CAMEROON: RUNNING OUT OF ANTI-RETROVIRAL DRUGS

UNCLAS SECTION 01 OF 02 YAOUNDE 000357 SENSITIVE SIPDIS DEPT FOR AF/C, ACCRA FOR JEANNIE FRIEDMANN, DEPT FOR USAID USDOC FOR ITA - K BURRESS E.O. 12958: N/A TAGS: KHIV KOCI SOCI PGOV CM SUBJECT: CAMEROON: RUNNING OUT OF ANTI-RETROVIRAL DRUGS REF: 08 YAOUNDE 877 ¶1. (SBU) SUMMARY: The Government of Cameroon (GRC) anticipates it will run out of anti-retroviral (ARV) drugs by September 2009, leaving an estimated 60,000 patients without medication. The GRC has sought international funding to meet this shortage and has apparently not considered using its own resources. The interruption of life-saving anti-retroviral treatment (ART) for tens of thousands of patients would likely result in avoidable deaths and heightened popular frustration over the GRC's failed governance of the health sector. END SUMMARY. An ARV Crisis in the Making? -------------- ¶2. (SBU) In May 2007, the GRC announced that it would start providing free ART to any citizen infected by AIDS and needing treatment. The GRC estimates that 135,000 people need treatment, but only 44% (or 60,000) are actually receiving it. (Comment. We give greater credence to the estimates of UNAIDS, which indicate as many as 157,000 Cameroonians currently need ART. UNAIDS plans a conference in May to reconcile the competing estimates. End Comment.) The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) allocated tens of million dollars in Round 3 funds to support the Ministry of Public Health's on-going country-wide ART programs, with the Global Fund subsidizing the cost of ARVs. Poor Planning/Execution Leads to Crunch -------------- ¶3. (U) The GRC has overspent the Global Fund Round 3 budget, meaning that the funds, which were supposed to run through December 2009, will actually be exhausted as early as September 2009. Due to the increase in patients on ART, the GRC has overspent the ARV line item by 300%. In a recent meeting Poloff attended, the Ministry of Public Health announced that it will require an additional $3.8 million to continue providing anti-retroviral treatment to patients currently on ART until the end of the calendar year. The GRC began to ask for additional bilateral funding from donors, previously unaware of the problem, in August 2008. Donors Unlikely to Bail Out GRC -------------- ¶4. (SBU) At a donor roundtable on March 16, representatives from France, Germany, UNICEF, and UNFPA stated that their institutions are unlikely to contribute �A;additional funds for the purchase of ARVs. All of these groups already contribute either to the Global Fund or to health programs in-country. The representatives were unanimous in arguing that the GRC has the financial capability to fund ARV treatment, if the budget is reorganized and priorities are shifted. GRC Lacks Ownership, Buy-In For Global Fund Programs -------------- ¶5. (U) Despite some improvements in the management of Global Fund programs, high-level GRC health officials told Poloff privately that the GRC has not been paying its share of the Global Fund project, blaming a combination of communication difficulties between the Ministry of Public Health and the Minister of Finance and a general lack of buy-in from the GRC. Officials responsible for the HIV/AIDS program in Cameroon told Poloff that the GRC does not yet have an action plan to cover provision of ARV, and continues to hope that international donors will step up to fund it. The Director of the GRC's National AIDS Control Council (NACC) announced in a March CCM meeting that if a solution is not forthcoming, the Ministry of Public Health will likely to cut other services to patients living with HIV/AIDS and orphans/vulnerable children (part of the Round 3 project) in order to avoid interruptions in ARV treatment. Changes in the CCM -------------- ¶6. (U) Until recently, the Country Coordinating Mechanism (CCM) of the Global Fund in Cameroon was poorly organized and consumed by infighting. Post has used its seat on the newly YAOUNDE 00000357 002 OF 002 reconstituted CCM to lobby for improved governance. A recent visit by Global Fund representatives from Geneva, which gave strict instructions as to how the CCM should function, has prompted many fundamental changes. Communication has been improved by hiring a technical secretary, creating an email list serve, and planning meetings well in advance. In an important change from the previously opaque process dominated by the Ministry of Public Health, the CCM will have ample time to review and comment on Round 9 proposals from the Ministry of Public Health and civil society to decide which should be considered. Comment: GRC Failing to Take Ownership for ART -------------- ¶7. (SBU) The GRC should be able to fund ARV provisions from its national health budget of 113 billion Central African Francs ($226 million). This budget is a $50 million increase from the previous year, with the increase supposedly going to support free medical treatment for people living with HIV/AIDS. Unfortunately, corruption and poor governance (reftel) have meant Cameroonians continue to die of AIDS despite ample domestic and international funding. Although early in its new iteration, the CCM is taking a more active role in design and implementation of Global Fund projects. Post believes the CCM would benefit from additional training on its proper functioning, especially its role in monitoring implementation of projects. ¶8. (SBU) The GRC has five months to develop and implement a plan of action or tens thousands of ARV patients will be forced to interrupt treatment. We are concerned about this looming disaster, but do not perceive the same sense of urgency from Cameroonian officials. As the international community appears unwilling to bail out the GRC from this crisis of its own creation, we anticipate the Ministry of Health will end up cannibalizing other programs in order to provide some semblance of continuity in the politically popular "universal" provision of ART. But tens of thousands of Cameroonians who need ART are not receiving it, a number that is likely to increase as the program falters in the coming months and contribute to already simmering social anger at the GRC's poor governance. FOX