PEPFAR and Its Role in Botswana

While many people disagree with policies enacted by George W. Bush during his presidency, there is little debate that as a head of state his support of global health initiatives rivals all others. Perhaps Bush’s crowning achievement was the President’s Emergency Plan for AIDS Relief, know globally as PEPFAR. PEPFAR, launched in 2003, represents the largest effort by any nation to combat a single disease. PEPFAR focuses on expanding access to HIV prevention, care and treatment in low-resource settings – the first phase of the program provided antiretroviral (ARV) treatment to more than 2 million people internationally. In July of 2008 the Lantos and Hyde Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act was signed, authorizing up to $48 billion over 5 years to combat HIV, TB and malaria. Botswana, a nation that has been severely impacted by the AIDS epidemic, is among the 33 nations chosen to receive PEPFAR aid.

Yesterday our group had the opportunity to sit for an informal chat with an employee of the Partnership for Supply Chain Management (PFSCM), a company contracted to sit within the Ministry of Health in Botswana to address allocation of PEPFAR funds and provision of supplies, such as ARVs. PFSCM is stationed in Gaborone for three years, and is working with the Botswana government to build an optimal system for procurement and distribution of supplies.

Botswana is one of the only African countries committed to providing life-long HIV care and ARV supplies to citizens free of charge. This represents a massive amount of funding funneled into procurement of ARVs. By Botswana’s own estimates, about 17.1 % of the population is HIV positive, a number that ranges up to 39% by World Health Organization estimates. The wealth gained from diamond mining, as well as the generous support of the PEPFAR program has made this supply of ARVs possible. Historically about 80% of the money used to supply ARVs has come from the PEPFAR program, while around 20% has come from the government itself. However, in next 2-3 years PEPFAR will fade out its funding, and will expect Botswana to cover the gap left in funding. What will this funding shift mean for health care priorities in Botswana? How will the government adapt in order to effectively address the change in funding streams, as well as ensure that those citizens already receiving life-saving HIV medications are not denied them in the future? These questions and many more remain to be answered.

References: http://www.pepfar.gov/index.htm