16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

SOUTH AFRICA’S ‘ROLLOUT’ OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY: A CRITICAL ASSESSMENT

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. ThLB0403

N. Nattrass
University of Cape Town, School of Economics (and AIDS and Society Research Unit), Cape Town, South Africa

ISSUES: This paper provides a critical overview of South Africa’s ‘rollout’ of highly active antiretroviral therapy (HAART). The Health Minister claims that South Africa’s performance has been relatively good and that the rollout is almost entirely domestically funded. This paper shows that South Africa’s performance has been comparatively poor, that the recent growth in HAART coverage has been strongly underpinned by foreign donors, and that if the Health Minister had mobilised the resources allocated to her by the Treasury, another 300,000 people would be on treatment. Political will and ministerial intransigence remains a key obstacle to improving HAART coverage in South Africa.

DESCRIPTION: The number of people on HAART in South Africa has risen dramatically from less than 2,000 in October 2003, to almost 200,000 by the end of 2005. Yet South Africa’s HAART coverage is poor both in comparison with other countries and the targets set by the government’s own Operational Plan. This paper shows that the public sector HAART rollout has been uneven across South Africa’s nine provinces and that the role of external assistance from NGOs and international funding agencies has been substantial. The National Treasury allocated sufficient funding to the Department of Health for a larger HAART rollout, but the Health Minister has not spent it accordingly (with the result that 300,000 fewer people are now on treatment than originally envisaged in 2003). Failure to invest sufficiently in human resources – especially nurses – is likely to constrain the future rollout, thereby compromising the health and lives of thousands of South Africans.

LESSONS LEARNED: Fiscal and human resources are important factors driving HAART coverage. However, in South Africa’s case, failure of national leadership remains a key constraint.

RECOMMENDATIONS: Constant monitoring of HAART coverage is required - as well as ongoing pressure from civil society organisations.

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2006-08-13
ThLB0403

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