PEPFAR pulls plug on NGOs

Published: 6 hours ago

Zimbabwe could lose out on a major HIV prevention breakthrough after the United States announced that its new initiative under the President's Emergency Plan for Aids Relief (PEPFAR) will not be distributed through non-governmental organisations (NGOs).

PEPFAR, in partnership with the Global Fund and Gilead Sciences, is rolling out lenacapavir — a twice-yearly injectable drug that has shown near 100% effectiveness in preventing HIV during trials. The intervention aims to reach up to two million people in high-burden countries.

But a senior US State Department official, Jeremy Lewin, said the new model would bypass NGOs, which Washington accuses of draining budgets through "very high indirect cost rates" and operating as a "shadow healthcare system." Instead, national governments will be expected to distribute the drug through their own public health systems.

"We are making a deal to help purchase this innovative medication and get it to countries. It's those countries that are going to be responsible for distributing it through their national healthcare systems," Lewin said.

Health experts warned that Zimbabwe's heavy reliance on NGOs for nearly two decades could now prove costly. Since 2006, PEPFAR has implemented most of its HIV programmes locally through NGOs in partnership with USAID and the CDC.

US-based health economist Fungisai Nota said lenacapavir was a "global blessing," but countries like Zimbabwe risk being sidelined.
"For too long, our government took a back seat in public health provision and relied on NGOs. We are still far behind in developing the infrastructure needed to benefit from this new model," Nota said.

Public health economist Tendayi Chipango urged Zimbabwe to explore local or regional manufacturing of the drug under license and strengthen domestic health financing.
"The way forward is not exclusion but moving from dependency towards a resilient health system that is integrated, accountable, and responsive," she said.

While the new approach is meant to build self-sufficiency, experts warned that without urgent reforms, Zimbabwe may be left behind in accessing one of the most promising HIV prevention tools to date.
- Newsday

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