US embassy cable - 05PRETORIA3475

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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