By: Thoboloko Ntšonyane
MASERU
Following the United States Executive Order to freeze aid for 90 days, there has been growing concern over this impact on sexual and reproductive health and rights (SRHR) services prompting calls for the lawmakers to leverage their influence and oversight powers to influence budgetary priorities. Advocates argue that now amid the realignment of global aid priorities Lesotho should now build resilience through strategic mobilisation of local resources.
This came into light during the Southern African Development Community Parliamentary Forum (SADC-PF) National Working Group on SRHR, HIV and AIDS Governance Project meeting with key stakeholders last week. The Working Group consists of the MPs, development partners, civil society organisations, media and the National AIDS Commission.
The meeting sought to understand how the recent developments surrounding the US funding cuts and their significant impact on the health sector, particularly in the areas of HIV, SRHR and Tuberculosis (TB).
The Lesotho HIV and TB Sustainability Roadmap which outlines the nation’s strategy to sustain its HIV and Tuberculosis (TB) response through 2030 and beyond, calls for strengthening of resilience in healthcare in order to sustain the gains made. “To achieve sustainability, Lesotho must prioritise actions that integrate emerging evidence, foster innovation, maximise investment efficiency, and drive high-level advocacy.”
Dr Tapiwa Tarumbiswa, HIV and AIDS Manager at the Ministry of Health (MoH) submitted to the MPs that they have a role to play to help bridge the funding gaps saying the foreign aid is not sustainable. He made the case that the parliament should support the health sector, advocate for necessary funding, and ensure that essential services in HIV, SRHR, and TB remain accessible and effective.
He stressed that “Parliament [should] play a pivotal role in advocating for alternative funding sources, strengthening national health policies, regional and international diplomacy, public awareness and education. Parliamentarians can engage in regional diplomacy and international advocacy to urge other nations, particularly donor countries, to increase their support for global HIV efforts.
“Regional parliamentary bodies can promote cross-border initiatives that allow countries to pool resources and share knowledge on combating HIV, thereby reducing dependency on any one donor.”
He said the alternative funding sources that can be considered include the establishment of the national health insurance or the HIV/TB AIDS Fund.
It will be recalled that the National HIV and AIDS Strategic Plan 2023/2028 estimates that at least M13 billion funding is required in financing needs.
Dr Tarumbiswa reported that the reduction in funding from the US has not only caused a strain on HIV/TB prevention, treatment and care but has also caused the layoffs whereby 625 health professionals lost jobs. He said at least M852 million is needed to ensure sustained continuity of affected services such as gender based violence, HIV/TB services (treatment and care), family planning, community led monitoring, key populations, supply chain.
According to the MoH data, the United States President’s Emergency Plan AIDS Relief (PEPFAR) is the biggest contributor to the HIV funding accounting for 64.1% funding, which is M1,2 billion, the Global Fund comes second accounting to 22.3%, M439 million and the government of Lesotho covers the 13.6%, which in figures translates to M268 million. And the other donors cover the rest to make a total of HIV funding to the tune of M2,2 billion.
The MoH has shown that their goal is to among others ensure universal access to comprehensive SRHR, reduce maternal and neonatal morbidity and mortality, and increase in community awareness and education on SRH. However, owing to the aid freeze which resulted in termination of healthcare workers contracts, this has had an impact on the essential services delivery.
According to data available Lesotho inches closer to meeting the UNAIDS 95-95-95 targets, with 95% of people living with HIV knowing their status, 91% of those are on medication, and 98% have their viral load suppressed.
While the National AIDS Commission Chief Executive, Lebohang Mothae who is also the National Working Committee’s Chairperson assured that the country is on track to achieving global targets, she reiterated that the reliance on external aid and limited private sector investment challenge the financial resilience.
Mothae argued that the restrictive laws and slow policy implementation hinder services access for marginalised populations adding that underfunded community-led organisations lack resources for effective monitoring, innovation and training.
She called for the resilient health systems with the robust supply chains, well-mapped laboratory networks, institutionalised quality assurance mechanisms, and the local production capabilities integrated with strong government, private sector and community collaboration.
The Public Accounts Committee Chairperson, Hon ‘Machabana Lemphane-Letsie stated that the recently passed national budget has been thinly stretched and interrogated how they as parliament can assist the nation.
She talked to the strategies that are necessary to maximise support for Basotho.
Innocent Modisaotsile, the United Nations Population Fund (UNFPA) Representative to Lesotho also emphasised the importance of mobilising local resources, urging parliaments to challenge the executive’s approach to local plans. He cautioned that if the current situation persists without a robust plan, it could place strain on SRHR services, particularly in factories where there is a high concentration of women and young people.
Women and youth are reportedly bigger consumers of the SRHR services, such as reproductive health needs, sexual health awareness, family planning services and preventive care. Also, women are said to be at a heightened risk of GBV.
For her part, the National TB Programme Manager Dr Llang Maama said the MoH has reached a 20% reduction in TB incidences from 2015. She said there is no direct funder for TB programmes but funders support their activities.
Dr Maama said that TB contributes to 43% productivity loss adding that for every $1 invested, there is a $9 return.
Taking stock at the aid cut impact on TB, she highlighted that it will place pressure on the TB programme and hamper the country to make it to the finish line of the sustainable development goals (SDGs) and the End strategy “bearing in mind that Lesotho is in an uncomfortable position of holding the highest TB burden in the world”.
The National TB Programme Manager said they are yet to receive the report after April 20th following the evaluation of the US foreign aid review. This report she said will say which programmes will continue to be supported and which ones will be dropped.
The aid continuation uncertainty has caused the termination and placed some healthcare services on pause. There are some which remain active despite fears over their sustainability. The Lesotho vision of a future free from AIDS and TB by 2030 may become more challenging to achieve if alternative means are not devised to supplement the resources gap due to aid reductions.