April 07, 2005
"You see the problem and you feel like you want to help but you can't because it's not up to you to decide. It's hard to work in that environment."
Mozambique's five-year plan to fight AIDS is optimistic. It has planks for nearly every ministry, from drug treatment and care for AIDS patients to program for prevention, education and orphan work. It's all coordinated through the Ministry of Health and a National AIDS Council established just a few years ago to manage the response. It's optimistic, but it's not pie-in-the-sky optimistic.
"The education and health department must work together. New schools, new teachers, help people see what's wrong and what's correct. We have to have more prevention, communication and treatment with the health department."
All the ministries must be firing on all cylinders in order for this plan to work. But it's not so easy. The ministry of health, which was doing all of this work before the establishment of the AIDS council, is territorial. The council itself is a new bureaucracy, centered in Maputo, where the money flows in and, some say, doesn't flow out again to the provinces and ministries.
"They send money for our function but that money's not enough. Many times we are working here without light, without power, without telephone. The budget isn't enough to pay."
Part of the reason the council is so slow to work is that it's supposed to be a secretariat, not a full-fledged ministry. With its provincial arms, it has become a massive grant management system. They can hire people to push paper but not to do program activities, such as training groups how to apply for money. As a result, it receives substandard proposals that Maputo reluctantly concludes it cannot approve.
"As conceived, we don't have to train people, only to give them instructions and information, not to train. What is needed is giving people more school, more opportunities to learn, to have information, different information about how to avoid [AIDS]."
Take the education ministry. The new head says the department must hire thousands of new teachers to fill all the vacancies in the country, and in some provinces, teachers have yet to be paid this year. But without the teachers, fewer people see prevention information, which already faced an uphill battle to dissemination.
"They don't believe in HIV. Since they are not literate it is very hard for them to accept our messages. We have to tell them again and again and they think what we are telling them is not true. All of us we are trying to introduce new manners of thinking."
Classrooms stand vacant. People work without power. Hospitals re-use gloves and needles because they have no other options. It's well and good to pump in money for a narrow purpose. But with AIDS, one little purpose always turns out to be very broad.
"Many times, I think I am going. Then I think people will suffer so much more."
Posted by Adam Graham-Silverman at April 7, 2005 03:00 AM