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IDASA Budget Briefs

Monitoring AIDS Treatment Rollout in South Africa:
Lessons from the Joint Civil Society Monitoring Forum (JCSMF)

Budget Brief No. 161

Nhlanhla Ndlovu and Rabelani Daswa1

AIDS Budget Unit (ABU) – IDASA

13 April 2006

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Idasa is a co-founding member of the Joint Civil Society Monitoring Forum (JCSMF) and is releasing this brief as a summarized version of the JCSMF resolutions and minutes from meetings held over the past one and a half years, on behalf of the forum. The JCSMF was founded on 12 June 2004 by the Aids Law Project (ALP), Health Systems Trust (HST), Centre for Health Policy (CHP), AIDS Budget Unit at the Institute for Democracy in South Africa (Idasa), Open Democracy Advice Centre (ODAC), Treatment Action Campaign (TAC), UCT School of Public Health & Family Medicine, Public Service Accountability Monitor (PSAM) and Mйdecins Sans Frontiиres (MSF). The forum was formed to monitor and support the implementation of the Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa.

Executive Summary

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 treatment plan vary from province to province.2 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.

  1. The authors would like to acknowledge invaluable inputs from the Joint Civil Society Monitoring Forum (JCSMF) members, especially Ms Fatima Hassan of the AIDS Law Project.
  2. JCSMF. 2004. Inaugural Launch (1st Resolutions) of the Joint Civil Society Monitoring Forum for the Comprehensive HIV and AIDS Care, Management and Treatment Plan for South Africa. September 2004. Polokwane – Limpopo.

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