According to UNAIDS, ‘Sub-Saharan Africa remains by far the region worst affected by the AIDS epidemic. The region has just over 10 per cent of the world’s population, but is home to two-thirds of all people living with HIV.’ Yet international funding has tended to neglect some of the Francophone countries of the region.

A new report profiles three Central African countries and guides donors on how to fill the gaps in the prevention and treatment of a global pandemic. Belgium’s King Baudouin Foundation (KBF) funded HIV/AIDS in Burundi, the Democratic Republic of the Congo and Rwanda, produced by New Philanthropy Capital (NPC).

HIV/AIDS does not simply take lives. The disease kills young adults and leaves many orphans without the opportunity to attend school, which means low adult productivity a generation later. Orphans need to be cared for by the government, whose tax base is reduced as more and more adults are killed. A 2003 World Bank Report stresses: ‘Keeping infected people alive and well … is not only the compassionate thing to do, but it is also vital for a country’s long-term economic future.’

How to break this vicious cycle?

Because the causes of the pandemic are complex, the battle must be waged on three main fronts:

• prevention and education;
• treatment and care for people with HIV/AIDS;
• support for people, such as orphans, who are indirectly affected.

Approaches need to be both holistic and appropriate to the local context. The report recommends that any intervention must consider local factors such as gender, attitudes to risk, religious beliefs, economic conditions, health systems and other infrastructure, as well as what local people want. The strength of a country’s healthcare system is also central to the success of an intervention.

A snapshot of need and response

Funding to combat HIV/AIDS by long-distance donors is not straightforward. Few foundations or private individuals are in a position to dedicate in-country resources to support grantmaking activities. NPC’s report provides the detailed, contextual information and analysis prospective donors need to understand the extent of the pandemic, social needs, and the outcome of responses under way. Based on extensive field research, the report identifies the organizations working in each country, describes various projects, and advises how donors can target their resources most effectively.

There is another rationale for the report, as Luc Tayart de Borms, KBF’s Managing Director, explains. ‘We strongly believe there are places in Africa that are not on international donors’ radar screen because they are predominantly Francophone. The international donor community should not ignore Central Africa. At the same time, their support should be targeted if it is going to make an impact.’

What to fund and where?

Burundi, the Democratic Republic of Congo (DRC) and Rwanda are extremely challenging – and different – environments and funding and implementing projects in them is difficult. In all three countries, the fight against HIV/AIDS is being made more difficult by extreme poverty and war.

The report examines each country in depth, providing a history, social context, prevalence of HIV and effect of AIDS, existing provisions, an inventory of active international organizations and funders, as well as gaps in provision. Three options for action are outlined:

• Strengthen the healthcare system. Medical infrastructures to deliver care and treatment are increasingly stretched by the unfolding pandemic, and capacity-building is essential to maintain and expand it. However, this cannot be done at the expense of other life-threatening diseases that thrive in poor environments.
• Support an established international or local NGO. The report details the various organizations and the effectiveness of their delivery mechanisms.
• Build the capacity of smaller local NGOs. Capacity-building of organizations to effectively receive grants from the Global Fund and the World Bank will help them implement effective, coordinated and accountable programmes.

The report notes that funding government-supported programmes could work in Burundi and possibly in Rwanda, but not yet in DRC because of political instability. NPC visited 45 out of the many organizations with significant HIV/AIDS programmes in Central Africa and gathered information on a number of others.

They selected five in each country as possible funding recipients because of their quality, the impact of their operations, and their need for secure or additional funding. They range from organizations that could benefit significantly from as little as US$20,000 to those that could make good use of more than US$100,000.

Burundi

Burundi is one of the poorest countries in Africa and the second most densely populated. HIV/AIDS is responsible for up to 70 per cent of hospital bed occupancy. UNAIDS estimates that 40,000 people die from AIDS each year, resulting in 240,000 orphans and 35,000 HIV-infected children.

Because of ongoing conflict, projects by the state and NGOs have been concentrated largely in the capital city. Despite a chronic shortage of doctors outside the capital, there is considerable well-organized activity on the ground. NPC believes Burundi is a ‘funding priority’, particularly for provision of (antiretroviral) ARV drugs and treatment of opportunistic infections (OIs) with conventional drugs.

