AFRO-NETS> Accelerating action to combat the HIV/AIDS pandemic in Zambia

["Dr. Paul Zeitz" <pzeitz@usaid.gov>]

Accelerating action to combat the HIV/AIDS pandemic in Zambia
-------------------------------------------------------------

GOAL

To support an expanded multisectoral response to the Zambia HIV-AIDS 
pandemic to scale-up the delivery of effective interventions by Govern-
ment, NGOs, and the private sector.

CONTEXT

Devastation of HIV-AIDS in Zambia

Zambia has one of worst HIV-AIDS pandemics in the World, with an esti-
mated 20% of the adult population HIV-positive. AIDS-related deaths are 
rapidly escalating, and expected to peak in 2005. Life expectancy is 
plummeting, with the average Zambian lifespan dropping from 54 years to 
37 years. The pandemic is also leading to an unprecedented AIDS orphan 
crisis, with an estimated 1,000,000 orphans by the year 2000, repre-
senting approximately 10% of the total population of Zambia. A secon-
dary tuberculosis pandemic is also debilitating the economically pro-
ductive work force. Historic improvements in child survival are also 
being lost in the specter of HIV-AIDS. In summary, the Zambia HIV-AIDS 
pandemic seriously threatens the country's prospects for sustainable 
economic development as it depletes the country's most educated, ener-
getic, and productive population.

Zambian Response

To combat this crisis, President FJT Chiluba announced in March 1999, a 
new commitment to rapidly expand the national response with a war 
against AIDS when he said, "We must all unite in the fight against 
AIDS." The Government of the Republic of Zambia (GRZ) is in the final 
stages of planning for the implementation of a new National HIV-AIDS 
Council and an HIV-AIDS Secretariat which has been designed to support 
an expanded multi-sectoral response.

Debt Burden Hinders Effective Response

A major factor hindering an effective HIV-AIDS response in Zambia re-
sponse is the macroeconomic situation and the unsustainable debt bur-
den. During 1998, the real gross domestic productivity (GDP) per capita 
is estimated to have declined by 5%. Inflation rose from 18.6 percent 
at the end of 1997 to 30.6 percent at the end of 1998. Interest rates 
rose sharply while the Kwacha depreciated rapidly. These factors led to 
tight fiscal constraint as revenues were below targets, while expendi-
ture pressures increased. The 1998 GRZ debt servicing obligations of 
$123 million paid to the Paris Club Members and the multilateral insti-
tutions was equivalent to 69% of the amount budgeted by the GRZ from 
its own resources for the social sectors. For example, District Health 
Boards only received 30% of their expected budget in 1998, therefore 
they were unable to effectively implement HIV-AIDS prevention and con-
trol activities, TB control, or control of sexually-transmitted infec-
tions. The GRZ currently has no formal mechanism for providing finan-
cial support to civil society NGOs that are at the front lines in the 
battle against HIV-AIDS. The debt burden severely compromises the abil-
ity of GRZ and the civil NGO sector to effectively respond to the HIV-
AIDS crisis.

DECLARING WAR ON HIV-AIDS BY SCALING-UP RESPONSE

Accelerating Action Through a Multidonor 'Debt for Development' Agree-
ment

The GRZ is in the final stages of developing a proposal for "Accelerat-
ing Action Against the Zambia HIV-AIDS Pandemic Using a Multidonor 
'Debt for Development' Agreement." This proposal will be presented to 
bilateral and multilateral cooperating partners during the May 26-28, 
1999 Consultative Group Meeting in Paris. To accelerate the Zambia de-
velopment process, by accelerating the national response to the HIV-
AIDS pandemic, a multi-donor 'Debt for Development' Agreement is pro-
posed. This agreement is based on the following implementation steps:

Plans of Action:
Government of the Republic of Zambia (GRZ) and non-governmental organi-
zations (NGOs) finalize HIV-AIDS Response Plans of Action (GRZ Minis-
tries and NGO Response Plans). These plans will include a multiple year 
strategic plan, budget, and a monitoring and evaluation framework;

