From Policy to Practice: SADC Member States Making a Difference

1. From Policy to Practice: SADC Member States Making a Difference The Case of Zimbabwe’s AIDS Levy – A Presentation by Dr. T. Magure NAC CEO

2. HIV situation in Zimbabwe • Estimated number of people living with HIV – 1,390,211 • Prevalence of HIV – 15% • Estimated HIV incidence in 15 – 49 years – 0.98 • Estimated number of new infections – 69,105 • Estimated annual HIV deaths – 63,853 • Number of people in need of ART – 905,368 • Adults on ART: 618,980 (76.9%) • Children on ART: 46,319 (40.5%) • Estimated AIDS Orphans – 889,339 I. Taramusi

3. BACKGROUND • First case of AIDS in Zimbabwe was identified in 1985 • Government first introduced a measure of universal screening of blood for HIV before transfusion in 1985 • Was followed an Emergency Short Term Plan (STP) in 1987, a Medium Term Plan (MTP 1) in 1993, and a 2nd Medium Term Plan (MTP2) in 1994. • NAC was established in 1999 and became operational in 2000to coordinate, facilitate, mobilise, support and monitor a decentralized national Multi-Sectoral response to HIV and AIDS • NAC was established by an ACT of Parliament • Interventions guided by National Strategic Plan – now ZNASP 2 (2011-2015)

4. Motivation for AIDS levy • Worsening HIV and AIDS Situation in the 1990s • Limited government and donor support • External support was the lowest in the region (US$4 per person living with HIV compared to between US$23 to $400 in other countries). • It became evident that treatment costs for HIV demanded more resources than any other illness • Establishing home –grown resource mobilisation initiative to raise resources for the national response to HIV and AIDS • Act as seed fund to mobilise external support • Show government commitment to fight the disease

5. Levy- concept • The levy idea was conceived in late 1990s, in response to worsening HIV and AIDS situation • People living with HIV were becoming organised, making demands – with support from some advocacy and activist organisations • Lobbying for establishment of a specific fund entrenched, involving labour movements, government ministries and depts • Through lobbying, dialogue began between Govt Ministries leading to the birth of the idea of the Levy • Levy established in 2000 • Funded through 3% tax on employee taxable income and corporates

6. Levy processes and procedures • All formally employed individuals and corporates are levied 3% of their taxable income, which is remitted towards the National AIDS Trust Fund • ZIMRA (tax authority) directly deposits the funds into a NAC account • Strategic institutions also funded through board resolutions (they include MoHCC, Blood safety agency, Youth organisations, etc)

7. NATF (Levy) Management arrangements • The NAC Board administers the fund • The board has produced detailed instructions on administration of fund • Secretariat (management) follows the guidelines in allocating funds to specific thematic areas • Board sub-committees play an oversight role over management implementation • An internal audit department follows up on adherence to allocations and utilisation • Externally, fund audited by Dept of Audit and Comptroller (Ministry of Finance) • Parliament Portfolio on Health on regular basis • Fund has been decentralized through NAC structures, in terms of reach

8. Levy Utilisation • 55% Treatment, Care and Support • 11% Prevention • 4% Enabling Environment • 5% M&E, Prog Coordination and Management • 25% Program logistic & support • The Council uses both direct and indirect modes of disbursement to implementers.

9. Impact of Levy • Scale up of prevention programmes –prevalence rate dropped from over 29% in 1997 to 15 in 2010 • 25% contribution towards ART coverage • Basis for further resource mobilisation (Global Fund, USG, CHAI, and others) • SADC Best Practice – documented by SADC and shared in region • Created enabling environment for SADC HIV Fund programmes in Zimbabwe; and Global Fund programmes • Flexibility in use to address emerging related challenges – e.g. drug stock ruptures under Global fund, cancer drugs, etc • Attracted interest from Uganda, Tanzania, Zambia, Botswana, Mozambique, Kenya, etc who have come to learn lessons

10. AIDS LEVY UPDATE (2009-2014) • Collections since from 2009 to March 2014 - $128.4m • Total Spending on HIV Activities - $125.4m • Investment in HIV Interventions - $87.8m (70%) • Program Management and M & E - $8.14m (6.7%) • Program Logistics & Support - $26.7m (21.3%) • Board Related Expenses - $0.43m (0.3%)

11. NATF Supported Expenditure

12. NATF Supported Interventions (2009-13)

13. Care & Treatment Exp Breakdown

14. Lessons Learnt • Self-financing of the HIV response allows Government greater autonomy in determining the content of HIV-related activities • It is a fall back strategy in times of few friends • It demonstrates commitment by the nation to address local challenges • It serves as a basis for the attraction of additional donor funds • AIDS Levy helps Zimbabwe to translate national policies as well as regional policies and aspirations (SADC)

15. Challenges • While the AIDS Levy is an innovative domestic funding model it has it’s own potential risks and it still leaves the overall response and MOHCW heavily reliant on external resources • Economy currently preforming at below expected levels resulting in stagnating of inflows • Therefore need for innovative ways to increase domestic resource base, exploring further and concretizing the investment case work that was initiated for resource optimizations for results through improved efficiencies, cost reduction measures, prioritization of high impact interventions , enhanced synergies and integration

16. Recommendation – way forward • Prioritising interventions with greatest impact. • Integration of activities • Effective and efficient use of resources. • Scaling up PPPs • Widening base of levy collection including informal sector • Increase capacity of various sectors to coordinate