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Risks and opportunities in Budget 2002 HIV/AIDS funding approach
Alison Hickey - IDASA Budget Information Service BudgetWatch May 2002 - Republished courtesy of IDASA
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The most significant development in Budget 2002 is that national government is increasing its reliance on provinces to direct and implement programmes and allocate funds for HIV/AIDS as they choose. National government is banking on the idea that provincial underspending - plaguing HIV/AIDS conditional grants up to now - will decrease if provinces are given more room and discretion with funds provided by national government. This is a gamble worth taking. To reduce the risk, Budget 2002 simultaneously addresses the problem of lack of provincial capacity by earmarking funds to strengthen provincial management.
Conditional transfers to provinces do not have a good track record in South Africa. The danger here is that provinces will not spend the money as intended by national government unless it is earmarked. Budget 2002 introduces a new funding mechanism that transfers HIV/AIDS money to the provinces with fewer limitations and close oversight on how they spend it.
Government's strategy with HIV/AIDS will be to send more funds directly to the provinces (via conditional grants and the equitable share) and to allocate less and less to national departments (primarily Health) to implement and direct HIV/AIDS programmes themselves. Of the total dedicated funds going to HIV/AIDS in 2002/03, nearly 75% will be passed to the provinces (approximately half those funds are ring-fenced).
Most of the remaining funds are on the budget of the national Department of Health, and go towards SA National AIDS Council (SANAC), AIDS Vaccine Initiative, loveLife Programme, condoms, media and public awareness programmes, and grants to non-governmental organizations (NGOs).
From an advocacy perspective, the heavy use of this new funding mechanism is very important, because it means that provinces will have room to decide themselves how this significant pot of money is spent. It will now be up to NGOs to continue to put pressure on provincial governments to ensure that those funds go to meaningful HIV/AIDS programmes.
The second key point is that care overtakes prevention as a priority in the HIV/AIDS budget this year. With a total HIV/AIDS budget expanded to over R1 billion this year, all interventions are receiving absolute increases. However, the share of HIV/AIDS funds going to care jumps from 7% last year to over 50% of the HIV/AIDS budget this year, while prevention's share drops sharply.
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