by Pamela Mhlanga – SANF 04 no 102
Revisiting state budgeting models and processes to meet new priorities in financing HIV and AIDS prevention, treatment, support and care for the infected and affected is an urgent priority for southern Africa.
This is more so in light of the landmark declaration by SADC Heads of State and Government in Maseru, Lesotho in July 2003 (Maseru Declaration), to, amongst other things, intensify resource mobilisation through allocating at least 15 percent of annual state budgets to improve the health sector and adopting a multi-sectoral approach.
The 15 percent target to the health sector puts state budgeting processes and models under the spotlight. The national budget is a key economic policy instrument in a country, and effective budgeting provides the key to the sustainability of any government programme. HIV and AIDS programme sustainability is crucial in light of longer-term global benchmarks such as Goal Six of the Millennium Development Goals, a global development blueprint in the coming years, which envisages that countries would have halted by 2015 and begun to reverse the spread of HIV and AIDS.
How then are southern African state budgets performing in financing the implementation of HIV and AIDS programmes and structures?
In a recent study titled “Funding the Fight: Budgeting for HIV and AIDS in Developing Countries”, an analysis of state budgeting for HIV and AIDS was done in Kenya, Mozambique, South Africa and Namibia, whilst in Latin America the focus was on Argentina, Chile, Ecuador, Mexico and Nicaragua.
The Institute for Democracy in South Africa (Idasa) and Centro de Analisis e Investigacion (FUNDAR) coordinated the study in Africa and Latin America respectively, in partnership with national organisations in the study countries.
The study found that the policy and planning instruments to direct budgeting for HIV and AIDS, such as national strategic short and medium term plans, were comprehensive and in place. Of note was Namibia which, in addition, has a 2000 HIV and AIDS Charter of Rights. Further, all African countries studied had shifted from considering HIV and AIDS a mere health issue, to a development issue, resulting in a multi-sectoral planning framework.
In spite of this, however, the study noted that tracking resources allocated to HIV and AIDS was difficult due to the weak links between policies, plans, objectives and outputs, and the budgeting process in terms of allocation of resources. Thus, in almost all countries, budgeting revealed very little of the multi-sectoral approach. For example, allocations for HIV and AIDS programmes in line ministries other than health were not apparent.
The study also noted that until recently, there have been more resources allocated to preventive action as opposed to treatment of HIV and AIDS, though the trend reveals an increase in financing of treatment programmes. An example is the introduction of antiretroviral (ARV) treatment programmes in all countries that were covered in the study, with varying degrees of coverage and success.
The most significant finding of the study, however, is that the target of allocating 15 percent of annual state budgets to the health sector, to address HIV and AIDS priorities remains distant for most African countries. The health allocations as a share of total government expenditure range from six percent in Kenya, to just below 12 percent in South Africa and 15 percent in Mozambique.
In spite of a steady increase in allocations to the health sector over time, health care systems in African countries remain underdeveloped and are struggling to cope with the impact of HIV and AIDS; state budget reprioritisation and remodelling to address the multi-faceted nature of the epidemic is thus urgent.
With regard to implementation, decentralised structures, such as those found in Namibia and Kenya, are beneficial to an integrated response to programme implementation and efficient use of resources.
The study revealed heavy reliance by governments on external aid to finance the implementation of HIV and AIDS programmes (save for South Africa), with little generated from state revenue.
The SADC Secretariat in its 2002-2003 annual report noted continued macroeconomic instability and high inflation rates experienced in most SADC countries, and this has an impact on their ability to generate revenue to finance budgets that can realistically address the enormous challenge of HIV and AIDS, including its gender and other dimensions.
Of the funding that has been directed to address HIV and AIDS priorities in respective African countries, the study noted the difficulty in isolating these funds from overall allocations to the health and other sectors.
A big gap in budget implementation is thus the lack of disaggregated data of funds for HIV and AIDS specific programmes from other programmes.
If this data is not readily available, then monitoring implementation shall remain difficult. It is evident that the Maseru Declaration and other regional and international commitments to squarely tackle the HIV and AIDS epidemic will remain on paper only, if not matched by adequate inflow of resources and their strategic management.
The priority given to HIV and AIDS in state budgeting is a clear indicator of political will to fund the fight against the epidemic, and remodelling budgeting approaches to respond to the reality will ensure that the political will already generated is sustained. (SARDC)
