Measuring Progress: Zimbabwe’s Innovative Financing for HIV/AIDS

Perry Mwangala, the Global Fund’s Fund Portfolio Manager for Zimbabwe, discusses the country’s innovative and domestic financing efforts for HIV/AIDS.

Friends: Can you provide a bit of background on the history of the HIV/AIDS epidemic in Zimbabwe?

Perry: The history of the HIV/AIDS epidemic in Zimbabwe has followed a similar trajectory to that of the epidemic across Africa. The first cases of AIDS were detected in the mid-1980s. In the face of a limited response, rates of prevalence and incidence peaked in the late 1990s and early 2000s. Since the new millennium, these rates have steadily declined as testing, preventative measures and treatment have been implemented and expanded throughout the country. Anti-retroviral therapy (ART), for example, has been greatly scaled up, increasing coverage from 62 percent of adults in 2009 to 77 percent in 2013. Today, HIV prevalence is 15 percent compared to its peak, in 1997, of 26.48 percent. Similarly, incidence is .98 percent today versus 5.5 percent in 1992. Clearly, progress is being made.

Historically, Zimbabwe has been widely regarded as having one of the best healthcare response programs in the region. Since the colonial era, Zimbabwe has been recognized for its strong commitment to developing technical expertise in a variety of sectors, including agriculture, education and healthcare. In fact, politicians from around the region traveled to Zimbabwe specifically to seek health services.

Friends: What steps is Zimbabwe taking to ensure a sustainable response to the disease going forward?

Perry: Zimbabwe’s biggest challenge in fighting HIV/AIDS is financing. The country had a devastating economic collapse between 2000 and 2008 and it has still not completely recovered.

To address the HIV/AIDS financing challenge, at least in part, in 1999, Zimbabwe established an AIDS Levy that was intended to be a sustainable resource. The National AIDS Council (an independent entity) was established by parliament that same year to collect and oversee the Levy. The AIDS Levy has been in effect since 2000, and represents the government’s commitment to financing the fight against HIV/AIDS.

Friends: How did the AIDS Levy come about?

Perry: In 1992, Zimbabwe experienced a crippling drought. In an effort to carve out adequate funding to address this crisis, the government enacted a drought levy. This experience established not only a precedent for such a mechanism, but also the cooperation — between the president, parliament, the ministries of finance and health and labor groups — that was necessary to have a specific income tax to address a particular issue. Leveraging this experience, the AIDS Levy was established in 1999 as part of the nation’s larger effort to combat the epidemic.

Friends: How does the AIDS Levy work?

Perry: The AIDS Levy is a 3 percent tax on the income of all formally-employed individuals and most companies in the country. This revenue is aggregated in a trust fund and used to support the national AIDS response.

Fifty percent of these funds are dedicated specifically to the procurement of commodities, including anti-retroviral drugs. The rest goes to support other facets of the overall AIDS response, such as treatment, care and prevention.

Friends: How much money has been raised by the AIDS Levy to date?

Perry:  It is extremely challenging to pinpoint accurate values for AIDS Levy collections between 2001 and 2008 because of Zimbabwe’s economic collapse and subsequent hyperinflation. From the earliest we are able to measure, beginning in 2009 when the country officially began accepting foreign currencies, $5 million was collected from the AIDS Levy. A year later it grew to $20 million, and by 2012, reached $32 million. In all, this covers nearly one-third of the total costs for the country’s HIV/AIDS program.

Friends: Could this levy be duplicated by other countries?

Perry:  Yes, Zimbabwe’s AIDS Levy represents a significant financial innovation that is not only the first of its kind in Africa, but has inspired other nations like Uganda and Zambia to explore the creation of similar schemes.

Friends: How does Zimbabwe’s “Healthcare Worker Retention Scheme” support a sustainable response to HIV/AIDS in the country? What is it doing to recruit the health workforce back and retain it?

Perry: When the economy collapsed, Zimbabwe’s currency became virtually worthless, and many of its healthcare workers moved to neighboring countries to find work. In 2009, as the economy began to right itself, Zimbabwe worked with a number of donors, including the United Nations Programme on HIV/AIDS, the U.K.’s Department for International Development, the President’s Emergency Plan for AIDS Relief in the U.S. and the Global Fund, not only to recruit back the health workforce but also to retain it. It created a “healthcare worker retention scheme” whereby donors pay healthcare workers’ salaries in order to entice them into returning to Zimbabwe. With these efforts, the number of healthcare workers in the country has increased from 13,000 in 2010 to about 30,000 today.

While this initiative is entirely donor funded, the return of a robust level of technical expertise to the country has supported the continued development of a strong healthcare framework.

Friends: In your opinion, what does the future hold for Zimbabwe’s response to HIV/AIDS?

Perry:  Zimbabwe is taking many of the right steps towards containing the HIV/AIDS epidemic, both in terms of treatment as well as the development of sustainable funding. These steps provide hope for continued progress. Though donor support will remain crucial to continuing progress in the country, innovative efforts like the AIDS Levy are concrete steps toward increased self-reliance.

This post was originally published in October 2014.

 

Footnotes

[1] Hanene, Thuletu Tikili. “Zimbabwe’s AIDs Levy blue print for future HIV funding.” HIV/AIDS/Zimbabwe Charity, INC. August 19, 2012. http://www.hivaidszimbabwe.org/zimbabwes-aids-levy-blue-print-for-future-hiv-funding/, (accessed July 22, 2014).