hiv/aids financing and health policy in south africa
DESCRIPTION
HIV/AIDS Financing and Health Policy in South Africa. By Chrystelle TSAFACK TEMAH. Background. Abolition of apartheid and election of the government of National Unity in 1994 with adoption of the Reconstruction and Development Plan - PowerPoint PPT PresentationTRANSCRIPT
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)Accra - Ghana, 10th - 12th March 2009
HIV/AIDS Financing and HIV/AIDS Financing and Health Policy in South Health Policy in South
AfricaAfricaBy
Chrystelle TSAFACK TEMAH
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)Accra - Ghana, 10th - 12th March 2009
Background Abolition of apartheid and election of the
government of National Unity in 1994 with adoption of the Reconstruction and Development Plan « Render health care unified and accessible to all South
Africans » District health system and free primary health care
Mid’ 90s: HIV/AIDS reaches epidemic dimension Highest absolute number of infected people in the world Highest number of deaths due to AIDS and AIDS orphans
End 2003: Adoption of a national roll-out plan to provide free ARV to all people in need
711,000 people in need, but only 225, 000 were received treatment in 2007
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)Accra - Ghana, 10th - 12th March 2009
Motivation Despite its gravity, HIV/AIDS, it is only one of
the many public health issues in South Africa South Africa is still dealing with infectious diseases,
infantile mortality and malnutrition
Growing toll of chronic diseases (obesity, cardiovascular diseases, diabetus, etc…)
Two questions addressed in this paper: How does HIV/AIDS financing fit into the overall
health policy in South Africa?
Are the resources allocated to the fight against HIV/AIDS in the country used efficiently?
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)Accra - Ghana, 10th - 12th March 2009
Overview
South African health System
HIV/AIDS Financing
Efficiency of HIV/AIDS Financing
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)Accra - Ghana, 10th - 12th March 2009
South African health System
Post-apartheid health reforms Free primary health care, free care to pregnant women,
nursing mothers and children under 6.
District health system: services offered according to local conditions and health problems. Financed through conditional grants and equitable shares.
Health financing Public sector: 40% of THE and accounts for 80% of
population. Financed through tax collection and user fees
In 2000, private sector was spending € 91 per patient, opposed to € 6,75 in the public sector. Financed through prepaid plans and OOPE
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)Accra - Ghana, 10th - 12th March 2009
Table 1: Trend of Indicators of health expenditure in SA (1998- 2005)
1998 2000 2002 2005
Total expenditure on health as % of Gross domestic product 8,4 8,4 8,7 8,7
General government expenditure on health as % of Total expenditure on health 44,8 42,4 40,6 41,7
Private sector expenditure on health as % of Total expenditure on health 55,2 57,6 59,4 58,3
General government expenditure on health as % of General government expenditure 11,5 11 10,7 9,9
Social Security funds as % of General government expenditure on health 4 3,3 3,8 4,1
Prepaid and risk-pooling plans as % of Private sector expenditure on health 74,7 75,6 77,7 77,3
Private households' out-of-pocket payment as % of Private sector expenditure on health 23,6 22,8 20,9 17,4
External resources on health as % of Total expenditure on health 0,2 0,4 0,3 0,5
Total expenditure on health per capita at exchange rate 261 244 206 437
Total expenditure on health per capita at international dollar rate 585 625 689 811
General government expenditure on health per capita at exchange rate 117 103 84 182
General government expenditure on health per capita at international dollar rate 262 265 280 338
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)Accra - Ghana, 10th - 12th March 2009
HIV/AIDS Financing
National sources of financing
Conditional grants (10%): ring-fenced funds allocated to health, education and social development sectors. Allow to ensure that national priorities will be sufficiently resourced in provincial budgets
Equitable shares (86.5%): means found by the government to correct distorsion due to differences in provincial tax revenues. Allow discretionary spending by the provinces
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)Accra - Ghana, 10th - 12th March 2009
HIV/AIDS Financing (ct’d) External sources of financingExternal sources of financing
The Global Fund : 4 main projects funded at the end of 2005
LoveLife initiative (2003): $12,000,000. Promotion of healthier sexual practices among adolescents
Institute for Health and Development Communication (2003): $2,354,000. Producion of the new series of Soul City
