Implementing a national program in Zambia to address HIV/AIDS prevention, care, and support has been expensive. One of the encouraging trends in Zambia is that considerably more resources are now available to fight HIV/AIDS than were available even a few years ago. Resources for HIV/AIDS come from international sources, the government budget, the private sector, and individual households. Estimating past expenditures on HIV/AIDS and projecting future needs was difficult. However, Zambia recently conducted 2006/7 National AIDS Spending Assessment (NASA) to track the different financial inflows for HIV/AIDS interventions and the amounts spent on those different interventions.

It was until recently, difficult to cost HIV/AIDS interventions. There is an overall idea of what is needed to help prevent HIV transmission and mitigate the impact of the epidemic, the exact combination of interventions and programs is certain. The National HIV/AIDS/STI/TB Council took a lead role in the development of the National HIV/AIDS Intervention Strategic Plan, 2002-2005 and then prepared cost estimates for the interventions. The overall cost of the three-year plan would be close to $560 million, or about $187 million per year. Of the total, 44% is designated for preventing HIV transmission; 50% is for treatment and care and otherwise reducing the impact of the epidemic; and 6% is for monitoring, evaluation, technical support, and coordination. The largest line items are for in-school youth programs, primarily designed to promote sexual abstinence and delayed sexual activity, and the provision of antiretroviral therapy for PLHA. The $187 million per year would come from the government budget, from private sector and business sources, and from the cooperating partners. The country has not yet managed to mobilize this amount.

Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.

The United Nations led the initiative to create the independent Global Fund to Fight AIDS, Tuberculosis and Malaria. Its purpose is to increase dramatically the global resources available to address these three diseases and to finance effective prevention, treatment, and care and support programs. Developed and developing country governments, corporations, foundations, and even individuals contribute to the Global Fund. The Fund then solicits proposals from affected countries, evaluates the proposals, makes awards, and distributes the monies. Public, private, and non-governmental programs are eligible for grants, although countries usually submit a unified proposal.

Through August 2004, the Global Fund has approved and Zambia has become eligible to receive $478 million, of which $346 million is for HIV/AIDS work, $49 million is for tuberculosis, and $83 million is for malaria. The Round 4 grant to Zambia, announced in June 2004, is the largest, at $297 million. Each grant has a total lifetime budget over fiver years, although funding can be accelerated if necessary.

The HIV/AIDS funds are designed to support a broad range of prevention, care, support, and treatment programs. The funds move through four main channels known as Principal Recipients: Churches Health Association of Zambia (for FBOs), Ministry of Finance (for line ministries), Ministry of Health and Zambia National AIDS Network (NGOs and the private sector). To date the Global Fund has disbursed about $15 million of the HIV/AIDS grant to Zambia.

World Bank Multi-Country HIV/AIDS Program for the Africa Region (MAP2). The World Bank has also provided a five-year, $42 million grant through the Second Multi-Country HIV/AIDS Program for the Africa Region (MAP2). The project was known as Zambia National Response to HIV/AIDS (ZANARA).

ZANARA, through the Zambia Social Investment Fund (ZAMSIF supported community responses to the epidemic either by directly funding activities of community-based organizations or by facilitating interventions by NGOs, faith-based groups, or organizations representing PLHA. This component was known as the Community Response to HIV and AIDS (CRAIDS) initiative.

The Ministry of Finance and National Planning (MoFNP) administers the overall project and channels funds to line ministries. Each line ministry is expected to address the internal impact, or the way the epidemic affects the capability of the ministry to provide quality services, and the external impact, or the way in which the sector can contribute to prevention and care programs. The Ministry of Health also receives funds to implement its HIV/AIDS work plan.

Many Cooperating Partners (CPs) are providing substantive and increasing support to help Zambia address the HIV/AIDS epidemic. The U.S. Government is the single largest bilateral donor. The U.S. Government has chosen to Zambia as one of the recipient countries under the Presidential Emergency Plan for AIDS Relief, often known as PEPFAR. The United Kingdom's Department for International Development (DFID) is initiating a five-year program at a minimal cost of £20 million. The Netherlands, Denmark, Sweden, Norway, Ireland and Japan also provide support that is critical to national efforts. The United Nations system (UNAIDS, UNICEF, WHO, UNFPA, UNDP) is also an important source of support for Zambian programs.

