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
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

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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