Are countries spending enough on HIV/AIDS?

The impact of HIV/AIDS in Southern Africa is now well recognised, but the critical question is whether enough funding has been allocated to deal with the epidemic, a report by the Human Sciences Research Council (HSRC) said.

In April 2001 in the Nigerian capital, Abuja, African leaders committed themselves to allocating at least 15 percent of government expenditure to the health sector. But except for Zimbabwe and South Africa, none of the other Southern African countries surveyed in the report - Botswana, Lesotho, Mozambique and Swaziland - had fulfilled this promise. Analysts have questioned the accuracy of the Zimbabwe figures.

"Botswana comes closest among the remaining countries, spending 10 percent of government expenditure on health. The other countries spend about half of the 15 percent target," the study noted.

Although it was likely that Botswana and Swaziland would meet their obligation, the "constrained macroeconomic environment" in Mozambique and Lesotho made reaching the 15 percent threshold less likely.

Failure to meet these targets could also be attributed to "very poor tracking mechanisms", Teresa Guthrie, project coordinator for the HIV/AIDS budget programme at the Institute for Democracy in South Africa (IDASA), told IRIN.

"In some of these countries you will find that the money is hidden in other government components, and not necessarily in the health budget. We cannot really say they have not been meeting targets - it has just been difficult to track the money they have spent," she commented.

Nevertheless, the aggregate government expenditure on the disease in the six southern African countries surveyed was nearly US $70 million annually - ranging from a high of US $33 million in South Africa to a low of US $0.8 million in Lesotho. When measured as a percentage of GDP, expenditure on HIV/AIDS was highest in Botswana.

Government spending per HIV-positive person in these six countries was more than three times higher than the average in the sub-Saharan African region as a whole.

According to the report, apart from South Africa, the countries relied heavily on donor funding. In Mozambique, Lesotho and Swaziland, more than 80 percent of total spending on HIV/AIDS was funded externally.

This raised questions about "who controls the AIDS money", IDASA's HIV/AIDS budget programme manager, Alison Hickey said. She warned that donor-funded projects - particularly antiretroviral campaigns - would not last unless national governments started to shoulder the burden of their AIDS spending.

"The whole point of Abuja was to get political leaders to make health a priority in their national spending - with their own resources," she added.

The Global Fund was another strategy for mobilising resources, which governments could use as a crutch. "It is important that the gains made by the commitment in Abuja are not reversed by the Global Fund's US $500 million allocations made to Botswana, Lesotho, Mozambique, Swaziland, South Africa and Zimbabwe," the report said.

Admitting that more resources were needed in the region, Hickey called for better accounting and monitoring of HIV/AIDS financing.

"We need to ... look at whether governments are spending correctly on the right programmes, and also whether the money is actually being spent," she said. - IRIN


January 2004