The South African government needs to strengthen its response to HIV and AIDS by providing sufficient, cost-effective financial, human and information resources. Budgets are just one element of a government response and can be complemented with a variety of factors, such as increased political will, strong parliamentary oversight, reviewing and refining existing policy, and investing more resources on capacity issues facing government departments. In addition, strong monitoring and evaluation systems must be developed and utilised to ensure that the government response is efficient and effective.
Given the increasing trend in HIV prevalence, there is an urgent need to intensify public sector responses to HIV and AIDS and to seek support from other potential roleplayers, such as donors and the private sector. Increasing HIV prevalence rates demand that the government must strengthen its HIV and AIDS response. There are numerous examples why the government response to the epidemic needs strengthening. Inter alia, KwaZulu-Natal, Gauteng and Mpumalanga recorded the highest prevalence rates in 2004 of 40.7 per cent, 33.1 per cent and 30.8 per cent respectively. Notably, the Mpumalanga figure is a slight decline from 32.6 per cent prevalence reported in 2003. The Survey reports, “There have been increases in prevalence across all age groups between 2003 and 2004. Nearly forty percent of women aged between 25 and 29 years are HIV positive.” 2 Young women between 25 and 29 years of age had an increased prevalence rate of 38.5 per cent in 2004, compared to 35.4 per cent in 2003. For the 30 – 34 age group, prevalence increased from 30.9 per cent in 2003 to 34.4 per cent in 2004.
Basically three government departments utilise HIV and AIDS conditional grants for HIV and AIDS to drive the government response. The health sector spends the money on prevention, treatment, care and support interventions. The education sector uses the money for HIV and AIDS lifeskills and prevention education in schools whilst the social development departments spend the money on HIV and AIDS community and home based care activities, frequently implementing by non-governmental organisations
In 2005/6, the national departments of health, education and social development utilised a variety of criteria to determine the provincial split of the 2005/6 global HIV and AIDS conditional grant amounts received from National Treasury. The health department split the health HIV and AIDS conditional grant, also referred to as the Comprehensive HIV and AIDS Grant, using “ante-natal HIV prevalence, estimated share of HIV positive births, estimated share of AIDS cases, share of reported rapes, and establishment of at least 1 treatment point per district.”3 The education sector used its component of the Equitable Share Formula4 whilst the social development sector used the provincial HIV prevalence figures reported in the 2003 ante-natal survey.5 However, for the 2004/5 split the social development sector used both the provincial HIV prevalence as well as the poverty index.6 Once the money is split the national departments transfer the conditional grants to their provincial counterparts, but retain the authority over monitoring and management (oversight). These transfers are spent in line with specific conditions set by the national departments to ensure that the money is spent on nationally-identified priorities.
Ndlovu’s 2004/5 provincial budget analysis7 provides a comparative background reading to this Budget Brief. This brief analyses provincial HIV and AIDS budgets for 2005/6, with a concise look at final conditional grant spending records for 2004/5. The Brief first provides a quick scan of HIV and AIDS allocations contained in the 2005/6 National Budget before outlining allocations in the provincial budgets; it will then unpack discretionary allocations in the provincial health budgets; look at final spending figures on the 2004/5 conditional grant budgets; and then conclude.
This Budget Brief is part of an annual series of Budget Briefs which review provincial budgets. See the 2004/5 analysis by Nhlanhla Ndlovu, “HIV and AIDS expenditure in the 2004/5 provincial budgets: Trends in budget allocations and spending”, Budget Brief No. 147, 19 October 2004. Idasa – BIS.
Department of Health. 2004. National HIV and Syphilis Antenatal Sero-Prevalence Survey in South Africa. Available at www.health.gov.za.
National Treasury – Division of Revenue Bill, 2005: 112.
National Treasury – Division of Revenue Bill, 2004: 108.
Ndlovu, N. 2004. “HIV and AIDS expenditure in the 2004/5 provincial budgets: Trends in budget allocations and spending”, Budget Brief No. 147, 19 October 2004. Idasa – BIS.