Papua New Guinea has signed a $14.2 million grant with the Global Fund under the new funding model that emphasizes outreach and targeted prevention messages for key populations, as well as continuing service delivery even to the most remote areas in the Pacific nation.
Speaking at a signing ceremony on 15 June, Lady Roslyn Morauta, chair of the country coordinating mechanism, noted that while there has been progress in reducing the HIV infection rate to a national prevalence of just over 1%, “the new grant seeks to go further by reaching people who might have difficulty accessing services and medication due to stigma or gender-based violence.”
Included in the grant will be considerable work at community level aiming to improve adherence to treatment regimens among the estimated 30,000 people currently taking ARVs in PNG. Current default rates are high – over 25% in some areas due to the challenging terrain, high cost of transport and societal issues including an entrenched culture of violence.
The grant, to be implemented by the corporate principal recipient Oil Search Health Foundation, also includes funding for peer educators to reach the most vulnerable around urban ‘hotspots’ where the key affected populations of men who have sex with men, transgender people and sex workers tend to congregate. Ensuring that these populations will not be deprived of access to health services because of stigma and discrimination will also drive awareness and sensitization training for the so-called gatekeepers: the health workers and law enforcement personnel who could be key allies in ensuring that everyone can access treatment.
Some of the grant money is going to help strengthen the national health system’s ability to monitor its population: a crucial need in a country with weak strategic health information and an antiquated paper-based reporting mechanism at the provincial levels. Better data collection and analysis of the size of the key populations will be carried out by the Institute for Medical Research, including a bio-behavioral study planned for 2016 in three of the main urban areas where HIV incidence is currently higher.
Other sub-recipients include service deliverers Anglicare and Hope Worldwide, as well as IgatHope – an organization for people living with HIV.
The new focus on key affected populations, however, has caused some concern among the religious institutions that are responsible for 50% of the services delivered in rural areas. They say that due to the nature of HIV transmission in those areas, abandoning the work being done at community level to respond to what has thus far been a general epidemic, could contribute to a rise in new infections.
While there is some money in the grant that will help to expand testing of pregnant women, people suffering from TB and those who present at facilities with sexually transmitted infections – a major problem in PNG as well as across the Pacific region – the resources available under the grant are decidedly fewer than they have been in the past, and major modifications had to be made in the development of the concept note.
Catholic HIV/AIDS Service, which had been a pioneer in delivering ARVs in the country and a major recipient of Global Fund support in the past, works in nine provinces nationwide identified as high-burden, supporting 20 sites that deliver Fund-supported services. Reorientation of Fund investments to an even narrower band of ‘priority’ provinces – just five of the 22 – means that some of the original sites risk closure.
Another concern relates to what is not being covered by the grant: commodity purchases including rapid diagnostic test kits, drugs for opportunistic infections and ARVs themselves. As part of its counterpart financing requirement, the PNG government is taking on responsibility for all purchasing – with some support from technical partners. UNICEF will support the National Department of Health (NDoH) for the purchase through the Global Drug Facility of ARV, test kits and drugs for opportunistic infections, while the medical supply stores of the central government will be responsible, with help from WHO, to procure condoms and other prevention materials.
Funds within the NDoH will be quarantined to ensure they are available for the commodity purchases, paid for from the recurrent budget. The NDoH has quarantined 15 million kina (around US$7.5 million) per year for procurement of these commodities.
There are, however, massive problems in the supply chain, both in terms of human and financial resources, in developing and sticking to procurement templates, in data management: so much so that many partners have developed parallel chains to ensure that there are no delays in stocks arriving. This is a prohibitively expensive alternative solution and not sustainable in the long term.
There are also problems of distribution – not just of supply. Such challenges revealed themselves during a recent Aidspan visit to the island province of East New Britain. A health facility serving one of the largest clusters of communities around the capital, Rabaul, spoke of months of delays in receiving orders for both test kits and condoms. And when they did arrive, they were expired by more than six months.