South Africa recently received a significant boost in the fight against HIV. Or at least, in the fight to fund the fight against HIV. The grant, the largest from the Global Fund to date, includes money for strengthening systems and expanded male medical circumcision. At the same time, Malawi's application, focused on various things including strengthening prevention of mother-to-child transmission of HIV through innovative programmes aimed at retaining trained health workers and similar sustainable, broadly useful objectives, was rejected. Potentially because it was too ambitious.
Perhaps there are good reasons for this. Perhaps the disease burden is greater in South African than in Malawi where 59% of deaths between 15 and 59 years are blamed on HIV/AIDS. Perhaps the Global Fund feels that the priorities of South Africa are more in line with their agenda than those of countries like Malawi, which begs questions about which population group or groups are being prioritised in prevention efforts.
A further concern is what expectations donors like the global fund are placing on countries themselves. Malawi's GDP is 4.9 billion (US). South Africa's GDP is 258.9 billion (US). One wonders if some of the money the Global Fund is directing towards strengthening health systems in South Africa couldn't be redirected to Malawi and the South African government take the responsibility instead.
Other countries not getting funding or getting limited funding for their HIV and TB programmes include Swaziland, Mozambique, the DRC and Zimbabwe. The Global Fund is an independent organisation but many of the donors are countries. One wonders how the funding of projects is being directed and to what extent need is really being considered.