MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Both NDOH and donor participants observed a lack of joint activities or reviews amongst the major
donors operating in South Africa, though frequent meetings between the NDOH and HIV-related
donors have recently been revived. Donors have been asked by the NDOH to report on their
activities in different parts of the country and the NDOH is looking to build its liaison capacity with
GHI and donor assistance.
There was a general call from respondents in the study for a donor database for South Africa. Some
major GHI funds go directly to NGOs or CSOs without any interaction with government, and it is
therefore difficult to trace donor activities (ND5). Such donors have independent reviews and
evaluations, reporting directly to their head offices in or out of country (GHI3, ND6).
Financing
Most external financing for health‐related issues in South Africa is disease‐specific and centres on
HIV/AIDS. Though malaria and TB receive attention, malaria-related efforts are geographically
limited and TB efforts tend to relate to HIV/AIDS.
The overall health expenditure of the NDOH in 2007/2008 was roughly US$ 1,823 million
(approximately US$ 1 = SAR 7 in 2008). Around 19% was spent on the HIV/AIDS and STIs
programme, with US$ 1,3 million expended on TB control and management [16].
Donor expenditure on HIV/AIDS in South Africa in 2007 – excluding PEPFAR – was equivalent to
around a quarter of the total amount spent by the NDOH. PEPFAR’s allocated funding for South
Africa was US$ 1.4 billion from 2003 to 2008, with the figure for 2007 over 100% of the amount
spent by the NDOH in that year and equivalent to 83% of all government expenditure on
HIV/AIDS‐related projects [17].
Most donor support for clinical services is channelled through the government, except for PEPFAR.
As of November 2008, the South African government supported 630,775 patients across 259 sites
on ART as part of its regular health budget [18]. PEPFAR presently finances and supports ARV
treatment for 30,000 patients in South Africa independently of the South African government
(GHI1). No external financing is used for budget support, with all donor-funded projects in South
Africa regarded as additional monies (ND6).
External financing for malaria‐related programmes began in 2003 with a round 2 grant from the
Global Fund as part of a multi‐country initiative between South Africa, Mozambique and
Swaziland, with South Africa’s Medical Research Council (MRC) acting as the implementing agency
[19]. As of 2006, the NDOH is again the sole funder of MRC South African‐specific activities in
Limpopo, Mpumalanga and KwaZulu Natal (D3).
Donor support of TB activities tends to focus on capacity support for integrated HIV and TB
management. The Global Fund has funded monitoring and evaluation training and the setting up
of MDR TB centres, with the EU providing training to senior and middle management in
government and NGOs, as well as the training of staff on TB treatment defaulters. Belgium has
provided similar support (ND4). Research is another key area that has been supported by GHIs. For
instance, the CDC provides grants to the MRC and academic research institutions for studies on
HIV and TB. Some hospitals have also had equipment and infrastructure used in the diagnosis and
treatment of TB refurbished (ND4).
The NDOH, independently and in its role as principal recipient of Global Fund round 6 funds NGOs
that work on HIV and TB. However, there have at points been concerns about the ability of the
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