SOUTH AFRICAN HIV/AIDS SPENDING IN 2006 BUDGET

UNCLAS SECTION 01 OF 03 PRETORIA 001052 SIPDIS SIPDIS DEPT FOR AF/S; AF/EPS/SDRIANO DEPT FOR S/OFFICE OF GLOBAL AIDS COORDINATOR STATE PLEASE PASS TO USAID FOR GLOBAL BUREAU KHILL USAID ALSO FOR GH/OHA/CCARRINO AND RROGERS, AFR/SD/DOTT ALSO FOR AA/EGAT SIMMONS, AA/DCHA WINTER HHS FOR THE OFFICE OF THE SECRETARY/WSTEIGER, NIH/HFRANCIS CDC FOR SBLOUNT AND DBIRX E.O. 12958: N/A TAGS: ECON KHIV SOCI TBIO EAID SF SUBJECT: SOUTH AFRICAN HIV/AIDS SPENDING IN 2006 BUDGET Summary -------------- ¶1. Summary. Finance Minister Trevor Manuel presented South Africa's 2006 Budget, highlighting the South African government's planned expenditures and revenues over the following three years. Expenditures on social development constitute over half of total expenditures. Spending on health and HIV/AIDS continues as a high SAG priority. The Department of Health spends over 80% of HIV/AIDS funds, with the Departments of Education and Social Development receiving the remainder. Provinces will receive more funding through equitable share allocations rather than funds earmarked for particular purposes. However, relying more on equitable share funding, where provinces have discretionary spending authority, makes it difficult to insure these funds are actually spent on HIV/AIDS, especially without clear government-wide monitoring. End Summary. Social Development Spending -------------- ¶2. The strength of the South African economy and tax revenue collection allow for generous increases in spending on social services in the budget. During the 2006/07 fiscal year, spending on social services, consisting of education, health, welfare, housing and community development expenditures, should constitute 52.7% of total government spending. The total commitment to social services will rise by 11.6% annually over the next three years. Education and welfare constitute the top two priority spending areas, at 17.8% and 15.5% share of total governmental spending during next fiscal year. Health, at 10.5% share of total government spending in 2006/07, is third overall. ¶3. Expenditures in the South African budget are presented by either departments or function (protection, social services, economic services and general governmental services). Functional expenditures include spending by government and important public sector entities, such as state-owned enterprises and institutions such as the South African Research Council, Human Sciences Research Council and the National Health Laboratory Service. Government spending on health (classified by function rather than department) will average 9.7 % of total consolidated expenditure (including national, provincial and some public entities) over the next three years. A substantial amount of total 2006/07 health spending of R54.5 billion ($9.1 billion) is targeted at improving health care infrastructure and service delivery. The hospital revitalization program received an additional R900 million ($150 million),increasing the national budget funding for improvements to provincial hospitals from R1.2 billion ($200 million) in 2005/06 to R2 billion ($330 million) in 2008/09. HIV/AIDS Spending -------------- ¶4. From a departmental perspective, the Health Department is the major source of HIV/AIDS expenditures, followed by the Departments of Education and Social Development. Other departments such as the Departments of Science and Technology and Public Services Administration have announced HIV/AIDS programs but have not given definite planned spending amounts. Table 1 gives planned HIV/AIDS spending for the top three departments in billions of rands from fiscal years 2004/05 until 2008/09. Table l, HIV/AIDS Spending by Department, billion rand -------------- -------------- 2004/05 2005/06 2006/07 2007/08 2008/09 Health 1.11 1.57 1.98 2.08 2.19 Education 0.13 0.14 0.14 0.15 0.16 Social Development 0.01 0.05 0.06 0.06 0.60 Total 1.25 1.75 2.18 2.29 2.41 Consolidated spending including transfers to provinces Department of Health Budget -------------- ¶5. The National Department of Health's budget will increase nominally from R9.8 billion ($1.6 billion) in 2005/06 to 11.2 PRETORIA 00001052 002 OF 003 billion ($1.9 billion) in 