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HIV/AIDS Financing
By Paul Whelan (Institute for Democracy in South Africa) - Abstract of Chapter in SA Health Review 2001
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There is a complex array of mechanisms through which resources destinedfor HIV/AIDS flow to provincial health departments, the key site ofdelivery of a number of HIV/AIDS prevention and care services. Much of this complexity has emerged in the last two years, as the national Department of Health (DoH) sought to establish alternative, perhaps more cost-effective modes of prevention, care and treatment at provincial level.
Provinces have recently also prioritised and sought to increase the status of HIV/AIDS structures and the level of resources they receive. National resources directed towards HIV/AIDS units in provincial health departments come from two sources: a ?‘top slice?’ of the national collected revenue and from national DoH budget. National resource flows are in two forms: application-based conditional grants and resources in-kind. The chapter looks at how national quantifies and identifies these resources and the mechanisms through which provinces are required to access them, and suggests that some of these resources seem to be inequitably distributed. Some provinces experience problems with the timing of resources and find them difficult to access.
Resources at a provincial level come either from a provincial healthdepartment budget or a combination of provincial health budgets and a ?‘top slice?’ of the province?’s equitable share. In most provinces theseresources are not quantified on the basis of an intervention or pendingstrategies. Units require considerable budget and business planning abilities to direct all these resources effectively. Given the lack of coherent strategic plans within provincial HIV/AIDS units, these skills seem to be lacking. As many of the interventions being introduced at provincial level are new, well-functioning and activity-sensitive financial control and monitoring systems need to be put in place to evaluate and improve the interventions and the spending patterns behind them. The structure of the financial information management systems is such that detailed activity reporting is very difficult.
Many resource management challenges arise because HIV/AIDS managementstructures in their present form are new. In many cases institutionalmemory has been lost over the years through a lack of continuity ofstaffing. The alternative modes of delivery require a huge increase in the involvement of Non-Government Organisations (NGOs). NGOs working in this field are usually quite small and newly formed. The Public FinanceManagement Act (PFMA) provisions, in effect, mean that only financiallycompetent NGOs can receive transfers of public resources.
For these new delivery modes to be successful, innovative ways have to be found to both resource NGOs and simultaneously build-up their financial competencies. This chapter looks at how resources are being directed toward identified interventions and projects. Some of the incentives that are in place to promote efficiency in spending are considered. Budgets are examined to determine how they are related to need, spending capacity and the project costs by looking at budgeting and control processes. In the case of "in-kind" resource support, consideration is given to how these are matched to the needs of the delivery agency. |
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