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Health budget decisions may be violating Constitution

Several health-related budget decisions taken in the past financial year violated the Constitution, the National Health Act, the Public Finance Management Act and the Promotion of Administrative Justice Act.

This is according to a group of activists, researchers, unionists, health workers and academics who have written letters to the ministers of health and finance, expressing grave concern over budgeting practices within the public health system and the dire effect it is shaving on HIV/AIDS, including the antiretroviral (ARV) treatment and prevention of mother-to-child transmission programmes.

The group ,calling themselves the Budget and Expenditure Monitoring Forum (BEMF),includes the Treatment Action Campaign (TAC), the Democratic Nursing Organisation of South Africa (Denosa), the National Education, Health and Allied Workers Union (Nehawu), the Southern African HIV Clinicians Society and the AIDS Law Project .

‘€œIn essence the group is concerned with preventing further treatment interruptions and moratoriums, moving towards achieving the NSP (HIV & AIDS and STIs Strategic Plan 2007-2011) targets,’€ said BEMF representative Mark Heywood.

‘€œIn a nutshell we are asking for a bigger health budget, including for ARV treatment, better management of health expenditure and proper monitoring and evaluation of the HIV programmes,’€ he said.

In the letter to Health Minister Dr Aaron Motsoaledi, whom the group acknowledges did not contribute to the current state of affairs, the BEMF says that the moratorium on starting new patients on ARVs in the Free State is an example of an unlawful decision.

An estimated 30 lives were lost every day in the province as a result of the five-month moratorium alone, not taking into account cutbacks to other services as well.

Recent reports from the Free State indicate that there are still widespread medical goods stock-outs including critical drugs for HIV and TB, unreliable access to PMTCT services, waiting lists for ARVtherapy initiation and a failure to buy the volume of drugs agreed upon.

The BEMF letter points out that the last reliable estimate of the number of people on ARVs in the public health system was about 450 000 as of July 2008. This means that about 770 000 people who were eligible for treatment were untreated at the time.

In the letter the group claims that, despite agreed upon targets in the NSP, the quantities of drugs provided for in the tender is not being purchased. This means that far fewer people are accessing treatment than are provided for in the tender and the HIV Conditional Grant.

Furthermore treatment guidelines have not been published since 2004 which means health workers are reluctant to prescribe the improved drug regimens contained in the draft guidelines.

Finally, Motsoaledi’€™s attention is drawn to the concerns over the inadequate monitoring and evaluation of the ARV and PMTCT programme. ‘€œNot even the number of patients participating in these programmes is known with any confidence, let alone more sophisticated data such as median CD4 counts, viral loads and regimens used,’€ the group says.

In a separate letter to Finance Minister Pravin Gordhan the group repeats its concerns over the violations of the laws. It calls on Treasury to monitor the HIV Conditional Grant and to top up the grant over the medium term economic framework period in November to ensure there are sufficient funds.

It also appeals to Treasury to take into account the effect of the Occupation Specific Dispensation for healthworkers and to review the provincial budgets to ensure sufficient funds have been allocated to meet these costs.

‘€œWe believe, based on what we have observed over the past number of years, that the implementation of health services, such as ARV treatment, has been hampered by managerial concerns that over-expenditures on health services are more dangerous than an under-delivery of health services. Performance must be rewarded rather than an ability to remain within budget for certain programmes in the health sector,’€ said the BEMF.

The Ministry of Finance has acknowledged receipt of the letter.  ‘€“ Health-e News Service.

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Anso Thom