To what extent do budgets reflect a state’s pronounced commitment to combating HIV/AIDS? What factors determine the types of funding provided for combating HIV/AIDS and which funding mechanisms are used? This study carried out by the Institute for Democracy in South Africa (IDASA) in conjunction with civil society organisations from Africa and Latin America, analyses HIV/AIDS budget allocations in both of these regions. It describes the impact of HIV/AIDS and examines actual health and HIV/AIDS allocations with a view to making recommendations for future policy-making.
Nine countries are covered by this study: Argentina, Chile, Mexico, Ecuador, Nicaragua, South Africa, Namibia, Kenya and Mozambique. The health care systems of these countries are at different stages of development. Common amongst them are that their health systems are inaccessible in rural areas, have poor infrastructure, lack resources and suffer from a shortage of healthcare professionals. HIV/AIDS, therefore, puts strain on an already overstretched system.
Unless health expenditures (ranging from 5 to 18 per cent) are increased, it will be almost impossible to provide universal ARV treatment programmes to people infected with HIV/AIDS. Particularly in the case of African countries, health budgets and HIV/AIDS allocations are extremely dependent on donor funds. For the socio-economic and health repercussions of the epidemic to be addressed, long-term commitment to finance interventions through state revenue is required.
Despite differences in transmission modes, the numbers of people affected and approaches to HIV/AIDS, there were significant similarities between the countries studied:
- All countries have comprehensive national strategic HIV/AIDS plans to enable better co-ordination. However, HIV/AIDS should be also integrated into national development plans.
- HIV/AIDS legislation has been developed in most Latin American countries. Other countries should follow this effort to protect and promote the rights of HIV-positive people.
- National co-ordinating bodies should be autonomous and located outside of health ministries. They should have the power to address the epidemic’s socio-economic and health repercussions.
- Greater transparency and accountability are required in the budget process. Specific mechanisms and data disaggregating should be established and future funding commitments clearly specified.
- HIV/AIDS allocations should be increased, especially outside health budgets. Clear objectives and outputs should be defined and adequate resource-tracking enabled.
- A better balance of activities – care and support, prevention and treatment – is required. The socio-economic impact of the epidemic should also be addressed through development projects.
The HIV/AIDS epidemic presents a number of challenges to states and donors alike. Donors should:
- Support capacity building efforts that enable civil society organisations to carry out adequate budget analysis.
- Support efforts to develop disaggregated data on HIV/AIDS budget allocations.
- Acknowledge the risk that donor funding poses to the sustainability of long-term scaled-up projects, when HIV/AIDS activities are highly dependent on it. More state commitment should be promoted.
- Collaborate with governments and national HIV/AIDS co-ordinating bodies, so that all donor funding can be under a centralised agency and therefore better tracked.
- Support the adoption of medium-term expenditure frameworks (MTEFs), so that states have to be accountable for projected expenditure and not only for current and past allocations.
