Why drop in HIV/Aids donor funds matters

Uganda, on December 1, joined the rest of the world to commemorate World Aids Day as the country straddles along the path to end the epidemic by 2030. In this explainer, Elizabeth Kamurungi unpacks the financial hurdles that Uganda could run into as donors tighten the purse strings.

What does the funding picture look like?

Forty years since the virus was identified in the country, the huge chunk of funding dedicated to combating the epidemic has come from donors. Petitions to the government to match up their contributions have not yielded. Now the donor taps are slowly shifting, raising concerns on sustainability of the successes.

Statistics from the Uganda Aids Commission (UAC), the lead coordinator of the multi-sector response to the epidemic in the country, indicate that 84 percent of the budget for all interventions by both government and other partners is met by donor funding. The government contributes eight percent, with the rest coming from the private sector.

“Consolidation of gains and sustaining future progress in the prevention and treatment of HIV/Aids in Uganda is in danger of reversal due to dependency on donors, who have signalled need for government to take majority funding and even reduced funding for areas such as HIV prevention and coordination,”  Dr Wilson Musoba, the UAC director general, says.

For example in 2015, the funding for the UAC from donors fell by Shs10b. This brought the budget down to Shs7b, and affected coordination and prevention interventions. Only one donor stayed with about Shs3b. Dr Musoba explains that while the government stepped in to cover the Shs10b, shortfalls and reliance on donors’ remains.

What has occasioned the current threat to turn off the tap?

The reduction in resources allocated to the epidemic is attributed to emerging global priorities such as climate change and security. Domestically, Uganda’s economic growth and progression into the middle-income status means its eligibility for grants will change and conditionality such as co-financing will be introduced.

“Donor support over time has been declining, and over time we have lost crucial donors like the governments of Ireland and Denmark, which were contributing to the HIV/Aids basket fund,” an August report by the Parliament Committee on HIV/Aids states.

“We are concerned with the over reliance on donor funding, which is declining and in addition, the delays by the government in operationalising the Aids Trust Fund (ATF). These have affected the overall implementation and coordination of comprehensive HIV intervention services,” the report adds.

What sort of impact are we looking at here?

Uganda has made significant progress in the fight against HIV/Aids, with prevalence having reduced from 18 percent in the 1990s to 5.5 percent in 2021. More than 90 percent of the 1.4 million people living with Aids have been put on treatment and are living productive lives.

Dr Steven Watiti, who now works with the Community Health Assistance Uganda, which is funded largely by donations from the UK, the Netherlands and some private donors, says while there may not be a direct decline in the funding, it has not increased. The number of people who need the care is, however, growing.

So what should be done going forward?

Dr Watiti believes investment in health—not just the HIV response—must be increased so as “to create a robust system to deal with all these epidemics, and pandemics.”

He adds that “if there was no Taso (The Aids Support Organisation), JCRC (Joint Clinical Research Centre), many people would have died. The interventions should have been integrated into the health system by now.”

Dr Waititi applauds the government for putting in place infrastructure such as health centres and the human resource, but says it should increase funding to things like the medicines and testing kits

Is it all doom and gloom?

No. Mr Tadeo Atuhura, the communications manager at Mild May Uganda—one of the key institutions conducting HIV interventions, says their operations have not been affected and their funding remains sufficient. But, evidently, the road ahead will have a few speed bumps.