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 Saturday 07 February 2009
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CENTRAL AFRICAN REPUBLIC: Finally making the AIDS money work

Photo: UNICEF/CAR/2008/Holtz
"Sick people were going to the centres and being turned away"
BANGUI, 5 February 2009 (PlusNews) - After years of delays, HIV/AIDS funding in the Central African Republic is finally making its way to thousands of HIV-positive people in desperate need of care and treatment.

Hope and excitement were in the air in 2003, and again in 2004, when the Global Fund to Fight AIDS, Tuberculosis and Malaria allocated two grants, totalling US$40 million over five years, to combat HIV/AIDS in the Central African Republic (CAR), where an estimated prevalence of 6.3 percent makes it the hardest hit country in central Africa.

But people soon lost hope. The United Nations Development Programme (UNDP), chosen by the Global Fund as the principal recipient of funds in CAR, faced huge obstacles implementing programmes in a country left with weakened infrastructure after years of devastating conflict.

Conditions in the country caused major delays, acknowledged Abdoulaye Bagnou, coordinator of the Global Fund grant implementation unit at UNDP. "There were real gaps; we must be honest and recognise this," he told IRIN/PlusNews.

"We had to rely on a health system that was really lacking. The health information system did not work, so we didn't have any information about the number of sick people or what stocks were available," Bagnou said.

"There were national guidelines for treatment, but doctors did not know [about them] and prescribed whatever they wanted. It was like trying to do a [world champion racing driver Michael] Schumacher with a broken car - we had to keep moving whilst trying to repair the car."

Recognising the difficulties

The national committee to combat HIV/AIDS, CNLS, believes there should have been more consultation. "For a long time, the UNDP was working alone without consultation with others and ignored the role of the CCM [the Country Coordinating Mechanism for Global Fund grants in a country]," said Yachinthe Wodobode, the national coordinator at CNLS.

''It was like trying to do a [Michael] Schumacher with a broken car - we had to keep moving while trying to repair the car''
"They did not take into account what the Ministry of Health considered were national requirements," she told IRIN/PlusNews.

The consequences for HIV-positive people have been disastrous. "We had breaks in treatments, including paediatric treatments, and medication had to be destroyed, as it went out of date," recalled Christian Miangué, president of the national Central African network of people living with HIV, RECAPEV.

"Sick people were going to the centres and being turned away, as they didn't have the right kind of drugs; they were told to go and buy them themselves."

A clearer future ?

The Global Fund management unit at UNDP recognised all these failures, but said they had been rectified over the last few months. "We have used US$17 million in nine months, meaning that by building capacity we can get results," said Bagnou.

The previously weak CCM has been reorganised and strengthened; staff were trained in 2008, thanks to technical and financial support from the American government.

These improvements made it possible for the Geneva-based Global Fund to decide in November 2008 to make CNLS the principal recipient of a new HIV/AIDS grant of nearly US$44 million over five years.

The Common Humanitarian Fund (CHF), an emergency fund implemented in 2007 by the United Nations, has also enabled other aid organisations and NGOs to come to CAR by helping them overcome other obstacles, such as convincing sponsors to fund the logistical costs of their work, mainly transport, which are very high in CAR as a result of the ruined infrastructure isolating many communities.

This funding has meant that the implementation of HIV/AIDS projects could begin in various parts of the country. "In the north there is the highest prevalence rate, yet there are the fewest number of services: in this way, AIDS can be seen as an emergency issue," said Nicolas Rost, who manages the CHF fund for the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) in CAR.

A few years ago, "the country was just coming out a period of conflict and they weren't ready, but things have changed now," Wodobode commented.

"The Global Fund were worried that the authorities or managers were helping themselves [to the money], but it is just an issue of monitoring and evaluation. If a good system is in place, then this will not be an issue."


Theme(s): (PLUSNEWS) HIV/AIDS (PlusNews)


[This report does not necessarily reflect the views of the United Nations]
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