Cablegate: South Africa Response to New Country Operational

This record is a partial extract of the original cable. The full text of the original cable is not available.

UNCLAS SECTION 01 OF 03 PRETORIA 003475

SIPDIS

SENSITIVE

STATE FOR S/OFFICE OF GLOBAL AIDS COORDINATOR RTOBIAS,
MDYBUL, MMOLONEY-KITTS
STATE PLEASE PASS TO USAID FOR GLOBAL BUREAU
HHS/PHS FOR OFFICE OF GLOBAL HEALTH AFFAIRS WSTEIGER
CDC FOR GLOBAL HEALTH OFFICE DBIRX

E.O. 12948: N/A
TAGS: KHIV EAID PREL SF
SUBJECT: SOUTH AFRICA RESPONSE TO NEW COUNTRY OPERATIONAL
PLAN GUIDANCE

REF: OFFICE OF GLOBAL AIDS COORDINATOR AUGUST 19 NEWS TO

THE FIELD

Sensitive but unclassified. Not for Internet distribution.

1. (SBU) Summary. With fewer than six weeks remaining for
completion of 2006 Country Operational Plans, Post was
dismayed to receive significantly revised guidance on
required program and budget allocations (Ref Email). Post
is firmly committed to achieving 25 percent of the
Presidents 2-7-10 goals under the Emergency Plan for AIDS
Relief as well as to respecting the Emergency Plan
legislation. In collaboration with OGAC, we will make
every effort to develop a revised plan in compliance with
the new guidance. However, we wish to make clear that
moving the goalposts in the middle of the game undercuts
South Africas country-appropriate program design,
complicates partnerships with implementing organizations
and undermines collaboration with the Government. At
worst, it potentially harms our ability to achieve our
portion of the 2-7-10 goals. It is often said that the
Emergency Plan is intended to be a field driven program,
,
yet these important changes were developed without the
benefit of consultations at the field level, at least here
in South Africa. Post appreciates the efforts of those at
OGAC who are working with us to overcome communication
challenges between the field and headquarters. End Summary.

2.(U) The South Africa Mission and our inter-agency
HIV/AIDS Task Force is firmly committed to achieving our
assigned 25 percent of the Presidents 2-7-10 goals under
the Emergency Plan for AIDS Relief. The Mission is fully
engaged in all of the efforts required for a successful
program: developing technically sound plans appropriate
for the South Africa context, partnering with competent
South African, U.S. and other implementing organizations,
nurturing a supportive relationship with the South African
Government and engaging constructively with program
leadership in Washington and Atlanta for policy guidance.
During the first year and a half of Emergency Plan
n
implementation, the South Africa team has made substantial
progress in each of these areas and toward the achievement
of its designated targets.

3. (U) In light of the efforts underway to achieve
Emergency Plan goals, we were dismayed by the recent
program guidance from the Office of the Global AIDS
Coordinator (OGAC) just as focus countries are completing
FY06 country operational plan (COP) submissions (Ref
Email). Given the magnitude of South Africas program in
dollars committed (over $150 million) and implementing
partners involved (over 200), we began planning the FY06
COP and budget in May. Our budget table represents the
results of discussions with all of our partners and
exhaustive inter-agency deliberations to develop a program
that is both appropriate for South Africa and meets OGAC
objectives, as previously defined.

4. (U) Our Emergency Plan program for FY06 has already
been substantially shaped by budgetary requirements. For
or
example, in order to meet previously identified goals, we
have not increased programs supporting prevention of mother
to child HIV transmission this year despite high levels of
mother to child transmission in the country. We have
reduced support to counseling and testing (CT) programs in
order to reach treatment targets. We have not been able to
increase support to palliative care by more than $500,000,
despite the fact that the best anti-retroviral (ARV)
treatment programs also include palliative care "wellness"
components for HIV positive patients not yet eligible for
ARVs.

5.(U) This integration issue makes it extremely
difficult to reach 55% of funding dedicated to treatment
because, as integrated treatment programs expand, other
supporting program elements such as wellness and CT should
expand as well. The newly revised budgetary guidance
compounds conflicts between program goals and budgetary
mandates. The revised measurement of abstinence and be
faithful (AB) targets will require that we increase funding
support to AB programs at the expense of other prevention
programs. Similarly, the new stricter insistence on 55% of
funding dedicated to ARV treatment can only be accomplished
by further reductions in other areas. We were reassured at
the annual Emergency Plan meeting in May and in the prior
version of the COP guidance that As was the case last
year, you are not required to meet the 55% treatment
earmark. Instead, focus countries were instructed to show
continued progress toward this result.

6.(U) The changes to the COP guidance will place
additional burdens on our implementing partners, to adjust
their programs, recalculate their targets and re-write
their largely completed FY06 program plans and COP entries.
These additional burdens interfere with service delivery
and target achievement and could have been avoided with the
timely dissemination of any essential guideline revisions.

.

7.(SBU) The impact of these changes on our relationship
with the South African Government is particularly
worrisome. We have overcome significant challenges to
build a firm foundation of political and private sector
support for the Emergency Plan, with the direct assistance
of President Bush and Ambassador Tobias. One of the
fundamental principles outlined in these engagements has
been our commitment that every Emergency Plan project will
contribute to the implementation of the South African
Comprehensive Plan. This commitment has been demonstrated
through programming decisions, and the resulting trust has
facilitated aggressive Emergency Plan implementation in
South Africa. The recent guidance cannot be cast as fully
consistent with the strategy of the South African
Government, and we will not have time to coordinate it with
the Government and NGOs, making it difficult to argue that
we are truly partners.

8.(SBU) Program design and budget requirements have
e
caused us to reduce the overall percentage of our program
dedicated to prevention from 22% in FY05 to 17% in FY06.
Under the newly adjusted budget, the aggregate amount of
country funding committed to prevention is just about level
from FY05 to FY06, while other programs, particularly
treatment, will expand considerably. The South African
Government has criticized the Emergency Plan for what they
view as an overly strong emphasis on treatment, and is
vocal on the need for the Emergency plan to maintain an
emphasis on prevention programs consistent with the South
African Government's comprehensive ABC approach. We can
work with the South Africans to coordinate our views and
activities, but not with less than six weeks notice.
9.(U) Comment. Post is firmly committed to achieving
25 percent of the Presidents 2-7-10 goals under the
Emergency Plan for AIDS Relief as well as to respecting the
Emergency Plan legislation. We have identified changes
ges
required to meet the revised AB guidelines, and OGAC has
expressed a willingness to accommodate South Africa on the
stricter treatment target. However, we wish to make clear
that moving the goalposts in the middle of the game
undercuts South Africas country-appropriate program
design, complicates the Missions partnerships with
implementing organizations and potentially undermines US
collaboration with the South African Government. At worst,
it potentially undercuts our ability to achieve our portion
of the 2-7-10 goals. Post appreciates the efforts of those
at OGAC who are working with us to overcome communication
challenges between the field and headquarters. We trust
that the way forward will continue to include field
leadership in program design as we all work together to
achieve the Presidents goals. End Comment.

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