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Last Updated: Friday, 22 December 2006, 17:49 GMT
Cameroon corruption hinders Aids fight
By Jenny Cuffe
BBC World Service, Cameroon

HIV-positive Flore Irene Etang with her mother Clair Melane Messou
Patients at Abongmbang say they are being charged for HIV tests
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.

Urbain Olanguena (Copyright: WHO/P Virot)
The policies and strategies are to help the poorest, and now we have to work on the effectiveness of our policies
Urbain Olanguena
Cameroon's public health minister

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.

Medicine stall at Yaounde market
'Free' anti-retrovirals often end up being sold at Yaounde market

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."


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