8 may 2011
DESCRIPTION
Community and health facility budget advocacy issues around HIV/AIDS and TB service delivery at district level 5 th SA AIDS Conference. 8 May 2011. Some background observations. Budget and expenditure analyses indicate increased resources for HIV and AIDS - PowerPoint PPT PresentationTRANSCRIPT
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Community and health facility Community and health facility budget advocacy issues around HIV/AIDS budget advocacy issues around HIV/AIDS and TB service delivery at district level and TB service delivery at district level
55thth SA AIDS Conference SA AIDS Conference8 May 20118 May 2011
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Some background observationsSome background observations
• Budget and expenditure analyses indicate increased resources for HIV and AIDS
• Massive growth in ARV treatment patient numbers • Remarkable improvement on absorptive capacity =
government’s ability to spend• Exceptional leadership of the Provincial Offices of the
Premiers: ECAC & KZN PAC• However, inadequate governmental information and financial
management systems, Basic Accounting System (BAS) not fully utilised or understood by managers
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The problem:The problem:• Insufficient participation of citizens in budget policy planning and
implementation monitoring• Lack of technical skills to monitor use of public funds at local level
– Inadequate output monitoring at service delivery level– Translation of actual spending into real life impact?
The interventionThe intervention• CEGAA and TAC embarked on a pilot budget monitoring and
expenditure tracking (BMET) project in O.R. Tambo (EC) and uMgungundlovu (KZN)Districts, to:– Build community & local government capacity to monitor health care provision
from a budget perspective– assess quality of health care services for PLWHA&TB– identify key challenges and develop resolutions for improving service delivery – enhance social accountability – undertake/ support strategic advocacy activities for budgetary changes to
improve HIV/AIDS and TB quality interventions.
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Some key findings from initial community and health Some key findings from initial community and health facility surveyfacility survey• Most patients (82%, n = 405) reported that they received the health care
services they needed in recent months (2010)• 17% did not receive the services they needed, due to, inter alia: AIDS
treatment not available at clinic; long waiting queues (crowded facilities); long distance and transport
• However, most patients (64%) interviewed were happyhappy with the quality of health services they received!
• Notably, some patients were not happy not happy with waiting times (21%) and the current quality of service received (17%)
• Interestingly most clinic and hospital health workers (57%, n = 26 staff teams) were not happy not happy with the quality of health care service they provided due to a combination of reasons, such as:– Medical doctors not available on site; Shortage of general health staff
(burnout); lack of basic necessities (stationery, patient forms, syringes, sputum bottles, etc ); limiting physical space.
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Reconfirming Reconfirming OLDOLD budget advocacy issues and budget advocacy issues and recommendations, in summary...recommendations, in summary...
Common issues from both community members (patients) and health facilities - Common issues from both community members (patients) and health facilities - issues beyond HIV/AIDS and TB funding:issues beyond HIV/AIDS and TB funding:
• Staff recruitment and capacity development: – Clarify roles and responsibilities of human resources between provincial and
district health offices, and recruit more staff and build capacity AT HEALTH FACILITY LEVEL
– Improved staffing will reduce staff attitudes, burnout and long queues• Treatment (systems and personnel): Improve / systematise the ordering and
transporting process of all treatments from district depots to local facilities• Other support systems, not just ARVs: information management systems; active
involvement of facility staff, clinic committees and hospital boards in planning & budgeting; provision of sufficient information, counselling, care and support, and respect for AIDS and TB patients
• HIV prevention: Strengthen community level prevention efforts, DOH mobiles for deep rural areas? Strengthened school based strategies?
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Enforcing social accountabilityEnforcing social accountability
• Public hearings (“Izimbizo”) dominated by citizens giving testimonies of their own experiences of accessing health care
• Active engagement between citizens and decision makers and/or service providers on issues that affected PLWHA&TB
• The government officials and other stakeholders confirmed that the findings and recommendations were not new.– Acknowledgment of pitfalls in the health system and commitment to work
towards resolving the issues.
• Formation of Action Teams
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Thank You!
Nhlanhla NdlovuProgramme Manager
Centre for Economic Governance and AIDS in Centre for Economic Governance and AIDS in Africa (CEGAA)Africa (CEGAA)
Tel: +27 -33-394-0845Cell: +27-73-198-7219