Burundi’s good treatment plan needs funding. But even if it is realized, an urgent need remains to support affected families, particularly orphans and vulnerable children. Work should continue around targeted prevention efforts and changing attitudes. NPC’s ‘top five’ funding recommendations include the government coordinating body.

Democratic Republic of Congo

DRC has been ravaged by civil war and large parts of the country are inaccessible. Its infrastructure has never been fully developed. In some areas the epidemic is not as acute as in other regions in Africa. However, elements of the response to HIV/AIDS do need funding.

In 2001, an estimated 1.3 million people were infected, with a reported 173,000 infections per year. Today, the National AIDS Control Programme estimates 2.4 million people are HIV positive, 15 per cent of whom have developed full-blown AIDS and are in need of ARV treatment. An estimated 930,000 children have been orphaned and as many as 50,000 to 100,000 are infected.

The situation is most serious in the east, which has been destabilized by civil wars. The report recommends funders to support an international NGO or a technical operator to oversee implementation. NPC met with several NGOs, including AmoCongo, which supports 5,000 orphans and runs two HIV/AIDS clinics, and Merlin, which focuses on reproductive health, rape victims and prevention of mother to child transmission. Support for initiatives that foster collaboration would be helpful.

Rwanda

Rwanda’s infrastructure is reasonably good, but its history of conflict and proximity to East Africa has left a legacy of higher HIV prevalence than in DRC or Burundi. As a result, it has caught the attention of the international community and is quite well funded. However, there are opportunities for funders to support national efforts.

In early 2002, UNAIDS and WHO estimated that 500,000 adults and children were infected. In Kigali Central Hospital, HIV-positive people take up 70 per cent of the beds. UNICEF estimates there are about 250,000 AIDS orphans. Among the results of the 1994 genocide was HIV infection resulting from rapes.

Funding for families affected has been slow to trickle down. Orphans, vulnerable children and families need support, as do many grassroots organizations formed by survivors. AVEGA is a genocide survivors’ association that provides care, counselling and ARV treatment. The core of their work is support groups and home-based care. Private funding could help them continue these activities while expanding their ARV treatment programmes.

KBF works on the ground

An alternative to direct funding would be a contribution to KBF’s funds for HIV/AIDS in Central Africa. KBF works with organizations to arrange the practicalities of funding and to monitor recipients. To date, the foundation has funded six organizations to the tune of nearly €1 million.

Target areas for private funding

The report recommends the following areas for support by private philanthropists, but emphasizes the need for long-term funding initiatives:

• Support for people infected by HIV/AIDS, including care of the sick, orphans and vulnerable children, but not neglecting other family members. Families should be supported where possible so that they can remain together.
• ARV treatment programmes, particularly where delivery is scarce. However, the programme should include capacity-building in terms of delivery.
• HIV education and awareness, provided that programmes being supported are developing as fast as local knowledge and are useful.
• Programmes specifically providing voluntary care and counselling and treatment of OIs and sexually transmitted infections.

There is no one-size-fits-all, but efficient programmes share several key characteristics: professional and committed management, integration with the local community, stability of future funding, and prospects for growth.

Dianna Rienstra works with Phoenix Ink Communications. She can be contacted at Dianna@compuserve.com

For further information, contact Peter Thesin at KBF at thesin.p@kbs-frb.be

To download the report, visit the KBF website at http://www.kbs-frb.be

US donors can work through KBFUS

Individuals, corporations and foundations in the US can support the local non-profit of their choice in DRC, Rwanda or Burundi through a grant to King Baudouin Foundation United States (KBFUS). KBFUS will help you overcome the obstacles to international funding by taking care of the ‘due diligence’ process. It is a public charity, within the meaning of Sections 501(c)(3) and 509(a)(1) of the IRC. Donors may thus claim the maximum tax benefits allowed by US tax law for their contributions. KBFUS can also assist in the development of funding strategies for the region.
For more information, please contact Jean Paul Warmoes, Executive Secretary of KBFUS, on +1 212 713 7660 or at jeanpaul@kbfus.org