With less than two months left before the year is out, tuberculosis carriers in Kyrgyzstan are counting the days before foreign funding runs out for the treatment they require.
At the root of their plight are the theft of foreign aid by government officials and the apparent reluctance of authorities to return the misappropriated cash.
The Global Fund to Fight AIDS, Tuberculosis and Malaria — a donor organization that sources its financing from governments and philanthropists — overall has paid out $47 million to Kyrgyzstan. Since 2010, the fund has provided $5.6 million for research, training to improve diagnosis of tuberculosis, and infrastructure to help sufferers.
Those resources used to be handled by the government. But in 2010, administration of the funds was handed over to the United Nations Development Program after an audit found evidence of sketchy financial practices. The investigation, carried out in 2009, showed that $120,000 had been improperly pocketed by Kyrgyz public officials for personal use — $40,000 was earmarked for HIV programs and the remainder for tuberculosis.
Despite promises made by officials to make amends as recently as October, the money is yet to be returned. As a result, the prospect of further grants from the Global Fund to cover 2016-2017 is looking bleak. Akzhol Joroev, a public relations specialist at the UNDP’s Global Fund office, said a grant for the extension has not yet come through.
“The fate of the tuberculosis prevention grant is at the decision stage. The [existing] grant will end, but it is not yet known what the Global Fund is going to do next year,” Joroev told EurasiaNet.org.
Among organizations facing a crisis because of the impasse is Bishkek-based Alternativa, which assists vulnerable and marginalized people. “We take (former prisoners) into our drop-in center, they can live with us for a few months. Our workers keep watch over them until they complete their treatment,” Irina Pugachyova, one of the founders of Alternativa, told EurasiaNet.org.
With things as they are, the Alternativa drop-in shelter, which is run with money from Global Fund, is set to close its doors at the end of the year. Government facilities are ill-equipped to pick up the slack.
“How can we stop tuberculosis when our public social services don’t work? There is a public shelter, Kolomto, but it can’t fit all people in need. So many of them live in the centers within non-profit organizations. Where will they go [after those shelters are closed]? How can we talk about tuberculosis treatment when people have nowhere to live?” Pugachyova said.
Prisons in Kyrgyzstan tend to serve as breeding grounds for drug-resistant tuberculosis. Government data show prisons in Kyrgyzstan still have the biggest tuberculosis-linked fatality rate, although the figure has been on the decline. In March, the Health Ministry said 406 prisoners died of the disease in 2014, down from 466 the year before.
Kyrgyzstani officials would like to see the downward trend continue, but those hopes may be dashed by the rising prevalence of the multi-drug resistant form of the disease, a form that is especially pronounced among prisoners.
Ruslan, a 19-year old dentistry student in Bishkek, is a tuberculosis survivor who is working to spread the word that the disease can be beaten. He contracted tuberculosis when he was just 13. “I thought it was an incurable disease, but my mother told me I was wrong. I did not want to take medicines, because the medication process is very long, hard and unpleasant,” said Ruslan. “I was shy of my friends and classmates and so I hid my disease.”
Despite those misgivings, Ruslan persisted and is now volunteering for the Red Crescent and takes part in information campaigns.
Health workers dealing with the illness understand that overcoming lack of understanding about treatments is one of their main challenges. “It isn’t just about the number of pills to take. It is also about forming an attitude and an environment that induce a person to take the treatment. And our society can’t handle this”, says Ainura Ibraimova, a manager at Defeat Tuberculosis, a $12.7 million project funded by the US government’s foreign assistance body USAID.
Defeat Tuberculosis began operating in late 2014 and is set to run five years providing training for healthcare workers, improving laboratory equipment and expanding overall support for patients.
The uphill battle against tuberculosis may be complicated further, however, by Kyrgyzstan’s decision in July to make life hard for USAID in response to a perceived diplomatic slight by Washington. A now-revoked 1993 treaty between the United States and Kyrgyzstan provided for a tariff waiver on goods imported as part of US aid programs. Cancellation of the treaty could create obstacles when it comes to purchasing lab equipment for Defeat Tuberculosis programs.
“It has become challenging for us to find the ways out of the situation, but we have never stopped the project for a day”, Ibraimova told EurasiaNet.org.
The role of outside help dealing with tuberculosis is enormous. The World Health Organization in 2015 estimated that 63 percent of the money spent keeping the disease under control comes from international donors.
Speaking at the start of the year, Deputy Prime Minister Damira Niyazalieva was bullish in her assessment of the government’s ability to cope with the public health challenges associated with tuberculosis, even if the Global Fund did not renew its grant. “The Global Fund previously claimed it will probably stop funding our country in 2017,” Niyazalieva said in remarks quoted by Vecherny Bishkek newspaper. “We will increase budget spending on tuberculosis control in 2016-2017. Tuberculosis is a socially dangerous disease. We cannot ignore it, so we won’t stop the funding.”