2006/07, a real increase of 10%. Note. National Treasury forecasts South African 2006 targeted inflation to increase by 4.3%, while nominal health expenditures increased by 14.3%. End note. The highest growth in the health sector budget is in the HIV/AIDS subprogram. This budget has risen from R454.6 million ($75.8 million) in 2002/03 to a projected R2.2 billion ($367 million) in 2008/09, a 21% annual increase. As a result of providing more anti- retroviral treatment, real health expenditures will increase 7.3%, 3.6%, and 3.1% in fiscal years 2006/07, 2007/08, and 2008/09, respectively. HIV/AIDS Priority -------------- ¶6. The Health Department's spending on HIV/AIDS in 2006/07 is R1.9 billion ($320 million),up from R1.5 billion ($250 million) in 2005/06. HIV/AIDS spending by the Health Department is expected to reach R2.1 billion ($350 million) in ¶2008. Funding for condoms has increased from R70.8 million in 2002/03 to a projected R147.9 million in 2008. Treasury Minister Manuel announced an allocation of R40 million ($6.7 million) to manage and monitor the government's national HIV and AIDS plan and an additional R52.7 million ($8.8 million) for non-governmental organizations. The HIV/AIDS program consumes 94% of the total budget available for Strategic Health Programs in 2006/07, up from 64% in the 2002/03's budget. Note. The Strategic Health programs consist of: maternal child and women's health; medicines regulatory affairs, HIV and AIDS, Pharmaceutical policy and planning; and communicable disease. End note. ¶7. The Department of Health dominates HIV/AIDS spending, at 80% of the HIV/AIDS budget, although the Departments of Education and Social Development do allocate some funding for HIV/AIDS. The Department of Education's Lifeskills AIDS Education Grant will receive R144 million ($24 million) in FY2006/07, increasing 2% (real) in 2007/08. The Department of Social Development will receive R46 million ($7.7 million) in 2005/06, increasing to R55 million ($9.2 million) in 2006/07, R56 million ($9.3 million) in 2007/08 and R59 million ($9.8 million) in 2008/09. These funds will support access to social development services for the HIV-affected population. ¶8. In addition to conditional grants to provinces which are designated to support HIV/AIDS services, provinces receive equitable share funding. Provinces decide on how to spend equitable share funding. Recently, the Community and Home Based Care Services Grant, formerly supported by the Department of Social Development, has been moved from a conditional grant to the provincial equitable share funding. This change could result in some provinces redirecting previously earmarked home based care financing to other provincial funding priorities. ¶9. Other departments support HIV/AIDS programs, but the national budget does not include specific information. For example, the Department of Science and Technology plans to cost- share an AIDS vaccine program with the Department of Health, and the Department of Public Service and Administration mentions increasing HIV/AIDS expenditures for civil servants. Through the President's Emergency Plan for AIDS Relief, the USG is also supporting significant projects with the Departments of Defense, Justice, Correctional Services and Provincial and Local Government. Because of these commitments which are not specified in the published national budget summaries, a comprehensive government HIV/AIDS funding total is difficult to obtain. ¶10. As of the end of December 2005, National Treasury estimates that 112,000 patients were receiving antiretroviral treatment in public clinics. National Treasury also reports that the treatment component of the comprehensive HIV/AIDS plan now reaches 192 sites in all 53 health districts (and more than 170 local municipalities),compared to 139 accredited facilities in 2004/05. Comment -------------- ¶11. Given the increasing amount of HIV/AIDS funding allocated to equitable share funding and the difficulty of obtaining PRETORIA 00001052 003 OF 003 government-wide HIV/AIDS funding totals, civil society and Parliament will need to monitor HIV/AIDS provincial spending closely to make sure HIV/AIDS funding gets spent for the designated purpose. TEITELBAUM