Missing the mark

A year after the Cabinet approved an Aids treatment plan progress is patchy, with seven of the nine provinces lagging behind in meeting patient targets.

Provinces also underspent their conditional Aids budgets in the first quarter of this financial year.

This month the Department of Health said about 12 000 patients are on anti-retroviral (ARV) treatment. The Mail & Guardian’s calculations show the figure is closer to 14 000. That is still a far cry from the 53 000 initially set down in the treatment plan, a target that the department admits will not be met by next year.

A snap survey by the M&G of all nine provinces shows that the Western Cape and Gauteng have forged ahead with their own roll-out plans; together they are treating almost 10 000 of the 14 000 total. NGOs in some provinces are treating more patients than all of Limpopo, which lags behind, with only two sites, because of problems with laboratory systems. Cabinet will be briefed in the next two weeks on progress and the challenges facing the plan.

A preliminary analysis of HIV/Aids expenditure shows that for the first quarter of 2004/05 the spending rate on conditional grants — funds allocated by the Treasury to provinces for specific purposes — was slightly lower than in the first quarter of 2003/04.

This analysis, conducted by Nhlanhla Ndlovu, a researcher at the Institute for Democracy in South Africa’s Aids budget unit, notes it was ”difficult to decipher how provinces are spending their conditional grants for ARV roll-out specifically because the new funds for the ARV programme were added to the already existing health HIV/Aids conditional grant”.

Ndlovu found that provinces spent on aggregate 15% (R50,7-million) of the year’s total health HIV/Aids conditional grant allocation in the first quarter of 2003/04. In the first quarter of 2004/05 they have spent 6,5% (R50,2-million) of the financial year’s total allocation.

”Slow spending can affect the overall provision of comprehensive HIV/Aids prevention, care and treatment services. This is more of a red flag concern, given the fact that ARV roll-out began in the first quarter of 2004/05 and that provinces should have spent more on health facility and system upgrades, education and communication, continued prevention and care campaigns, ARV drug procurement and staffing,” said Ndlovu.

Aids experts warn that an exclusive focus on patient numbers to measure progress could lead to nothing more than a counting competition that shifts attention away from the quality of the treatment. Andrew Boulle of the School of Public Health and Family Medicine at the University of Cape Town said it is hard to assess the progress of the roll-out, but it has ”been slower than any of us wanted it to be”.

How the provinces are faring