The Global Fund to Fight AIDS stops its aid to Ukraine

For the last few days Ukraine has been closely observed by the international medical community. Perhaps nobody could expect such a sharp turn in its relations with the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which has approved Ukraine’s application for $92 million to implement the Overcoming the AIDS/HIV Epidemics in Ukraine project. However, the fund has decided to stop its aid to Ukraine, announcing this precisely one year after signing its first grant agreements with Ukraine’s Public Health Ministry in Geneva. Then the Ukrainian side in the person of Minister Andriy Pidayev stated that it will “adhere to the course of intensive partnership to prevent spreading of the epidemic” and is very proud to be a member of the fund’s board of directors.

In late January representatives of the fund’s secretariat came to Ukraine to find out the fate of the $7.5 million they have already transferred. The official resume was quite harsh: it will hardly be possible to reach the established goals, if the program is further implemented through the previously selected major recipients. The reason is that the country has spent only $740,000 of the transferred sum. In the fund’s opinion, this is evidence that Ukraine won’t be able to demonstrate its attainments by April 2005.

On the other hand, the same official statement claimed that Ukraine still has some chance. “We understand that your country needs money,” fund Director Richard Feachem said. “Thus, the question is that you should take measures to put the program back on the right course.” Moreover, in his interview with the BBC he stressed that suspending the financing would teach Ukraine a lesson, which in the future will make it use the funds more effectively.

Obviously, this lesson was meant for the Public Health Ministry. Though among money recipients in Ukraine there were also the UN Development Program and Ukrainian Fund to Fight HIV, all claims were laid at the door of the major medical institution. They said that the decision-making process here is overly bureaucratized, while the Global Fund is a financial organization striving for effective use of the funds and obtaining results.

The Public Health Ministry has not yet commented on this issue. However, as The Day learned, they have formed their opinion on this situation. During Vice Prime Minister Dmytro Tabachnyk’s meeting with representatives of the donor organization, the latter stressed that they have no claims against Ukraine’s coordinating mechanism. And suddenly a few days later they sent an official no.

There is a version as to the reason of such an unexpected turn. The two sides failed to agree on the issue of purchasing medications for anti-virus therapy. This question, being very important, is closely connected with money issues: 67% of all funds were allocated for purchasing these medications. The Ukrainian side has held a tender in accordance with the procedure earlier agreed upon with the fund and informed the donor on its results. However, the latter kept silence for eighty days. Without its consent the Public Health Ministry could not make any further steps. Earlier the Global Fund strongly recommended that the medications be purchased only from UNICEF. However, by the ministry’s calculations, this would cost $1.5 billion more.

Among many questions that could arise around this incident the major one is perhaps in what way this will affect the situation concerning HIV in Ukraine.

They put great hope in the Global Fund’s money. In any case, the 2004 budget allots only 14 million hryvnias (about $2.64 million) to fight the infection. However, there is also a program to be run from 2004 to 2008, the financing for which will be in general to 202.1 million hryvnias. However, considering that anti-retrovirus therapy alone costs approximately $1000 per year per patient, and there are several thousand of those needing it, the allotted sums seem insufficient, to put it mildly. Another index characterizing the situation in Ukraine even more clearly is the incidence rate. According to official data, which is probably substantially understated, every year the number of people infected with AIDS in Ukraine increases by one thousand.

However, the Public Health Ministry believes that there is a way out of this situation. They claim that they will meet their responsibilities to those requiring anti-retrovirus therapy. They have enough medicines for this year, and after that Ukraine is planning to start producing anti-retrovirus medication itself, which will bring down the costs of this therapy threefold. At present, as The Day learned from a source close to the Cabinet of Ministers, it is possible that a decision will be made to return the money allotted to the fund. It will most likely be paid from the State Epidemics Fund, which is normally used in case of epidemic emergencies. In addition, it is known that the World Bank supports Ukraine in issues of fighting HIV. Considering the current situation, it is planned that the sum allocated for the HIV/AIDS issues in state budget will increase substantially for 2005.