Tatjana Peterson, Senior Fund Portfolio Manager at The Global Fund, discusses the fight against HIV/AIDS in Tanzania.
Friends: What is the history of the HIV/AIDS epidemic in Tanzania?
Tatjana: Initial HIV/AIDS cases in Tanzania were detected in the 1980s. By 1986, the epidemic was widespread, spanning throughout the mainland.
From the outset, the Tanzanian government was deeply committed to fighting the disease. In 1985, the government, through the Ministry of Health, established the National AIDS Control Programme to coordinate prevention and control. But the epidemic continued to grow, reaching its peak in the 1990s. The Tanzania Commission for HIV/AIDS (TACAIDS) was formed in 2000 to provide strategic leadership and coordinate public and private stakeholders.
Today, Tanzania continues to face a generalized epidemic with 5 percent of people ages 15-49 testing positive for HIV. Prevalence is higher among women (6.2 percent) than men (3.8 percent) and is also higher in urban areas. The good news is that, due to early government-led efforts to coordinate public and private sector activities as well as the arrival of significant international funding, overall prevalence has dropped since 2002.
Friends: The Global Fund and PEPFAR provide 90 percent of the HIV/AIDS financing in Tanzania. What are their respective roles and responsibilities and how are they coordinating with the national government?
Tatjana: As of January 2015, Tanzania has received $772.2 million in funding from the Global Fund to fight HIV/AIDS. The Global Fund provides financial support to the government and civil society organizations, with significant resources allocated to health commodities such as antiretroviral drugs (ARVs), HIV rapid diagnostic tests, lab supplies and other supporting interventions. In addition, the Global Fund has made significant investments in health systems strengthening initiatives both through disease programs and as a stand-alone grant, helping to build human resources, infrastructure, procurement and supply management, and leadership skills.
PEPFAR, meanwhile, funds the work of a wide range of implementing partners and provides resources for the procurement of certain health commodities (e.g. ARV procurement requests, second-line adult and pediatric ARVs, lab supplies and equipment). It also provides overall support for service delivery at health facilities, community sites and management teams at district, regional and national levels.
PEPFAR implementing partners, together with the Tanzanian government and Global Fund financing, have achieved national coverage in support of HIV service delivery. The Global Fund-financed activities are interrelated and complementary to both the government’s policies and strategic plans and to PEPFAR goals. Being on the ground, PEPFAR supports the Global Fund financed implementation through its active participation in the Global Fund governance model at the country-level and by providing technical assistance to grant implementers in order to remove operational bottlenecks. Indeed, the success or failure of each of the three partners — the Global Fund, PEPFAR and the Tanzanian Government — has direct bearing on one another and to the HIV/AIDS program in general.
Friends: Given that international funding is declining, how is Tanzania addressing the resource gap?
Tatjana: According to the World Health Organization, Tanzania’s government expenditures for health in 2012 made up 7 percent of the total Gross Domestic Product (GDP). It is estimated that the government allocates 5 percent of these funds for HIV/AIDS activities. At the same time, the government has committed to increasing its contribution to the national response program and, as reported in its March 2014 Global AIDS Response Country Progress Report, finalized a health financing strategy that includes a national health insurance and community fund, fiscal contributions and public private partnerships for health financing.
Tanzania will also soon have an AIDS Trust Fund (ATF) that would draw funds from a ring-fenced budget established by the government and other sources including both international and national private donations, bequests, and investment incomes. Legislation to develop the ATF is currently moving through the Parliament. The ATF should be operational by July 2015, at the beginning of the next financial year, and could, over time, decrease donor dependence by as much as 36 percent.
Friends: How is the private sector contributing to the fight against HIV/AIDS in Tanzania?
Though private sector funding is modest at the moment, we are witnessing an increased willingness to engage in the health agenda in many ways: through lifestyle change programs in corporations which include discussions on health topics such as alcohol abuse and malaria prevention, educational campaigns, and organized counselling for family members, to name just a few. All such interventions aim to reduce hours lost to diseases and to increase the productivity of the workforce. At the same time, through public-private partnership programs, the government is developing a number of mechanisms such as the ATF and providing enabling conditions for the private sector’s increased engagement.
