By Jenny Cuffe (BBC World Service)
In Cameroon alone, the Global Fund and World Bank have allocated more than $133m (£68m) to stem the tide of HIV/Aids. But with corruption endemic, are the millions being spent on combating the disease being used effectively?
Latest figures show that 5% of Cameroon's population are infected with HIV/Aids, and there are plans to ensure they all have access to anti-retroviral drugs and cheaper treatment.
Both the Global Fund and a local NGO, the Scouts Association, have recently given money or testing kits to a hospital in Abomngbang in the rural east of the country so that it can provide free screening.
But when Serge Tchapdar went along, he was told he would have to pay - and he tells me his friends were also asked to do so.
And four members of staff - including the one in charge of the unit - say the hospital did not give any free tests.
The hospital's director, Dr Jean-Paul Kengue, says the tests were done for free - but the records he shows me as proof do not show this.
Suffering
The tests are indicative of the problem in Cameroon. Tackling Aids cannot happen until a cure is found for Cameroon's second deadly virus - corruption.
The government says it has put more than $4.5m (£2.3m) into the fight against Aids; resulting in treatment at specialist centres for 25,500 patients, the cost of anti-retrovirals falling to $5 from $13, and pregnant women, children and the very poor getting them free.
Roffine tells a different story.
"I am really suffering, because for the past four years I have been sick from HIV," she says.
"My parents discovered I was HIV-positive and they threw me out. I can't pay rent. I can't afford payment for my treatment.
"I don't have any work. I can't do anything for myself. I do everything to get drugs. At times I beg."
Roffine attends one of Yaounde's HIV clinics where she is entitled to free anti-retrovirals.
But after giving her the first month's supply, the pharmacist told her she would have to pay for any more - because her clinic did not receive enough money to buy the drugs it needed from the national supplier Cename, and the only way to get more was to charge.
It is a familiar story throughout Cameroon - patients complaining they are not getting the free or subsidised drugs they are entitled to.
Urbain Olanguena, the Cameroon's minister of public health, says Roffine's case is an isolated incident due to structural problems.
"It doesn't question the global system that today permits Cameroon to give drugs free of charge to people with no money," he adds.
"But if they need treatment they must get it free of charge... the policies and strategies are to help the poorest, and now we have to work on the effectiveness of our policies and ensure the implementation of these policies."
Abuse
The $133m coming into Cameroon from the World Bank and the Global Fund has dwarfed the government's annual spending on HIV/Aids.
To distribute the funds, the minister has devised an elaborate system, co-ordinated by the National Aids Control Committee.
The committee passes money to Provincial Technical Groups, who then divide it between 48 private and several thousand non-governmental organisations (NGOs). At the bottom are the local committees, groups of volunteers who develop their own plans.
This system is wide open to abuse.
Halidou Demba of international NGO Action Aid says local committee presidents and treasurers sometimes misuse the money to buy food grains, stock them in their houses and sell them when food prices are very high in their local market.
Effectively, there is a hierarchy of individuals and organisations all giving money to the man above and taking from the man below.
The individual sums may be small, but multiply them across the country and you're talking millions of dollars.
Challenge
The complete absence of written records makes proving corruption extremely difficult, and until recently the subject has been taboo in government circles. But in the New Bell Prison in Douala, three former civil servants are now awaiting trial, accused of embezzling $700,000 that should have been used for the fight against Aids.
Damaris Mounlom, who runs an NGO for women's health and development, blew the whistle on the financial irregularities in the Provincial Technical Group, where the accused worked.
"When we went to the field we found that every local committee have spent the money in the corruption," she says.
"The people responsible came to see them and said, 'Give me 200,000 because I am here, I have spent the petrol. I must teach you how to protect yourself. Give me 200,000.' - and so on."
But when Mrs Mounlom blew the whistle, she found herself blacklisted by the health ministry, and has now been removed from the National Aids Strategy Committee.
And corruption means donors are now asking whether there is sufficient return for their investment.
Francois Mkounga, who oversees the World Bank's HIV project - a loan of $50m (£25m) - says they are trying to improve the situation, but there is only so much they can do.
"If the civil society is not providing good information on what is being done on the field it will be very difficult to address those issues of corruption," he explains.
"There will be always allegations, but no way to address specific issues.
"We need to have a clear view of the mechanism being put in place by people dealing with corruption... we discuss with the government and try to get the government to understand where things are not working well.
"It's a challenge every day."
Story from BBC NEWS.
Dibussi, thank you for putting this on your blog and by the way, good job always.
To me, working in this area in several African countries, this is a very loaded piece.
The Corruption in Cameroon stinks to high heavens and affects every facet of life in that country. In Southern African countries, corruption in the communities is not much of a problem and much reduced even at government levels. So Southern African countries are so attractive to Foreign donors who want to assist in health programs so much so that, the major problem is 'the absorptive capacity'. Most bilateral and multilateral donors that give several millions (sometimes hundreds) complain that less than 50% of donated funds were used for the funding cycle. And it is true that there is lack of capacity (managers, skilled health care workers etc) to absorb these large sums. Cameroon and most central African states and to a lesser extend W. African States have a similar shortage of skilled workers BUT CAMEROON'S FUNDS get used up before the projects are conceived. This has made the country so unpopular and hostile to international donors. Nothing substantial to show at the end of the funding cycle.
So much for that! Most people will measure how well African countries are managing HIV/AIDS particularly on treatment by the numbers of people or uptake in the treatment program. An even bigger fish to fry is, how are those already on treatment managed? Starting the drugs at the right time, right combination, the medicines are always available and affordable, the patient knows what to do at all times, docs, nurses, pharmacists are always available and well trained and most important how well is treatment monitoring done and individualized? The ultimate is the patient’s quality of life and outcome. To gauge all these, do not go to Yaounde or Douala; go to rural areas: Kouseri, Nkambe, and the Eastern Province etc.
While I give an F grade to most ministers in Cameroon, I do give an E grade to the minister of health in Cameroon who is not a medic. But an E for health is very bad. I hope he is not trying to be defensive on the above story but quickly move to improve his accountability systems. I however wonder if that can be done in the Cameroonian milieu where that is the order of the day from top to bottom.
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