Health economists have welcomed the R1 billion allocated in the 2002-2003 budget for the national HIV/AIDS programme – although some have cautioned that it will be important to see that this money reaches those provinces worst affected by the epidemic.

In his budget speech, finance minister Trevor Manuel said that in addition to an estimated R4 billion spent by provincial health departments on AIDS-related illnesses, funding for “prevention programmes in schools and communities, hospital treatment and community-care programmes will amount to R1 bilion next year, rising to R1,8 billion in 2004/5.”

Manuel said that this amount included a “progressive roll-out of a programme to prevent mother-to-child transmission at the conclusion of the current trials.”

Director of the Health Economics Unit at the University of Cape Town, Dr Di McIntyre was positive about the budget allocation.

She said it was “particularly encouraging” to see that in addition to funding for prevention programmes which have been part of the government’s response to HIV/AIDS for some time, there was now recognition that funding was needed for hospital treatment.

“The fact that hospital treatment is identified means that they are recognising that HIV/AIDS is starting to have a major impact on hospital expenditure and there is a need for relief for hospitals,” said McIntyre.

She said that government’s willingness to put money into home-based care was also a welcome move.

Also upbeat about the budget was Director of the Centre for Health Policy at Wits University’s School of Public Health, Professor Helen Schneider who said the AIDS budget was “excellent news”, although not entirely unexpected.

The biggest needs are in routine health services, especially hospitals. What’s good about the budget is that it looks like money will go to strengthening existing infrastructure to cope with the need for care and support people with HIV/AIDS,” said Schneider.

McIntyre cautioned that it was important to ensure that the amount of money pledged needed to be backed up by mechanisms to ensure that the money was well used.

“Last year the conditional grants for HIV/AIDS were not weighted sufficiently. For instance, KwaZulu-Natal should have received a sizeable share, but this was not the case. A key factor will be to see that the funds are heavily weighted to support those who need it the most.”

McIntyre added that the finance and health departments needed to think of “innovative ways” to ensure that money was spent appropriately.

“If they’re talking about home-based care, there are many non-government organisations who can assist in this work. The department must improve their capacity to deliver.”

The AIDS Consortium which represents some 400 AIDS service organisations and 300 individual members cautiously welcomed the finance minister’s commitment to helping roll out the mother-to-child prevention programme.

While it praised the move as a “step forward for women living in townships and rural areas”, it added that these women relied on the public health system to ensure that they gave birth to healthy babies.

Consequently, the Consortium called on the Minister of Health “to present the country with a proper comprehensive pogramme to impact on the prevention of mother to child transmission of HIV nationally – now!”

 The Consortium added that the “significant measures” contained in the budget to strengthen the national HIV/AIDS programme were still short of what was needed.

The Consortium called for additional finances to be targeted to ensure maximum impact in reducing new infections and prolonging lives of those already infected.

“Key departments including the Ministries of Finance, Trade and Industry and Health need to research the actual cost of the impact of HIV, what is needed to address the fact that people are dying prematurely, the cost of treatment of both opportunistic infections and antiretroviral treatment for those who need it, and then to use these statistics to develop a treatment and prevention plan, with a budget for implementation”.

HIV/AIDS researcher for the Budget Information Service at IDASA, Alison Hickey said the R1 billion for HIV/AIDS was an increase of more than R600 million on the previous year’s spending.

She said that a particularly welcome development was the inclusion of a new conditional grant for provincial management of HIV/AIDS programmes.

“This is fantastic. One of the things we’ve identified in previous years are problems in provincial management. They’ve allocated an amount of some R6,7 million to address this need.”

Hickey said another trend in the funds allocated to health was that it looked as though the role of the Department of Health was being strengthened.

“It looks like a lot of money will be flowing through the health department rather than farming it out via the education or social development departments,” she said.

Looking ahead to where funds would be needed, Schneider said that in the same way that the basic income grant has come onto the political agenda in recent months, next year’s budget would need to grapple with the question of universal access to antiretroviral treatment of HIV/AIDS.

“At the moment it’s a politically difficult issue to address, but it will be a future issue,” said Schneider.