees, (c) funding of projects proposals submitted by army, prison services, the churches, and (d) procurement and distribution of AIDS-related care materials.344 In sum, the AIDS levy in Zimbabwe aimed at providing holistic funding for HIV and AIDS interventions at national, provincial, district and ward levels in areas that included
―prevention, mitigation, care, treatment, capacity building, co-ordination and research.‖345
Revenue from the AIDS levy could not sustain national HIV and AIDS interventions because of mismanagement and this affected its capacity to assist people infected and affected by HIV. Consistent with this observation, van Donk stated that there were general complaints that the AIDS levy in Zimbabwe encountered administrative challenges. The fund‘s problems could have been exacerbated by the public‘s ―limited knowledge of the existence of such funds to the extent that most vulnerable groups remained unassisted.‖346 While the intention of the fund appeared to be quite noble, the failure by National AIDS Council to cope with overwhelming demands amid economic decline became apparent. The State was aware of this and thus had to admit:
Nonetheless, the ultimate sustainability of the levy is determined by the overall state of the economic environment. Hyperinflation and a significant increase in unemployment levels inevitably reduce the income obtained from such a levy.347
Given this situation, in which the AIDS levy could only assist limited numbers of people in need, churches were faced with the reality of responding to the needs of PLHIV and OVC. The failure by the State to adequately meet its obligations to the
344 Prisma, ICCO and Woord Daad, A survey on HIV/AIDS in Zimbabwe, (September 2007), 12.
345 Madzingira, ―The Zimbabwe Ntional AIDS Levy Trust,‖ 17.
346 Van Donk, ―Development planning and HIV/AIDS in sub-Saharan Africa,‖ 141. See also, Kaseke and Dhemba, ―Zimbabwe country report,‖ 12.
347 Madzingira, ―The Zimbabwe National AIDS Levy Trust,‖ 31.
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Zimbabwean citizenry left the churches with few options and that included outsourcing of resources to fend for HIV interventions.
Between 2000 and 2007, the socio-economic and political history of Zimbabwe had an effect on people infected and affected by HIV and AIDS. The attention of the Government shifted from social responsibility for the majority of the poor citizens to other non-essential priority areas. For example, Tabona Shoko of the University of Zimbabwe observes that from 1999 onwards the politics of land in Zimbabwe ignored the plight of those infected by HIV and AIDS and therefore exacerbated the problem.348 The trend was common with historical responses to infectious diseases as noted by Myron Echenberg who stated: ―Historical responses to infectious diseases have followed a general pattern characterised by denial, blaming the victim, arbitrary use of State power, and criticism of allegedly negligent official authorities.‖349 Generally speaking, in Zimbabwe the State‘s funding of the public health sector including HIV and AIDS interventions was far from being adequate. The study will observe that non-governmental players including the churches carried out HIV and AIDS interventions in communities reeling under poverty and therefore the churches filled in an important gap.
In 1996 the Government of Zimbabwe required all NGOs to register under the Private Voluntary Organisations Act.350 This was repealed by the NGO Act passed into law in December 2004.351 The NGO Act stipulated that all organisations involved in community development, charity, relief, human rights, gender awareness and environmental protection register with the NGO board. At least one representative from NGOs working in the field of HIV and AIDS was appointed to the twenty-six- member board largely dominated by the State.352 Following the passing of the NGO Act into law, the number of home-based care programmes operated by NGOs
348 T. Shoko, ―Religion, land and HIV/AIDS,‖ Unpublished paper, University of Zimbabwe, (2007), 10. 349 M. Echenberg, ―Historical perspectives on lessons from South Africa and Senegal,‖ in Denis and Becker, The HIV/AIDS epidemic in sub-Saharan Africa, 90.
350 Kaseke and Dhemba, ―Zimbabwe country report,‖ 30.
351 Zimbabwe Government, The Non-Governmental Organisation Act of Zimbabwe, (December 2004).
The document was downloaded as pdf. See also Amnesty International, Zimbabwe: NGO Act is an outrageous attack on human rights, (December 2004), downloaded as pdf.
352 Zimbabwe Government, The Non-Governmental Organisation Act, 4, 5.
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including churches dropped drastically from 500 in 2001 to only 120 in 2007.353 The underlying motivation of the NGO Act was understood as being to curtail the influence of NGOs on Zimbabwean politics:
The Act also gives the Government sweeping powers to interfere with the operations of any NGO in Zimbabwe. …Under the Act, the Zimbabwean NGOs were prohibited from receiving any foreign funding to engage in human rights work.354
The NGO Act made it compulsory for churches to declare having received foreign donor funding and later this was actually done through the State‘s central bank. The State also closely monitored HIV and AIDS interventions under NGOs including those that were operated by churches. While the State did not appear to have adequate financial resources, the churches used external links to outsource resources. With this, the churches had to complement and almost replace the State‘s healthcare system. The case of the Government‘s inability to launch and sustain home-based care interventions early as discussed in section 2.5 that follows immediately below is a relevant illustration. While this was the case, the churches appeared to be willing to assist communities infected and affected by HIV and AIDS.