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A new study on the healthcare expenditure of six Southern African countries, has found that for the exception of South Africa and Zimbabwe these countries are not meeting the promises they made in international declarations and agreements of government expenditure to healthcare. This implies that present levels of funding by governments and donors on HIV/AIDS falls far short of what is needed for an effective response that combines prevention, care and support, and treatment. In April 2001, African leaders meeting in Abuja, Nigeria adopted the Abuja Declaration on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases in which they committed themselves to allocate 15% of their national resources towards healthcare expenditure. This was subsequently reiterated at the United Nations General Assembly Special Session on HIV/AIDS held in June, 2001. This Human Sciences Research Council (HSRC) report, “A comparative analysis of the financing of HIV/AIDS programmes in Botswana, Lesotho, Mozambique, South Africa, Swaziland and Zimbabwe”, assesses the level of financing on healthcare and HIV/AIDS in these six countries and evaluates their progress towards meeting these commitments. According to the study, only two countries namely South Africa and Zimbabwe, have managed to meet the 15% commitment. Botswana comes closest in meeting the target, allocating 10% of its expenditure to healthcare. The report highlights that poorer countries, such as Lesotho and Mozambique, are unlikely to meet the 15% target. The report estimates that expenditure on healthcare in the six countries ranged from a high of US$255 per capita in South Africa to a low of US$9 per capita in Mozambique. Southern Africa is the region most severely affected by the HIV/AIDS epidemic. UNAIDS estimates that of the 41 million people living with HIV/AIDS, 33 % are living within the six countries under review. The study found that total spending on HIV/AIDS by governments and donors falls well below that which is required for an effective response that combines prevention, care and support and treatment. Total expenditures by governments and donors on HIV/AIDS, excluding household out-of-pocket spending and the Global Fund allocations, amounts to approximately US$250 million for the year 2001, or to US$3 per capita and US$27 per person living with HIV/AIDS (PLWHA). This is far below the estimated US$4.6 billion required annually for prevention, care and support, and treatment, including anti-retroviral therapy. The study found that the combined government expenditure on HIV/AIDS for the six countries annually is close to US$70 million, while donor funding accounts for US$ 180 million. The median per capita HIV/AIDS expenditure by the governments of the six countries is US$1, and that of donors is US$2. The Government of Botswana, is the highest per capita spender on HIV/AIDS, spending US$30 per capita, almost 30 times the level of expenditure in the other 5 countries which is estimated below US$1.50 per capita. This is also indicative of the political commitment of the Government of Botswana in addressing the HIV epidemic. With the exception of South Africa, expenditures on HIV/AIDS in these countries are financed mainly by external sources. In Mozambique, Lesotho and Swaziland more than 80% of total HIV/AIDS spending is funded by external sources, the study found. The allocations from the Global Fund to Fight AIDS, Tuberculosis and Malaria to these countries will add an additional US$479 million over the total period of the allocations, and US$192 over the first two years of each award. However, in relation to the rest of sub-Saharan Africa, per capita expenditure on HIV/AIDS is ten times higher and expenditure per PLWHA in is more than three times higher in these countries. This is consistent with the higher levels of HIV/AIDS in the six Southern African countries. The study illustrates that there is still a long way to go before governments and donors meet their promised commitments in addressing HIV/AIDS situation in these six countries calls for prioritisation and targeting of HIV/AIDS spending. It is however important that the increased allocations, which the various mobilisation initiatives for international resources aim to effect, are not accompanied by increased inefficiency in budget management and budget execution. This would be a tragic outcome given the unprecedented level of commitment and focus on resource mobilisation for HIV/AIDS. Healthcare spending in South Africa South Africa spends 3% of GDP and just over 15% of government expenditure on healthcare. Government health expenditure accounts for 45% of the total health spending, and the remainder is financed from private sources (health insurance and out-of-pocket expenditure). Total health spending equals 7.5% of GDP. Compared to low- and middle-income countries the level of total health expenditure in South Africa is relatively high. However, the inequities and inefficiencies in the health system are quite costly. Consequently, this apparently adequate level of health spending is not translated very efficiently into health outputs, such as immunizations and antenatal visits, and health outcomes, such as infant and maternal mortality rates. South Africa spends a total of US$33.3 million on HIV/AIDS programmes. This translates into $0.78 per capita, or $6.65 per PLWHA. This level of financing has steadily increased over the years, and in recent years dedicated financing mechanism for HIV/AIDS expenditure (for example, conditional grants) have been devised to ensure prioritisation and protection of HIV/AIDS spending. Nearly two-thirds of total government expenditure id channelled through a block grant to provincial governments, the AIDS component of the equitable share grant. In 2001/02 provincial governments spent an estimated US$404.6 million on HIV/AIDS. This expenditure was mainly on hospital care for people with HIV/AIDS, treatment of opportunistic infections (including tuberculosis), expansion of tuberculosis prevention, and improved drug availability for the treatment of sexually transmitted infections. A COMPARATIVE ANALYSIS OF THE FINANCING OF HIV AIDS PROGRAMMES in Botswana, Lesotho, Mozambique, South Africa, Swaziland and Zimbabwe, can be downloaded for free.
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