The Global Fund to Fight AIDS, Tuberculosis, and Malaria has not distributed its grants to Zambia’s Ministry of Health since last August.1 The decision was made after Sweden and the Netherlands suspended aid when evidence of fraud was discovered in the Ministry of Health: senior officials have been charged with stealing US$5 million.2 The Fund demanded that the Ministry of Health return US$8 million in unspent funds and that the government take action against corruption within their ranks. US$17 million in aid have been distributed through other channels, and the United Nations Development Programme will take over the management of the Ministry’s grants.1
Though the Fund expects full grant activities to resume within the next two months,1 Zambians in rural areas are feeling the impact of the suspension. Outreach programs for persons living with HIV, such as mobile counseling and testing and ART services, have stopped.3 Rural residents living with HIV have been traveling to urban health centers to get drugs, when health workers previously brought the drugs to them. Obert Mubyana, district HIV and TB programmes officer for the Mpulungu district, said,
“The past three or four months, the situation has been very bad. We are not able to travel … [and] have a lot of patients that we need to monitor. …[we have] to carry out mobile VCT, mobile ART, we need fuel, we need allowances, so we have had to suspend a lot of programmes.”
Donor funds make up over half of Zambia’s health budget toward programs for malaria, TB, and HIV and training medical staff, so this suspension has raised concerns of a health crisis in the country.4 Many Zambians feel they are being punished.3 While it is certainly a donor’s right to withdraw help if it is being abused, it still begs the question: are citizens of countries that receive international aid unfairly punished for the crimes of their politicians when that aid is withdrawn? Is it short-sighted to target direct services with aid money, rather than trying to use it to build a country’s capacity to administer such services on its own? Can such a capacity even be built with donor funds? And how much sense does it make to suspend aid over allegations of corruption, when a certain baseline level of graft and embezzlement is already expected?
Though there are no easy answers to these questions, Zambia still needs them. The national average of HIV prevalence is officially estimated at 14 percent, but unofficial statistics from local health facilities suggest that the actual number may be around 50 percent.3 The Global Fund’s grants provide HIV treatment to over 200,000 Zambians, so a disruption of such aid would be devastating.