Uganda studies Zimbabwe’s HIV financing model as donor support comes under pressure

By Tichaona Katsvamutima

As African countries grapple with growing uncertainty over international health funding, Uganda has turned to Zimbabwe to study how the country has built and sustained a domestic financing model for its HIV response.

A parliamentary delegation from Uganda’s Committee on HIV/AIDS and Related Matters, led by its chairperson, Stephen Kisa, is in Harare on a benchmarking mission focused on Zimbabwe’s AIDS Levy, prevention of mother-to-child transmission of HIV and the systems supporting the country’s response to the epidemic.

Kisa said the delegation had come to Zimbabwe primarily to learn from the country’s experience in mobilising domestic resources for HIV.

“We are fundamentally here on an experience-sharing and learning mission,” Kisa said, explaining that the delegation wanted to examine how Zimbabwe had “successfully safeguarded its domestic financing through the NAC.”

The visit is centred on Zimbabwe’s National AIDS Council (NAC) and the National AIDS Trust Fund, supported through the AIDS Levy.

Established in 1999, the AIDS Levy imposes a charge on taxable employment income and corporate profits, with the proceeds supporting Zimbabwe’s HIV response through the NAC.

Kisa said Uganda was particularly interested in the institutional structure behind the financing mechanism.

“The institutional design of the AIDS Levy offers an exemplary blueprint for regional self-reliance,” he said.

Zimbabwe’s experience is of particular interest because Uganda has also sought to establish a dedicated financing mechanism for HIV and AIDS.

Uganda’s HIV and AIDS Trust Fund was created to provide a sustainable source of financing for the country’s HIV response, but its implementation has faced challenges. Ugandan lawmakers have raised concerns about whether revenues collected through designated levies are being adequately protected for HIV programmes.

Zimbabwe’s AIDS Levy generated US$66.4 million in 2025, according to the NAC’s latest annual report, making it the main source of its revenue.

But the domestic funding mechanism has not eliminated Zimbabwe’s reliance on international support.

The NAC reported that donor funding cuts disrupted some HIV prevention programmes, including voluntary medical male circumcision, pre-exposure prophylaxis and the DREAMS programme for adolescent girls and young women. NAC subsequently took over funding for some of the affected programmes.

The experience helps explain Uganda’s interest in the Zimbabwean model as international health financing comes under increasing pressure.

The Ugandan lawmakers are examining how domestic financing has been connected to prevention, treatment and community-based services, and how the institutional arrangements around the funding mechanism help sustain those programmes.

The second major focus of the mission is Zimbabwe’s efforts to prevent HIV transmission from mothers to their babies.

Zimbabwe has expanded HIV testing and treatment through antenatal services, but challenges remain around treatment initiation, retention and follow-up during pregnancy and breastfeeding.

The NAC has attributed continuing mother-to-child transmission partly to failure to initiate antiretroviral treatment, poor retention on treatment and new HIV infections occurring during pregnancy and breastfeeding.

Zimbabwean lawmakers emphasised that the exchange is not a one-way process.

Chairperson of the Zimbabwe Senate Thematic Committee on HIV and AIDS, Senator Angeline Kumbirai Tongogara, said Zimbabwe was sharing its experience while also recognising that it could learn from Uganda.

“Zimbabwe is happy to share its experiences with Uganda, but this is not a one-way process,” Tongogara said. “We also have much to learn from Uganda, particularly as countries across the region work to protect HIV services and strengthen domestic financing.”

She said the engagement was important as African countries faced similar pressures, including declining donor support and growing demand for sustainable national solutions.