South African Government Trying to Block $11.5M Global Fund Grant Awarded to KwaZulu-Natal Province

The South African government is trying to block an $11.5 million grant awarded by the Global Fund to Fight AIDS, Tuberculosis and Malaria to KwaZulu-Natal province, contending that KwaZulu-Natal's grant application did not go through the national government before being submitted to the fund, the Boston Globe reports. The Global Fund in April approved an $11.5 million one-year grant that would allow KwaZulu-Natal to expand the Harvard AIDS Institute's Enhancing Care Initiative from one hospital to every clinic in the province (Steinglass, Boston Globe, 6/11). Overall, the fund approved $72 million to be provided over the next five years to the province (Global Fund release, no date). The Harvard program, which is currently offered at one hospital in Tugela Ferry, provides medication for opportunistic infections, volunteer counseling and antiretroviral treatment for pregnant women to reduce the risk of vertical HIV transmission. The program does not currently offer antiretroviral treatment for others, but the province's proposal seeks to expand the program's services to include full antiretroviral therapy for HIV-positive health care workers. The proposal also provides for volunteer counseling and HIV testing in rural areas. In addition to the Global Fund grant, the Durban Chamber of Commerce and Industries has pledged $5.6 million in matching funds for the program.

Grant Application Process
Applications to the Global Fund are supposed to pass through Country Coordinating Mechanisms (CCMs), which are designated by national governments. KwaZulu-Natal applied directly to the Global Fund because South Africa did not have a CCM at the time of application, but the South African National AIDS Committee was later designated as the country's CCM. The South African Department of Health "put immense pressure" on the province to withdraw its application after the country's CCM was established, and the grant authors complied with the government's wishes. KwaZulu-Natal's grant request was withdrawn in early April, but the Global Fund awarded the funding anyway in late April. South African Health Minister Dr. Manto Tshabalala-Msimang objected to the Global Fund's action and is now asking that the grant be resubmitted through the National AIDS Committee.

Government Backing Required?
The dispute over KwaZulu-Natal's grant is "the first big political test for the Global Fund" because representatives to the fund are divided over whether proposals should be required to obtain the endorsement of national governments. "Subnational entities that made submissions will need to get the endorsement of their CCMs," Mazuwa Banda, the Global Fund's coordinator for Africa, said. But Millie Katana, who serves as the nongovernmental organization representative for developing countries on the Global Fund board, said that South Africa's CCM is "not required to approve KwaZulu-Natal's application," adding, "Someone is trying to hijack the responsibilities of the Global Fund board." The South African government said that it needs to approve all grants in order to "coordinate national policy." Government spokesperson Joel Ntshitenzhe said, "We need to ensure that submissions to the Global Fund are unified, so we don't have individual municipalities and provinces out on their own." But AIDS activists and NGOs say that "national governments with inadequate AIDS policies must not be allowed to seize control of the Global Fund's money" and grants should go to regional governments and NGOs with "superior proposals" to ensure the effectiveness of the fund. "The Global Fund board said [KwaZulu-Natal's proposal] was the most impressive approach to improving care they had ever seen. If that grant is not funded, then something besides what's best for patients has gotten in the way," Dr. Ric Marlink of the Harvard program, said (Boston Globe, 6/11).