VZCZCXRO1820
RR RUEHBZ RUEHDU RUEHGI RUEHMA RUEHMR RUEHPA RUEHRN RUEHTRO
DE RUEHYD #0357/01 1061528
ZNR UUUUU ZZH
R 161528Z APR 09
FM AMEMBASSY YAOUNDE
TO RUEHC/SECSTATE WASHDC 9846
INFO RUEHZO/AFRICAN UNION COLLECTIVE
RUCPDOC/DEPT OF COMMERCE WASHDC
RUEHGV/USMISSION GENEVA 0246
RUEAUSA/DEPT OF HHS WASHDC 0001
RUEHPH/CDC ATLANTA GA

UNCLAS SECTION 01 OF 02 YAOUNDE 000357 
 
SENSITIVE 
SIPDIS 
 
DEPT FOR AF/C, ACCRA FOR JEANNIE FRIEDMANN, DEPT FOR USAID 
USDOC FOR ITA - K BURRESS 
 
E.O. 12958: N/A 
TAGS: KHIV KOCI SOCI PGOV CM
SUBJECT: CAMEROON: RUNNING OUT OF ANTI-RETROVIRAL DRUGS 
 
REF: 08 YAOUNDE 877 
 
¶1. (SBU) SUMMARY: The Government of Cameroon (GRC) 
anticipates it will run out of anti-retroviral (ARV) drugs by 
September 2009, leaving an estimated 60,000 patients without 
medication. The GRC has sought international funding to meet 
this shortage and has apparently not considered using its own 
resources.  The interruption of life-saving anti-retroviral 
treatment (ART) for tens of thousands of patients would 
likely result in avoidable deaths and heightened popular 
frustration over the GRC's failed governance of the health 
sector.  END SUMMARY. 
 
An ARV Crisis in the Making? 
--------------------------- 
 
¶2. (SBU) In May 2007, the GRC announced that it would start 
providing free ART to any citizen infected by AIDS and 
needing treatment.  The GRC estimates that 135,000 people 
need treatment, but only 44% (or 60,000) are actually 
receiving it.  (Comment.  We give greater credence to the 
estimates of UNAIDS, which indicate as many as 157,000 
Cameroonians currently need ART.  UNAIDS plans a conference 
in May to reconcile the competing estimates.  End Comment.) 
The Global Fund to Fight AIDS, Tuberculosis and Malaria 
(Global Fund) allocated tens of million dollars in Round 3 
funds to support the Ministry of Public Health's on-going 
country-wide ART programs, with the Global Fund subsidizing 
the cost of ARVs. 
 
Poor Planning/Execution Leads to Crunch 
--------------------------------------- 
 
¶3. (U) The GRC has overspent the Global Fund Round 3 budget, 
meaning that the funds, which were supposed to run through 
December 2009, will actually be exhausted as early as 
September 2009.  Due to the increase in patients on ART, the 
GRC has overspent the ARV line item by 300%.  In a recent 
meeting Poloff attended, the Ministry of Public Health 
announced that it will require an additional $3.8 million to 
continue providing anti-retroviral treatment to patients 
currently on ART until the end of the calendar year.  The GRC 
began to ask for additional bilateral funding from donors, 
previously unaware of the problem, in August 2008. 
 
Donors Unlikely to Bail Out GRC 
------------------------------- 
 
¶4. (SBU) At a donor roundtable on March 16, representatives 
from France, Germany, UNICEF, and UNFPA 
stated that their institutions are unlikely to contribute 
additional funds for the purchase of ARVs.  All of these 
groups already contribute either to the Global Fund or to 
health programs in-country.  The representatives were 
unanimous in arguing that the GRC has the financial 
capability to fund ARV treatment, if the budget is 
reorganized and priorities are shifted. 
 
GRC Lacks Ownership, Buy-In 
For Global Fund Programs 
--------------------------- 
 
¶5. (U) Despite some improvements in the management of Global 
Fund programs, high-level GRC health officials told Poloff 
privately that the GRC has not been paying its share of the 
Global Fund project, blaming a combination of communication 
difficulties between the Ministry of Public Health and the 
Minister of Finance and a general lack of buy-in from the 
GRC.  Officials responsible for the HIV/AIDS program in 
Cameroon told Poloff that the GRC does not yet have an action 
plan to cover provision of ARV, and continues to hope that 
international donors will step up to fund it.  The Director 
of the GRC's National AIDS Control Council (NACC) announced 
in a March CCM meeting that if a solution is not forthcoming, 
the Ministry of Public Health will likely to cut other 
services to patients living with HIV/AIDS and 
orphans/vulnerable children (part of the Round 3 project) in 
order to avoid interruptions in ARV treatment. 
 
Changes in the CCM 
------------------ 
 
¶6. (U) Until recently, the Country Coordinating Mechanism 
(CCM) of the Global Fund in Cameroon was poorly organized and 
consumed by infighting.  Post has used its seat on the newly 
 
YAOUNDE 00000357  002 OF 002 
 
 
reconstituted CCM to lobby for improved governance.  A recent 
visit by Global Fund representatives from Geneva, which gave 
strict instructions as to how the CCM should function, has 
prompted many fundamental changes.  Communication has been 
improved by hiring a technical secretary, creating an email 
list serve, and planning meetings well in advance.  In an 
important change from the previously opaque process dominated 
by the Ministry of Public Health, the CCM will have ample 
time to review and comment on Round 9 proposals from the 
Ministry of Public Health and civil society to decide which 
should be considered. 
 
Comment: GRC Failing to 
Take Ownership for ART 
----------------------- 
 
¶7. (SBU) The GRC should be able to fund ARV provisions from 
its national health budget of 113 billion Central African 
Francs ($226 million).  This budget is a $50 million increase 
from the previous year, with the increase supposedly going to 
support free medical treatment for people living with 
HIV/AIDS.  Unfortunately, corruption and poor governance 
(reftel) have meant Cameroonians continue to die of AIDS 
despite ample domestic and international funding.  Although 
early in its new iteration, the CCM is taking a more active 
role in design and implementation of Global Fund projects. 
Post believes the CCM would benefit from additional training 
on its proper functioning, especially its role in monitoring 
implementation of projects. 
 
¶8.  (SBU)  The GRC has five months to develop and implement a 
plan of action or tens thousands of ARV patients will be 
forced to interrupt treatment.  We are concerned about this 
looming disaster, but do not perceive the same sense of 
urgency from Cameroonian officials.  As the international 
community appears unwilling to bail out the GRC from this 
crisis of its own creation, we anticipate the Ministry of 
Health will end up cannibalizing other programs in order to 
provide some semblance of continuity in the politically 
popular "universal" provision of ART.  But tens of thousands 
of Cameroonians who need ART are not receiving it, a number 
that is likely to increase as the program falters in the 
coming months and contribute to already simmering social 
anger at the GRC's poor governance. 
FOX