Government in Global AIDS Fund grant dispute

The South African government is allegedly trying to block a grant awarded by the Global Fund to fight AIDS, Tuberculosis and Malaria to the KwaZulu-Natal province, saying that the province should not have approached the fund directly. With a 36 percent HIV prevalence rate, KwaZulu-Natal is South Africa's worst affected province, but government is reported to have said it was unfair for the province to have secured so much when other provinces lack the capacity to submit bids. South African weekly magazine, the Financial Mail, reported that Health Minister Manto Tshabalala Msimang is now asking that the grant be routed through national government structures. The Global Fund in April approved a US $72 million grant to the province, which would allow for a range of care-oriented services for people living with HIV/AIDS. But the award was highly unusual, as the Fund's guidelines say that priority would be given to country coordinating mechanisms (CCM), designated by national governments. South Africa received US $165.2 million from the Fund, the largest allocation for any country. Of this, US $93 million will go to the CCM, the South African National AIDS Council (SANAC). "KwaZulu-Natal went directly to the Global Fund because a CCM had not been constituted at the time, that's where this problem arose," the province's bid leader, Prof Umesh Lalloo, told PlusNews. The designation of SANAC as the CCM happened at the last minute, and by this time, the province's bid had been submitted. "We would have liked to have used a national mechanism, but we were pressed for time," he added. At the time, the government was embroiled in a controversy over the provision of nevirapine to all HIV positive pregnant women and there was uncertainty over whether they would apply for resources from the Fund. The province was anxious to access the grant but was still in a "delicate stage" of discussions with the government and was reluctant to undermine any progress made, Lalloo said. The government had a legitimate view, which needed to be taken into account and press reports attacking the government would hinder these negotiations, he warned. "We respect their position and we want them to be involved in implementing this grant because we cannot tackle this epidemic in isolation," Lalloo said. The government is yet to respond. Department of Health spokeswoman, Joanne Collinge, said: "The [health] minister will be issuing a statement on this matter, as soon as possible." The dispute over the provincial grant was "the first big political test for the Global Fund" as representatives to the Fund were divided over whether proposals should be required to obtain the endorsement of national governments, Dr Mazuwa Banda, the Global Fund's coordinator for Africa, told the Boston Globe newspaper. At the time the grants were awarded, the Global Fund board said the KwaZulu-Natal proposal was the most innovative they had seen. The Nelson R Mandela School of Medicine's Enhancing Care Initiative and HIV/AIDS Public Health Programme, a collaboration between the medical school and the provincial Department of Health, facilitated the application. The success of the province's proposal has been attributed to the many public-private partnerships that were put forward. Lalloo said: "Apart from the university, we had the Durban Chamber of Commerce, NGOs like the South Coast highway hospice, NAPWA [National Association of People living with HIV/AIDS], legal networks, various religious organisations as well as the provincial department of health."