Feature Story

A confusing and evolving situation in Côte d'Ivoire 

The 90-day pause in US foreign assistance has caused a major shock to the national response to AIDS in Côte d’Ivoire. While the US Government released an emergency humanitarian waiver allowing some lifesaving HIV services to move forward during the overall pause, a lack of clarity about what is allowed has led to interruptions in services, even for HIV treatment which is allowed under the waiver.  85% of PLHIV on ART in Cote d’Ivoire are directly supported by the US President’s Emergency Plan for AIDS Relief (PEPAR) programme.  

The US funding pause is creating anxiety and confusion among beneficiaries, service providers and  programme managers. Partners in the AIDS response are reporting a lack of clarity about how to operationalize the waiver —restarting treatment-related activities in line with the waiver is proving much more difficult than stopping all activities. 

For example, government-run clinics and health centres are experiencing staff shortages as some health personnel have had to stop work to comply with the original US President’s Executive Order as PEPFAR tops up their government salaries.   

To assess the situation, UNAIDS has been consulting regularly with national AIDS programme managers, development partners and with civil society and community-led organizations to get a clearer picture of the situation on the ground.   

Both civil society and the national AIDS programme (MoH) have developed plans for the way forward. 

Findings    

The immediate and effective application of the stop-order is creating an alarming situation in terms of the provision and access to services.   

There is a significant communication lag regarding the waiver. Civil society organizations are particularly grappling with how, exactly, to implement the terms of the waiver given considerable budget cuts and given the waiver does not allow for certain complementary support services. This is particularly the case for activities for which US funding complements other sources of funding such as the Global Fund or government resources.  

Main impacts   

On health services:   

•  Immediate large-scale interruption of HIV-related services, including medical examinations and laboratory services    

•  There is a significant risk to adherence to ARV treatment    

• There is a threat to the continued implementation of the Paediatric Action Plan.   

• Tuberculosis programmes have been impacted through the cessation of Stop TB Partnership funding.   

• Critical national strategic planning processes led by the MoH have been interrupted:  2025 spectrum estimates, CIPHIA HIV survey, HIV sustainability roadmap 

On civil society organizations   

• There is a considerable real impact on operational and programmatic activities, including human resources.   

• Widespread temporary and permanent layoffs are reported and associated legal risks related to employee contracts.   

•  An inability to cover operating costs.   

• Co-funded activities and programmes are stopped because critical components are financed by PEPFAR  

• A threat to business continuity and long-term loss of capacity and expertise 

There is a disproportionate impact on vulnerable populations who not only no longer benefit from funding for their prevention, treatment and care activities but may also see their funding from PEPFAR threatened in the long term.   

Solutions and Strategic Recommendations   

Immediate actions:   

• Continued dialogue and joint assessment with the government, civil society and development partners.   

• Strengthen and integrate short and medium-term contingency planning.    

•  Accurately document the interruption of services.   

•  Improve sharing of information with stakeholders and reassure patients and affected populations.   

Resilience strategies :   

• Maintain and accelerate the medium- and long-term sustainability process in this context and ensure that the current situation is considered in this work.   

• Explore new partnerships and mobilise alternative resources    

(private sector, other donors).   

• Optimise the efficiency of programmes.   

• Monitor the impact of the pause on access to services for the most vulnerable, on community structures and their ability to deliver community-led responses.   

Critical points   

• High risk to the continuity of health services.   

• High risk of non-renewal of activities relating to vulnerable populations.   

• Need for a collaborative approach between CSOs, the State and international partners.   

UNAIDS is holding follow up consultations with government, civil society organizations and international partners to analyse needs during the pause and to coordinate efforts to ensure the continuity of HIV services.