Mail & Guardian Online - November 30, 2007
Lynley Donnelly

Examining accountability at national and provincial level, the report lists a host of problems in the management of funds allocated to fighting the disease. These include: poor budgetary management and execution or poor "budget tracking mechanisms", especially with regard to donor funding; lack of accountability and transparency with regard to financial management; massive under-spending by provincial health departments; and concerns over the "lack of institutionalised processes for the spending of HIV/Aids funding: the "more loose and unregulated the system", says the report, "the greater the chance of corruption".

The report notes that while most of the money spent on HIV/Aids comes from government, a large portion comes from donor funds. While some of the money goes to NGOs, the majority of donor funds go directly to government -- either to the National Revenue Fund in the treasury, or the national department of health, or directly to provincial government. However, according to the report, neither the national nor provincial departments are required to account for this money and how it is spent. "What is of greater concern is that while treasury allocates large amounts of money to HIV/Aids, the lack of mechanisms to govern the flow of money at provincial level makes it difficult for the treasury to ascertain how that money is accounted for," says Collette SchulzûHerzenberg, author of the report. The national treasury spend for 2006/07 is about R5-billion, according to the report. The flow of money targeted for HIV/Aids prevention and treatment is almost impossible to follow because of the lack of enforcement of accountability practice, she says.

According to the report the poorest performing provinces in 2005/06 were Limpopo, Free State and Kwa-Zulu Natal, which under-spent on their HIV/Aids conditional grants by R31 789 000, R19 476 000 and R11 918 000 respectively. The report also found "alarming anecdotal evidence" that chronic poverty encourages HIV-infected people to abuse resources. For instance some desperately poor patients deliberately suppress their CD4 counts by not taking ARVs, to access disability grants. There is further anecdotal evidence of theft from hospitals of ARVs, which are then sold on to people infected with the virus, who, for varying reasons, can't or won't access the public health care system.

The research examines a host of controversial issues involving government and the fight against HIV/Aids. These include Health Director General Thami Mseleku ordering the release of a confiscated shipment of tablets imported by Aids dissident Matthias Rath, the department's support for alternative medicines, such as Ubhejane, and alleged governance problems within state organisation such as the South African National Aids Council and the National Association of People Living with Aids. "The problem of political will and ineffective leadership is widely cited as the major constraint on implementation," says the report. But a senior researcher at the Aids Law Project, Jonathan Berger, says that the organisation and its partners have not perceived corruption as a major problem. Their concerns lie chiefly with implementation problems such as the accreditation of facilities to administer ARVs. Berger says the process is too bureaucratic and patients are forced to wait for months before commencing treatment. "There is certainly a fear in civil society that not only is there no willingness to implement programmes, but these are seen as attempts to sabotage programmes," says Berger. "Whether it is wilful sabotage or just plain negligence it shouldn't happen."

Media liaison for the ministry of health Sibani Mngadi is critical of the report, arguing that it follows no clear methodology regarding how accountability is measured. "In South African public services there are clear accountability measures regarding spending," says Mngadi, referring to the auditor general, the portfolio committee on health and the standing committee on public accounts (Scopa). "I don't think that Scopa or any of these bodies has failed in holding the department of health to account in any way," he says. "It does not mean that funds are being misspent," says Mngadi, "it may just mean that reporting processes need strengthening." Mngadi also says that since the introduction of ARV treatment, the procurement chain has become more secure.

071130
MG071107

Always watch for outdated information. This article first appeared in 2007. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2007. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .