INCREASING the HIV/AIDS budget in the current fiscal climate will be tough, but worth it in the long run, according to research published in the latest edition of the South African Health Review.
SA has the world’s largest HIV burden, with between 6.4-million and 6.8-million people infected with the disease. By December last year, 3.26-million of those with the disease were on treatment. The expansion of this treatment programme by about half a million people a year has required an extra R1bn-R1.5bn a year.
This has put increasing pressure on other aspects of health-care spending and raised tough questions for the government about how best to allocate its limited resources.
Healthcare spending is constrained by a long-standing government expenditure ceiling put in place because of low economic growth, the weak rand, a high fiscal deficit and a lower credit ratings cloud that have increased debt-servicing costs.
At the same time, the government has committed to expand its HIV/AIDS prevention and treatment programmes, the costs of which have grown 14-fold in nominal terms since 2004-05. Its HIV/AIDS allocations have grown from R1.2bn in 2004-05 to R17.5bn in 2016-17.
Modelling the costs of various responses to the country’s HIV/AIDS epidemic, the authors concluded that a more aggressive, earlier intervention would have a greater effect on health outcomes in the next 20 years and that this would lead to reductions in total spending in the long run.
A scenario that provided for condoms, medical male circumcision, antiretrovirals at current guidelines, prevention of mother-to-child transmission of HIV and infant-testing at six weeks would take SA close to the United Nations 90:90:90 targets to which the country has committed.
However, this would require significant additional funding in the medium term — an extra R6.95bn in the next 10 years, said Yogan Pillay — the Department of Health’s deputy director-general for HIV/AIDS, TB and maternal, child and women’s health — who is one of the health study’s authors.
The 90:90:90 targets aim to increase to 90% the proportion of people who know they have HIV, are on treatment and have a suppressed viral load.
Dr Pillay said SA’s HIV/AIDS programmes had scope to be more efficient, for example, by providing medication to stable patients via courier pharmacy services or adherence clubs, rather than at hospitals.
Contrary to recent media reports, there was no moratorium on provinces hiring health-care staff since the Treasury’s announcement of a hiring freeze, he said.
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