HIV-AIDS Response Fund:
GRZ establishes a "HIV-AIDS Response Fund" to receive agreed upon re-
sources from creditors. The implementation of this fund shifts re-
sources towards supplementary domestic investment in the national HIV-
AIDS response. Actual GRZ and NGO expenditures will serve as the base-
line for monitoring supplementary investments in the HIV-AIDS response;

Performance Milestones:
The "HIV-AIDS 'Debt for Development' Agreement" will be based on agreed 
upon performance milestones that support the implementation of the Zam-
bia HIV-AIDS Plan of Actions. Performance milestones will be developed 
to establish targets for legal, policy, technical performance, and peo-
ple-level impact, as well as, the establishment and implementation of 
systems of financial accountability;

The development phase of the Zambia HIV-AIDS 'Debt for Development' is 
driven by an unprecedented positive response from the people of Zambia. 
As the full impact the AIDS pandemic is affecting all Zambians, the 
HIV-AIDS 'Debt for Development' Agreement is providing a "ray of hope" 
in an otherwise desperately fatalistic environment.

Options for Creditors

Bilateral and multilateral cooperating partners will have different op-
tions for channeling resources into the "HIV-AIDS Response Fund." These 
include, but are not limited to:

Debt Servicing Swap:
so that principle and interest due to creditor countries would be paid 
into the HIV-AIDS Response Fund instead of to creditor countries;

Moratorium of Debt Servicing:
creditor have the option of issuing a moratorium on debt servicing 
which would defer debt servicing obligations (principle and interest) 
into the HIV-AIDS Response Fund;

Debt for Development Mechanisms:
creditor can transfer debt obligations into the HIV-AIDS Response Fund;

Direct Contributions:
creditor countries and multilateral institutions could provide direct 
contributions to the HIV-AIDS Response Fund as part of their overall 
assistance to the GRZ.

ORGANIZING FOR ACTION

Task Force for the Multidonor 'Debt for Development' Agreement to Ac-
celerate Action to Combat the Zambia HIV-AIDS Pandemic

The GRZ has formed an Interagency Task Force to support the develop-
ment, implementation, and monitoring of the multidonor HIV-AIDS 'Debt 
for Development' Agreement.

GRZ Institutional Oversight

The GRZ is in the final phase of establishing a National HIV-AIDS Coun-
cil and a National HIV-AIDS Secretariat which is charged with the re-
sponsibility of coordinating a multi-sectoral response to the HIV-AIDS 
pandemic. The National HIV-AIDS Council and Secretariat are the pro-
posed GRZ institutions that will be responsible for the development, 
implementation, and monitoring of the proposed HIV-AIDS Multidonor 
'Debt for Development' Agreement. The National HIV-AIDS Council and 
Secretariat would make recommendations on funding priorities to be sup-
ported by the HIV-AIDS Response Fund.

GRZ-Cooperating Partners HIV-AIDS Response Fund Steering Committee

A joint "GRZ-Cooperating Partners HIV-AIDS Response Fund Steering Com-
mittee" would be formed from various interest groups, such as Govern-
ment, Co-operating Partners (including creditor countries and multilat-
eral agencies, NGOs and other interest groups. The Steering Committee 
would make final decisions on resource allocation disbursements, moni-
tor the performance of the implementation institutions against the 
agreed upon milestones. The National HIV-AIDS Secretariat would be re-
sponsible for managing the proposed "GRZ-Cooperating Partners HIV-AIDS 
Response Fund Steering Committee."

Support for this Initiative is actively under discussion among UN Agen-
cies, US government officials, and other creditors.

--
Dr. Paul Zeitz
Senior Policy and Technical Advisor for PHN USAID/Zambia
and GRZ/Central Board of Health
Tel:  +260-1-254-303
Cell: +260-1-702-042 
Fax:  +260-1-254-532 
home: +260-1-264-700 
mailto:pzeitz@usaid.gov

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