By late last year, government was investigating procurement and tender fraud worth R25 billion, according to Finance Minister Pravin Gordhan.

Some R10-billion has been wasted by municipalities alone, and the last audit of the 219 municipalities found that 88 percent of them were non-compliant with the Municipal Finance Management Act, the Municipal Systems Act, and the Municipal Planning and Performance Management Regulations.

‘€œBut what are we doing about it? People are going on special leave when disciplinary and criminal charges ought to be brought against them,’€ according to Dr Adila Hassim, head of litigation with Section27.

Section27, Cosatu and others are raising funds to set up a Corruption Watch to draw public attention to what is happening and perhaps to instigate legal charges against culprits.

In its former guise as the AIDS Law Project, Section27 was behind a number of ground-breaking court cases that saw AIDS treatment extended to newborn babies and prisoners.

Although the AIDS epidemic in this country is slowing down, about 10 million South Africans will be living with HIV/AIDS within 20 years ‘€“ double the number currently. Substantial funds will be necessary to effectively address the epidemic, particularly to cover the cost of their lifelong antiretroviral treatment.

But donor money is fast disappearing, particularly for treatment. A decade ago, South Africa was awash with aid money for AIDS and the denialism of the former president and his health minister meant that non-governmental organisations often did the work of government in giving care, treatment and support to people with HIV/AIDS.

Now even organisations that have an excellent track record including the Treatment Action Campaign (TAC), Section27 and AIDS relief projects run by the Catholic Church are facing financial hardship.

Some donors, such as the Royal Netherlands Embassy, are pulling out of the country altogether. Others, like the US President’€™s Emergency Plan for AIDS Relief (Pepfar), are ‘€œrepriorising’€ and want the government to take over responsibility for treatment.

Pepfar announced last year that it was moving from ‘€œprimarily implementing programmes to providing technical assistance and capacity building to the South Africa government’€.

Started by US president George W Bush in 2003, Pepfar has donated over R19-billion to South Africa since 2004, working through some 600 partners and creating 20 000 jobs.

However, US President Barak Obama has other spending priorities and Pepfar is being scaled down and reorganised over a period of five years.

The impact of Pepfar’€™s change is being felt most acutely by projects that received funds for ARV treatment, which was almost 40 percent of Pepfar’€™s operating budget.

The SA Catholic Bishop’€™s Conference (SACBC), which has 14 ARV treatment sites serving 20 000 patients, is in the process of transferring patients to government clinics wherever possible.

An SACBC employee who declined to be named confirmed that their HIV/AIDS programme was facing ‘€œsubstantial cuts’€ in Pepfar funds and that they had already retrenched a number of staff countrywide.

In theory, the move towards government provision of health services is supposed to ensure that there isn’€™t a duplication of scarce resources, particularly doctors and professional nurses.

But in practice, in many areas of the country, government is unable to ensure that patients get decent care as it simply lacks the management capacity and resources to do so.

Professor Francois Venter, head of the SA HIV Clinicians’€™ Society, said that while he supported the reorganisation so that government took control over service delivery, this ‘€œmust not happen at patients’€™ expense’€.

What is crucial is a huge revamp of primary health care, which is currently underway, and the integration of the HIV/AIDS programme into that.

Government has already shown at national level that, with proper management, it has been   able to bring the cost of ARV treatment down substantially.

Health economist Dr Gesine Meyer-Rath was part of a task team set up by the health department to cut costs, and they homed in on the cost of antiretroviral drugs.

‘€œUntil 2010, South Africa had a system of preferential procurement for locally produced generics,’€ said Rath-Meyer, who works for both Boston and Wits universities.

‘€œThe new drug purchasing system used a reference list for ARV drugs modelled on the cheapest options available internationally, including prices from the Clinton Health Access Initiative, the Global Price Reporting Mechanism of the World Health Organisation and Pepfar,’€ said Rath-Meyer.

‘€œThe December 2010 ARV tender used the reference list as guidance for both local and international bidders. As a result, per drug prices were reduced by 50 percent on average,’€ said Meyer-Rath.

The total annual cost of the ARV treatment programme for this year is one-quarter lower than it was in 2008. Instead of government paying R11-billion to treat almost 1,8 million people, it will only pay R8-billion ‘€“ a massive R3-billion saving in one financial year.

This saving is a demonstration of what good leadership can do.

But it will be savings squandered unless those looting government coffers for their own enrichment are stopped. All the leaks in the supply chain right down to municipal level need to be plugged systematically so that South Africans get the healthcare they deserve.    


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