MPULUNGU, 25 September 2009 (IRIN) - A freeze in donor funding after allegations of Zambian government corruption is being keenly felt by those living with HIV in rural areas, which were receiving the lion's share of financial HIV/AIDS support.

"We are suffering very much here; every month we have to come here [the health centre in Mpulungu town] to get drugs," said Evans Sikazwe, who lives in Mpulungu district in Northern Province, about 1,100km north of the capital, Lusaka.

"Previously, health workers used to follow us [up] and bring us drugs in our area, but for the past two months we have been coming [to get them] on our own," Sikazwe told IRIN. He has been HIV-positive for the past two years and now has to travel 70km every month to access life-saving antiretroviral (ARV) drugs.

About 200,000 Zambians nationwide are accessing antiretroviral therapy (ART) services at various government health facilities, but only urban clinics are mandated to administer ART in rural districts.

In the absence of donor funds, outreach programmes such as mobile voluntary counselling and testing (VCT) and ART services have been discontinued. The Mpulungu clinic is the main referral centre for the district's 82,000 inhabitants.

"It is very unfortunate, especially for people like me who are on ARVs and also TB [tuberculosis] treatment. Things are very difficult ... this is like punishing us, and yet we need the support of everyone," Sikazwe said.

Corruption

In May 2009 several donors, including two of Zambia's main donors, the governments of the Netherlands and Sweden, announced the suspension of aid after it was confirmed that senior government officials had embezzled about US$5 million of donor funds from the health ministry. Donors provide 55 percent of Zambia's health budget for the prevention and treatment of malaria, TB and HIV, as well as training medical staff.

A tough stance on corruption had endeared the late President Levy Mwanawasa's administration to the donor community, but since his death in August 2008, that of his successor, President Rupiah Banda, has been deemed soft on corruption.

''The crisis in the health sector financial management, the issue of single sourcing of procurement of mobile hospitals, issues surrounding road sector investments and a general lack of progress in financial management reform in government are the most notable issues''
In the wake of the aid suspension, Zambia's Anti-Corruption Commission (ACC) and its Auditor-General investigated the corruption claims and a number of high-profile officials subsequently appeared in court. However, donors insist that Zambia needs to meet certain benchmarks in good governance and public financial management before further funding is released.

"The crisis in the health sector financial management, the issue of single sourcing of procurement of mobile hospitals, issues surrounding road sector investments and a general lack of progress in financial management reform in government are the most notable issues," the Dutch Ambassador to Zambia, Harry Molennar, told a local newspaper, The Times of Zambia.

"The recent developments in Zambia regarding high-profile corruption cases, and the international response to it, serve as a case in point to illustrate the need for both strong political leadership in the fight against corruption, and the resolve of that same leadership to let justice have its independent and transparent way," he said.

Obert Mubyana, the district HIV and TB programmes officer in Mpulungu, told IRIN that in "The past three or four months [since donor aid was suspended], the situation has been very bad. We are not able to travel ... [and] have a lot of patients that we need to monitor." A lack of funds has also meant that patients in outlying areas who need to start taking ARVs are not doing so.

"The whole grant ... per month ... [from] donors and government is about 120 million kwacha [about US$27,000], but after the withdrawal [of donor funding] we have been receiving as [little] as 40 million kwacha [about US$9,000]. This is not enough because ... [we have] to carry out mobile VCT, mobile ART, we need fuel, we need allowances, so we have had to suspend a lot of programmes," Mubyana said.

Trading hub

Mpulungu, Zambia's only port on Lake Tanganyika and a regional trading hub, attracts people from neighbouring Tanzania, Rwanda and the Democratic Republic of Congo, and is a high-risk area for HIV infection.

The town has thousands of sex workers, some of whom often travel the country's highways. "We come here this month; we go to Kapiri Mposhi [town on the main road about 150k north of Lusaka] next time. We go to Chirundu [on the Zimbabwean border] also, even Nakonde [on the border with Tanzania]," a teenage sex worker told IRIN. She charges about US$1.25 for her services.

HIV Prevalence is around 12.6 percent – the national average is 14 percent – but unofficial statistics from local health facilities estimate the rate could be as high as 50 percent. At Mpulungu clinic, 2,308 people have been tested for HIV since 2006, of whom 1,199 were found positive and 1,189 are receiving treatment.

"Of course, most of these people only come here when things are really critical, after they have failed with their ... [traditional healers], so there could be some margin of error," Flexon Mauluka, a data entry clerk at the clinic, told IRIN.

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