IDASA Budget Brief 161: Monitoring AIDS Treatment Rollout in South Africa: Lessons from the Joint Civil Society Monitoring Forum

There is a growing demand for AIDS antiretroviral (ARV) treatment amongst people living with HIV and AIDS in South Africa. Guidelines and procedural arrangements have been developed at national and provincial levels to accelerate the rollout of ARV treatment in the public sector.

A few provinces started slowly and cautiously to provide the ARV treatment while most provinces?’ ability to provide the treatment was frustrated by a shortage of staff and general administrative and other competing demands.

Capacity and political will remain central to the ability of the public sector to deliver required services.

At its inaugural launch, the Joint Civil Society Monitoring Forum (JCSMF) noted that political and managerial oversight as well as overall commitment to the ARV treatmentplan vary from province to province. It also reported that there is a lack of systematic national management and oversight. The most serious problems identified are:

• Severe human resource (HR) shortages in clinics and hospitals across the country.
• Wealthier provinces such as Gauteng and the Western Cape are scaling up much more speedily when compared to poorer provinces such as the Eastern Cape. National government and all other stakeholders should develop a plan to support poorer provinces. In particular, Limpopo requires urgent support as it has been reported as the slowest in rolling out the ARV treatment plan with progress moving at a ?‘snails pace?’.
• Gaps in communication and information sharing: these appear to be mainly between the national and provincial health departments as well as between the national department, provincial health departments and civil society organisations. Examples of these gaps are with regard to data collection and management, patient outcomes, patient numbers, gender and age breakdown of people on treatment, treatment literacy and community awareness initiatives.
• Good outcomes of ARV treatment for children are dependent on timely initiation of treatment and implementation of proper and holistic subsidiary care programmes for children living with HIV.
• On budgetary aspects of the Operational Plan, there is a lack of clarity on the extent to which provinces are using conditional grants allocated by the National Treasury or using funds from their own budgets to implement the ARV treatment plan.
• Due to lack of disaggregation in HIV and AIDS expenditure reporting, it is difficult to monitor how the ARV budgets are spent on ARVs and other treatment-related spending areas (for example, laboratory services). This is important to monitor because there still remains a need to prioritise other areas of HIV and AIDS spending such as prevention and care and support.


The full brief can be downloaded on the righthand side of this page or accessed via the hyperlink to the IDASA website, which can also be found on the righthand side of this page.