Inter Press Service - November 15, 2001
Anthony Stoppard

"We find under-spending at the provincial level is an urgent and critical problem. Largely due to the late transfer of funds, in the first year of the National Integrated Plan (NIP) for HIV/AIDS the provinces only managed to spend 36.5 percent of the total HIV/AIDS grants available to them.

"Although the conditional grant transfers occurred more timely in the second year, by midway through this financial year, provinces have only spent 16.8 percent of their conditional grants," says AIDS researcher, Alison Hickey of the independent Hickey, Budget Information Service (BIS).

Provincial capacity - particularly financial and project management, and business plan development - appears to be the key problem. Other factors having an impact on whether provinces spend their HIV and AIDS grants, include: the level of political support at a provincial level for HIV and AIDS programmes; and the existence of a provincial strategy to fight the disease.

This year, government has earmarked R294.3 million (36.8 million U.S. Dollars) for anti-HIV and AIDS programmes - mainly for funding for NIP and the Government AIDS Action Plan. The budget is scheduled to be increased substantially over the next three years - reaching over half a billion Rand (62.5 million U.S. dollars) by 2004.

This is in addition to the estimated R4 billion (500 million U.S. dollars) a year South African provinces spend treating HIV and AIDS patients or on AIDS prevention programmes in their schools, among other initiatives.

Most of the spending is hidden because the money is not clearly marked as AIDS related in provincial budgets, says the National Treasury. South Africa has the highest number of people living with HIV and AIDS in the world -- and the country's Medical Research Council released a report, last month, indicating that AIDS is responsible for up to 40 percent of the deaths of people between 17 and 49 years.

Despite the international row about South African President, Thabo Mbeki's doubts regarding the link between HIV and AIDS, the government is putting funds aside for programmes dedicated to education, prevention and treatment of the disease.

The HIV virus is commonly accepted to cause AIDS. Dedicated government anti-HIV and AIDS spending falls into three programmes: a life skills programme, in primary and secondary schools; a voluntary counselling and testing programme; and a community and home-based care and support programme.

"Initially the bulk of the resources supports life skills training in schools. As the disease and its impact spreads, the policy emphasis shifts towards treatment and strengthening the care component of the programme," explains Hickey.

But, most of the government's programmes are implemented by provincial health, educational and social services departments. Ironically, the four provinces with the poorest grant-spending records are also the ones with some of the highest HIV/AIDS prevalence rates, says Hickey, in her report, released on Nov 13.

For example, the province of KwaZulu/Natal has the highest estimated HIV and AIDS prevalence rate in the country, yet it only managed to spend 11 percent of the grant funds being provided by national government to fight the disease.

"More grant money to the provincial health, education, and social development department is not necessarily the solution. We need to be asking what can be done to more rapidly improve provincial capacity," says Hickey.

Government also is still being taken to task about its refusal to make anti-retrovirals - drugs which slow the onset of full- blown AIDS and can be used to improve the quality of life of suffers - available to people being treated in the public health service.

The Parliamentary joint monitoring committee on the improvement of the quality of life and status of women on Wednesday called on the national department of health to make anti-retrovirals available to pregnant mothers and rape victims - to reduce their chances of getting HIV.

The Treatment Action Campaign (TAC) is taking South Africa's national department of health and eight of the country's nine provinces to court, to force them to make anti-retrovirals available to pregnant mothers and rape victims. The case is expected to appear in the High Court late November.

Mbeki has repeatedly insisted that, in his view, anti- retrovirals are toxic and the government has taken an exceptionally cautious approach to introducing them into the public health system. Presently, they have only been made available at a few pilot projects.(END/IPS/AF/HE/AS/MN/01)
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