PEPFAR-Blog

There is minimal disruption to HIV services in Malawi. People living with HIV are receiving services. People living with HIV who go to facilities that have been are closed are being referred to government services that are open. Early last week, in response to UNAIDS’ advocacy, the government issued a press release assuring the public that HIV services will continue uninterrupted. Also last week the government developed a contingency plan, which will form Part B of the ongoing work to develop a Sustainability Plan for Malawi. The government issued a circular of the activities it will prioritize going forward. It has redeployed its staff to fill the positions that are vacant because of the stop order. In general services are ongoing. 

Unfortunately, PrEP and long-acting injectables are not part of the package the government will prioritize. Civil Society groups are concerned about the omission of prevention interventions beyond treatment and PrEP for pregnant and breastfeed women. UNAIDS is working with other international partners to see if they would be willing to support PrEP and long-acting injectables.

Staff partner reduction

Non-government organisations such as Partners in Hope, Partners in Health, Baylor College, Lighthouse Trust, Pakachere, CEDEP, EGPFAP, Right to Care, JPPHEIGO, MACRO employ more than 4000 cadre of staff in support of the AIDS response using PEPFAR and CDC resources. These cadre include 180 Doctors, 1640 Health Diagnostic Assistants, and 1870 treatment supporters received stop orders and ceased their activities. Some of these NGOs did not receive the Stop Orders but stopped activities as a precaution. They surrendered the work equipment, including computers and vehicles at the district health offices. Civil society organizations including the Malawi AIDS Services Organisation and the Malawi network of people living with HIV work has been impacted. They have stopped or slowed their community-led monitoring work.

Interruptions to Services at Key Populations Drop-In Centres

The drop-in centers for key population are not staffed because most of the staff are PEPFAR or CDC supported, who are not working. The drop-in centres are open but minimally staffed.  PLHIV are worried about what will happen when the stocks in country – approximately 9-months-worth – run out. Members of civil society are keen to understand how the government will move Malawi’s response to HIV forward, sustainably. They are also concerned about the continuity of prevention and treatment efforts going on in Global Fund Grant Cycle 7 given that the US government provides the bulk of contributions to the GFATM.

The UN Family Responds Together

The UNCT met to discuss the situation. Beyond HIV, the impact of the Stop Order was widespread including on support for the forthcoming elections, maternal and child health and resettlement of refugees. The UNCT agreed on a series of support and advocacy efforts to move forward including reaching out to the government to find out where they need our support and what austerity measures they will take given the freeze on funding.

Last week, the U.S. Ambassador assured the UNAIDS Country Office that PEPFAR-supported services will recommence early next week. She indicated the country needs to complete the sign the Sustainability Plan.

The UCO met the Minister of Health and reached out to other Senior Government Officials and the Sustainability plan has now been cleared by the Minister of Health. The UCO understands the Sustainability plan and the Contingency Plan are  one of the key items that the Minister will share with the President this Friday.  

The UCO will continue to meet with the Minister of Health and Ambassadors from other countries, the NAC, and civil society to understand the flow of services in the districts and see how best we can support.