There are several examples of public private partnerships that are currently operational in Tanzania. For example, the Abbott Fund and the Government of Tanzania formed a public-private partnership a decade ago designed to strengthen the country’s health care system and address critical areas of need. To date, the Abbott Fund has invested more than $100 million in this partnership. In addition, the Abbott Corporation has made more than $5 million in donations.
The private sector is also helping to support capacity building efforts. Project Last Mile is a successful collaboration that demonstrates the powerful partnership between Coca-Cola, the Global Fund and the Government of Tanzania. Established in 2010 to help Tanzania’s government-run medicine distribution network, the Medical Stores Department, build a more efficient supply chain, Coca-Cola’s logistics and beverage delivery model was used to deliver critical medicines to remote communities. As a result, Tanzania has been able to implement practices that have elevated its planning, distribution and performance management processes, improving its capability to deliver critical medical supplies throughout the country. It also has been able to increase the availability of medicines in clinics by 20 to 30 percent in regions where Project Last Mile has been implemented.
No discussion of private sector engagement would be complete without mentioning (RED), a Global Fund private sector consumer marketing initiative. (RED) contributes a percentage of items sold by many of the world’s biggest brands — Apple, Coca-Cola, Bank of America, Beats by Dre, Galaxy, Head, Moleskine, Starbucks, etc.— to fighting AIDS in Africa through Global Fund financing. Today, eight HIV programs in Sub-Saharan Africa benefit from the initiative including a Tanzanian HIV grant added to the portfolio in 2012. Since its inception, (RED) has contributed over $300 million to the Global Fund, $18 million of which financed the Tanzanian HIV program in 2013 and 2014.
Friends: In your opinion, what does the future hold for Tanzania’s response to HIV/AIDS?
Tatjana: Maximizing investments to achieve the greatest health impact coupled with mobilizing an increased level of domestic funding and cost sharing will be critical going forward. In addition, the government is working to address key challenges that remain in defeating the epidemic: lack of human resources, treatment integration for HIV/TB co-infection and a lack of integrated databases for HIV programs.
The efforts noted above are only part of the solution. The government will need to establish new and enabling policies that promote innovative — including pro-poor — financing strategies for health care. These will then be possible to combine with robust private sector engagement where defined outcomes are clear and agreed to among partners.
Footnotes The United Republic of Tanzania. Tanzania Third National Multi-Sectoral Strategic Framework for HIV and AIDS (2013/14 – 2017/18). The Prime Minister’s Office. November 2013. p. 18.
 The Global Fund. Tanzania Country profile. http://portfolio.theglobalfund.org/en/Country/Index/TZA. Last accessed February 2, 2015.
 World Health Organization, United Republic of Tanzania country profile. http://www.who.int/countries/tza/en/. Last accessed February 2, 2015.
 The United Republic of Tanzania. Tanzania Third National Multi-Sectoral Strategic Framework for HIV and AIDS (2013/14 – 2017/18). The Prime Minister’s Office. November 2013. p.32.
 The United Republic of Tanzania. Global AIDS Response Country Progress Report. March 31, 2014. p.30.
 President’s Emergency Plan for AIDS Relief. Mission Presentation. TACAIDS Conference. February 5, 2013.
 Abbot Fund. Public Private Partnership for Health Care in Tanzania: Improving Muhimbili National Hospital. http://www.abbottfund.org/project/17/68/Modernizing-Muhimbili-National-Hospital-in-Tanzania. Last accessed August 21, 2014.
 The Global Fund, “Project Last Mile Expands to Improve Availability of Medicines,” June 23, 2014. http://www.theglobalfund.org/en/mediacenter/announcements/2014-06-23_Project_Last_Mile_Expands_to_Improve_Availability_of_Medicines/ (accessed August 21, 2014).