A. Disbursement of funds for programs

Global Fund:

The Global Fund has established a central level institutional set up called the Country Coordinating Mechanism. In principle, the Country Coordinating Mechanism functions as a single mechanism for joint programming, implementation and reporting on Global Funds. It helps to organize and submit grant applications to the Global fund and monitor their implementation.

When grants are approved and the money arrives, it is given to the Principal Recipients, who are basically the body that are legally responsible for distributing it or using it to tackle HIV, Malaria or TB in the country. The four Principal Recipients in Zambia are: the Ministry of Finance and National Planning, the Ministry of Health, the Zambian National AIDS Network (ZNAN) and the Churches Health Association of Zambia (CHAZ).

One of the most important parts of the funding process is ensuring that the money given out in grants actually reaches the people who nee it. To ensure this happens, every Principal Recipients is assigned a Local Fund Agent (LFA). In Zambia the LFA for all Principal Recipients is PricewaterhouseCoopers (PWC).

PEPFAR:

Different from the Global Fund financing mechanism, the PEPFAR scheme actively seeks out suitable recipients and offer them money. The expenditure of PEPFAR money is coordinated by Ambassador Tobias' Office, but is distributed through a number of government agencies which include the U.S. Agency for International Development (USAID), the U.S. Department of Health and Human Services (HHS), the U.S. Department of Defense, the Department of Labor, the Peace Corps and the Census Bureau. The most active recipient of funds in Zambia is USAID.

The PEPFAR funding is therefore meant to indirectly support Ministry of Health, National AIDS Council, Private Sector Workshop Programs, Youth Organizations and the Ministry of Sport, Youth and Child Development, FBOs and NGOs in response to HIV/AIDS. The implementing agencies mainly include international NGOs and FBOs who access funds directory from PEPFAR. This is the sense in which PEPFAR actively seeks country partners for running the programs it supports. It is argued that PEPFAR funding, despite the over-performance seen earlier has no direct bearing on Zambia's Medium Term Expenditure Framework (MTEF), and only complements the scaling of the national response to HIV and AIDS in Zambia.

World Bank ZANARA:

Until 2008, ZANARA funds which were channeled through the Ministry of Finance and National Planning (MOFNP) were allocated to the following components:

Component "A" Community Response to HIV/AIDS (CRAIDS):

The objective of CRAIDS was to improve the response of the communities to HIV and AIDS by providing sub-grants to community initiatives that contribute to the prevention of HIV/AIDS, mitigate the impact of HIV and AIDS on the household and improves the quality and access to care of those affected by HIV and AIDS. CRAIDS has so far developed structures, systems and processes to facilitate the implementation of its work plan and budget as well as mobilization and support of communities and civil society organizations.

Component "B" The National AIDS Council (NAC) and its Secretariat

This objective of this component was to support the National AIDS Council and its Secretariat to carry out its institutional mandate of program coordination, monitoring and evaluation of the national multi-sectoral response to the HIV and AIDS epidemic.

Component "C" Line Ministries, including Ministry of Health:

The objective of this component was to expand the public sector multi-sectoral response to HIVand AIDS epidemic by initiating, facilitating and supporting the mainstreaming of HIV/AIDS related activities into the Line Ministries' work plans and to support the Ministry of Health's National Health Service delivery program.

Component "D" The Programme Administration Unit (PAU):

The objective of PAU is to facilitate the multi-sectoral response to HIV and AIDS by supporting the project implementing and coordinating agencies in carrying out activities under the project.Components A, B, C and D all received funding through official government budgetary and extra-budgetary channels.

B. Financing Modalities of the National AIDS Council for Coordination and M&E

Of interest as financing mechanism are the NAC financing modalities for coordination and monitoring the activities of the District AIDS Task Forces (DATFs) and the Provincial AIDS Task Forces (PATFs).NAC disburses financial resources to PATFs and DATFs for planning, coordination, monitoring and operational costs. At both provincial and district levels, NAC sends financial resources to directly to PATF or DATF designated accounts with a notification to the Provincial Permanent Secretaries who Controlling Officers for all line ministry departmental resources at Provincial level.