In the next few weeks, Kenya will be signing a $345 million grant agreement with the Global Fund to Fight Aids, Tuberculosis and Malaria. This grant will fund various HIV/Aids interventions, and is the first successful grant application to Global Fund since 2008. (SEE: Grant to boost lucrative drug market)

The success of this application has been attributed to Kenya completing a national Aids strategic plan in 2009 that detailed the country’s needs and plans for the next few years. Another factor was the collaboration of various governmental and non-governmental actors in the proposal process.

Given that Kenya faces significant near-future shortages of antiretroviral drugs, the grant could not have been more timely.

HIV/Aids continue to cause pain and suffering throughout the country. The 2007 Kenya Aids indicator survey showed that 132,000 adults and 34,000 newborn babies were infected with HIV each year. On average, 44 per cent of new infections took place in heterosexual relationships within a union/partnership, 20 per cent through casual relationships among men and women, 15 per cent through sex workers and their clients, 15 per cent in the homosexual community and prison populations, and 6 per cent through injecting drug users.

Kenya is thus currently experiencing a mixed epidemic with characteristics of both a generalised epidemic among the mainstream population, and a concentrated epidemic among specific most-at-risk populations and geographies. Against this backdrop, funds from the Global Fund will target areas that are most impactful in the fight against HIV in the country.

So what exactly does this funding mean for Kenyans — both the infected and the affected? There will be three main objectives of the funding. The first is the expansion of care and treatment services to those infected with HIV.

The second is increasing coverage of prevention services, testing services and interventions targeting the most-at-risk populations.

The third is strengthening of organisations that implement various HIV programmes such as the National Aids Control Council (NACC), the National AIDS and Sexually Transmitted Infection Programme (Nascop) and civil society organisations.

In his 2006 book, The White Man’s Burden, economist William Easterly highlighted the trade-off that exists between funding spent on prevention of HIV/Aids through condoms versus treatment through ARVs. While it is true that funds used in treatment efforts will not end up being used for prevention efforts (donor funding is a zero-sum game), recent research shows that treatment by itself plays a significant role in prevention.

A 2010 study published in the Lancet, the world’s leading medical journal, confirmed arguments that many activists had posited throughout the early 2000s — that ARVs effectively reduce the virus population in infected persons to a level that greatly reduces their chances of spreading the disease to non-infected people. This means that if infected people are started on ARVs early enough, the disease burden in a population of people can be reduced to a level where it can be effectively managed, and ideally new infections can be prevented as long as drug resistance to ARVs doesn’t happen.

As such, Kenya’s focus on improving care and treatment of infected individuals will also have a significant prevention impact.
Some key highlights of the first objective of care and treatment of infected persons are the over $250 million earmarked for procurement of ARVs, monitoring of emerging drug resistance and adverse drug reactions to ARVs, and provision of nutritional supplements and rapid uptake therapeutic feeds for people living with HIV in the 50 districts of highest HIV prevalence (districts defined according to the borders that existed before promulgation of the new Constitution.)

The second target objective of the Global Fund grant is increasing coverage of prevention services, testing services and interventions targeting the most-at-risk populations. Most-at-risk populations include sex workers, injecting drug users, homosexuals and prison populations.

Close to $15 million has been set aside for HIV testing and counselling and for most-at-risk populations including $1.6 million for the launch of pilot needle-exchange centres to prevent injecting drug users sharing needles, while close to $1 million has been set aside for post-exposure prophylaxis (PEP).

PEP is short-term antiretroviral treatment to reduce the likelihood of HIV infection after potential exposure, either occupationally (for example, a nurse accidentally pricking herself with a needle used on an HIV patient) or through sexual intercourse (usually used in post-rape care).

The third objective of the Global Fund grant is to sufficiently equip the non-government actors, government actors and private sector organisations implementing various initiatives. Close to $50 million has been set apart for this third objective. The lion’s share of these funds will be for capacity building at the Ministry of Finance, civil sector organisations, the Kenya Red Cross (acting as the principal recipient for all funds that will go to non-government actors) and NASCOP.

Close to a third of this $50 million has been set apart for the co-ordination and management of the Global Fund grant and will mostly flow through the NACC, the Ministry of Finance, Kenya Red Cross and NASCOP. A further $9 million has been set apart for monitoring and evaluation.

Interventions for women also feature prominently in this proposal. This is important considering the fact that in Kenya, HIV prevalence among women is at 8 per cent for women versus 4.3 per cent for men. Some $26 million will be provided as grants to health facilities to facilitate waiver of fees for skilled-care deliveries in 50 high HIV prevalence and maternal mortality burden districts. This means women in these districts will be able to give birth in government medical facilities at no cost.

Currently, over 90 per cent of antenatal clinics in Kenya have the ability to prevent mother to child transmission of HIV, but only 44 per cent of deliveries in Kenya are under skilled attendance. High hospital costs have been cited as the reason 56 per cent of women are giving birth at home. This fee waiver project builds upon a successful pilot project that was funded by KfW and resulted in 80 per cent of births taking place in medical facilities once hospital fees were eliminated.

Funding has also been set apart for screening of women for cervical cancer in 50 HIV treatment sites in the country. This is because in Kenya the incidence of cervical cancer in HIV patients is 15 per cent higher than in the general population. Cervical cancer is a defining illness in people living with HIV/Aids. A further $350,000 has been set apart for training service providers in post-rape care, and sensitising police on post-rape referrals.

Euphoria

Community based organisations (CBOs) and civil society organisations (CSOs) will also play an important role in the implementation of many of the programmes. A total of $12 million has been set apart for provision of community based support for people living with HIV/Aids. This support includes training and grants to 570 CBOs based in the 50 districts of highest HIV prevalence, and funds to support CSOs in the supervision of CBOs in those districts.

This $345 million grant earmarked for the fight against HIV/Aids presents a great opportunity for Kenya to fight this scourge, that continues to bring needless pain and suffering to the over 1.5 million Kenyans living with HIV/Aids and the millions affected by the aftermath of the disease.

Amid the euphoria of receiving the funds, Global Fund implementers should also think of how to use the funding not solely for disease-specific interventions, but also to strengthen the health systems in the country. As stated by Senior Fellow for Global Health at the Council on Foreign Relations Laurie Garrett, efforts to help the world’s poor and sick will only be fruitful once public health issues are looked at in general rather than focusing solely on disease-specific problems. This long-term thinking is what will ensure the sustainability of any successes attained in the fight against Aids.

Ciku Kimeria is a consultant at Dalberg Global Development Advisors. E-mail: [email protected]