A Project of the American Enterprise Institute and the Federalist Society

Elusive Trail Of AIDS Funds To NGOs In Africa


October 14, 2005

by James Macharia

Where have the billions of dollars poured into Africa to fight AIDS gone? A lot of this money is channelled through non-governmental organisations (NGOs) mainly to pay for life-prolonging drugs and education campaigns on a continent where many national healthcare systems are broke and in tatters.

Donors increasingly prefer to fund NGOs rather than African governments, many of which are seen as corrupt. But because the NGOs number in the thousands, it is unclear how much money they have received or how it was used.

"The trail of donor money is as clear as mud," said Annabel Kanabus, director of UK AIDS charity Avert. The United Nations AIDS agency, UNAIDS, says sub-Saharan Africa has just over 10 percent of the world's population but is home to more than 60 percent of all people living with HIV. Around 2.3 million people died of AIDS in the region in 2004.

UNAIDS estimates that $8.3 billion will be available to fight AIDS globally from all sources in 2005. Although this is up from $6.1 billion in 2004, when the U.S. alone gave $2.7 billion, it will leave a $4 billion shortfall, it says.

Even though some cash appears to have been misused, the main concern is that most of the money given so far has simply not been enough, and much of it does not reach those most in need.

"Too little of this money is currently reaching community initiatives," Geoff Foster, a child health expert in Zimbabwe said in a report for the charity Save the Children.


The biggest slice of the funding cake goes to the same big, well-known NGOs, while smaller community-based groups that often have a grassroots connection to those in need, such as orphans, were left empty-handed, experts said.

"Donors need to address this paradox," Jonathan Cohen, a HIV/AIDS researcher with Human Rights Watch, said. "Organisations that are best qualified to fight the disease on the ground are the least able to obtain funding."

U.S.-based writer Helen Epstein, who has researched on AIDS in Africa, says one such grassroot AIDS group in Soweto, South Africa, struggles to feed and counsel AIDS orphans. The organisation, run by Elizabeth Rapuleng, has a yearly budget of $60,000. "She (Elizabeth) worries about whether there will be enough food for the children, whether they all have toothpaste and shoes, and whether they are all going to school," wrote Epstein in the latest New York Review of Books.

A study on U.S. foreign aid showed much donor cash never leaves the country of origin. "At least 60 percent of U.S. foreign aid funding never leaves the U.S., but instead is spent on office overheads, travel, procurement of American-made cars, computers ... as well as salary and benefit packages," Curt Tarnoff and Larry Nowels, specialists in foreign affairs, said in a paper for the U.S. Congress on foreign aid spending. NGOs said salary packages were aimed at attracting scarce human capital, and were not designed to enrich individuals.


In Nigeria, Africa's most populous country, some 4 million people are infected with AIDS and UNAIDS says donors will have given some $500 million to NGOs to fight AIDS in 2002-2006. "This may seem like a lot of money, but when you set it against the size of the population it's not enough," said Pierre Mpele, UNAIDS coordinator for Nigeria. "They (NGOs) do very important work that cannot be quantified in terms of money."

Only 25 of 66 centres offering anti-retroviral treatment (ARVs) in the West African country were state-run, Mpele said.

NGOs fighting AIDS in Africa mainly get their cash from President George W. Bush's AIDS fund, which gave $2.4 billion worldwide in 2004, and the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria, which mainly funds governments.

South Africa, the country with the world's highest HIV/AIDS caseload -- more than five million people are estimated to carry the virus -- is the largest recipient country under Bush's 2005 plan, securing about $150 million for dozens of NGOs. The nation's top home-grown AIDS lobby group, Treatment Action Campaign (TAC), says it spends about half its annual budget of $3.06 million on staff and operational costs, which experts said reflected the spending pattern for many NGOs. Nathan Geffen, a TAC official, said the group spends the other half on education materials and training workshops.

It also spent $76,750 on CD4 tests -- which show how far HIV has advanced -- for 1,000 members, ARVs for 100 people and anti-fungal fluconazole for thousands more.


Alan Whiteside, an AIDS expert at the University of KwaZulu-Natal said most, but not all, NGOs used the money well. Government agencies ranked badly in comparison to NGOs. In Kenya, a former director of the National Aids Control Council, Margaret Gachara, was jailed in 2004 for a year for defrauding the government out of about $366,800 in accumulated salaries after she falsified documents to get the top job. Critics said her salary diverted funds that could have helped the fight against AIDS. Gachara was later freed under a presidential amnesty. Neighbour Uganda, praised for cutting HIV infection rates to around 6 percent from 30 percent in the early 1990s, is probing a health department scandal over how it spent AIDS money. Out of a promised $201 million over two years, the Global Fund had given $45 million, but stopped over concerns that there was possible misuse of the money. "To steal money intended for ... medication, food and welfare is to steal from them (AIDS patients) their last glimmer of hope, and to pull the only rag from under their feeble feet," said Justice James Ogoola, who is heading the inquiry.

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