“Enhancing the Care of HIV/AIDS infected and affected patients in resource-constrained settings in KwaZulu-Natal” (2003):$12,873,456
“Strengthening and expanding the Western Cape TB and HIV/AIDS prevention, treatment and care” (2004): $8,282,075
disbursed a cumulated amount of more than 128 million dollars at the end of 2008
NGOs and international aid PEPFAR, G7, OECD, DFID, EU, USAID, foundations, private business
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)Accra - Ghana, 10th - 12th March 2009
Efficiency of HIV/AIDS Financing
Crowding-out effect on health sector: public health issues Burden on health facilities (e.g: Kwa-Zulu Natal
provincial health services, Veenstra 2005) HIV/AIDS stay longer at the hospital, use more expensive drugs;
also more lab and radiology costs associated with HIV/AIDS patients
This difference increases with the reference level; it is higher for regional than for district hospitals
Millennium Development Goals and major public health issues
Treating 6.000 patients on ART costs just as much as providing full immunization coverage against measles and tetanus for all children in South Africa. Assuming cost per patient per year =1,000 USD
Treating 12.000 HIV/AIDS patients with ART costs as much as providing clean water to all people in need and ORT to all children aged 0-4 infected with diarrhoeal diseases
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)Accra - Ghana, 10th - 12th March 2009
Decomposing resources allocation Expenditure as shares of budget Trends in
expenditure by functional area and GDP (R million,
real 2003 prices) 99/00 01/02 02/03
05/06 Annualchange
(%)
Hospitals
21 958
22 861
21 572
23 580
1.2
PHC 4 906 5 295 5 701
6 346 4.4
HIV/AIDS
83 104 750 880 48.2
Nutrition
617 673 760 833 5.1
EMS 911 942 1 362
1 507 8.7
Admin 1 244 1 377 1 427
1 574 4.0
Total 32 212
34 589
35 117
3.0 3.1
2000/12004/
5
Change
(%)
Health as % of total budget 11.56 11.33
-1,98
Health as % of GDP 2.96 3.06
3,37
HIV/AIDS as % of total budget 0.09 0.49
444
HIV/AIDS as % of total health budget 0.67 3.86
476
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)Accra - Ghana, 10th - 12th March 2009
Efficiency of HIV/AIDS Financing (ct’d)
Justification for HIV/AIDS financing Burden of diseases and death
5, 700 infected people at the end of 2007 HIV/AIDS was responsible of 30 % of all deaths in 2000
and 47 % in 2007 Among 15-49 age group, it is responsible of 71 % of all
deaths
Cost-effectiveness Absorption capacity
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)Accra - Ghana, 10th - 12th March 2009
Efficiency of HIV/AIDS Financing (ct’d)
Cost-effectiveness of ART: Comparison of ART to the status quo (treatment for opportunistic infections only) in Khayelitsha
ART is efficient in economic terms costs R13 754 per QALY versus R14 189 per QALY for
patients who do not receive ART
ART leads to an average gain in life expectancy of 6.06 years.
Several reports confirm good outcomes of ARV use in the public health sector
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)Accra - Ghana, 10th - 12th March 2009
Percent spent from 2000 to 2003 on HIV/AIDS, conditional grant
allocation
22,30%
59,50%
35,60% 36,50%
66,10%
82,90% 81,30%
74,50%
86,50%
92,70%
85,00%
82,20%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Education sector Health sector Social development
Sector
Total HI V/ AI DS
Conditional Grantsperc
ent
actu
ally
spe
nt o
n cu
rren
t CG
's a
lloca
tion
2000/ 01
2001/ 02
2002/ 03
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)Accra - Ghana, 10th - 12th March 2009
Conclusion Overall, HIV/AIDS financing differs from
health policy in South Africa in three points ARVs, which are not included in the PHC package are offered free in the
public sector HIV/AIDS financing is not confined to the health sector external funding account for a greater part of financing in the case of
HIV/AIDS
Evidence that HIV/AIDS is highly affecting health system
In terms of resources allocated In terms of utilization of facilities In terms of crowding out of public health issues
Evidence that amount spent on HIV/AIDS financing is justified
HIV/AIDS has became the top single cause of deaths in the country ARVs allow to gain 6 years over the baseline scenario Provinces are increasing their ability to spend HIV/AIDS funds
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)Accra - Ghana, 10th - 12th March 2009
Recommendation
HIV/AIDS is striking people in their most productive years, thus undermining human capital, a development pillar. This alone justifies the amount of money devoted to the epidemic. Yet, other public health issues, cheaper and more cost-effective deserve attention and should be resolved in order to ensure fairness and ‘equity’ between patients suffereing from any cause.
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)Accra - Ghana, 10th - 12th March 2009
Thank you for your attention