sahr2001 - Health Systems Trust

HIV/AIDS Financing
8
Paul Whelan
Institute for Democracy in South Africa
There is a complex array of mechanisms through which resources destined for HIV/
AIDS flow to provincial health departments, the key site of delivery 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 health department budget
or a combination of provincial health budgets and a ‘top slice’ of the province’s equitable
share. In most provinces these resources are not quantified on the basis of an intervention
or spending strategies.
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 management
structures in their present form are new. In many cases institutional memory has been
lost over the years through a lack of continuity of staffing.
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