In 2001 at a meeting in Abuja, Nigeria, African countries committed to increase their expenditure on health to 15%. But to date, most African countries spend between 8% - 9% of their Gross Domestic Product (GDP) on health. Only a few countries such as Malawi have honoured the commitment. While they are delaying to improve their health spending, African governments are asking donor nations and agencies to sustain and increase their financing of AIDS programmes. As for South Africa, although it has the highest health budget than any other African country, it also falls far short of meeting the 15% target.
“South Africa is spending 8.5% of the GDP on health. It’s much higher than even the recommendation of the World Health Organisation. In Africa, we are spending more than all of them, but even in the other developing parts of the world, we are spending more than those countries”, says Healyth Minister, Dr Aaron Motsoaledi.
However, the money that South Africa spends on health does not produce better health outcomes. This has raised important questions that have impacted negatively on the allocation of funds for health spending.
“There is something that we are doing wrong. We have got poor outcomes regardless of spending more money than other countries”, Motsoaledi says.
“There was a very disturbing altercation between the Department of Health and the Finance Department, whereby the Health Department believed it is grossly under-funded and the Finance Department said: ‘You are well-funded, but mismanaging’. And I’m supposed to pronounce on that. My pronouncement is that it’s a mixture of the two. There was some bit of under-funding over the years of the public health care system, but there was also gross mismanagement”, he adds.
That is a double-edged sword South Africa is facing. The country has one of the highest rates of maternal, child and infant mortality and Tuberculosis and HIV infection. Increasing the health budget to 15% in the short-term seems improbable and without outside help, South Africa will not be able to nurse the health of its people, especially in the face of an HIV and AIDS epidemic that is not yet under control.
“Even if we look at South Africa, which is probably the richest country in the area, even South Africa, to realise its very good ambitious plan for the HIV fight, they will have to rely, also, in part on international funding”, says Dr Mit Philips, a health policy analyst with Medecins Sans Frontiers (MSF) a humanitarian health care agency, which is spear-heading the call for donors and rich nations to maintain their support of AIDS programmes in Africa.
An audit conducted by the MSF in eight African countries shows that international support for AIDS programmes is waning. Donor agencies including the Global Fund to fight AIDS, TB and Malaria and the US President’s Emergency Plan to fight AIDS (Pepfar) have, in recent years, reduced or kept their funding for AIDS programmes unchanged.
Many have cited the recent recession as the reason for the pulling out of resources. Another school of thought is that donors no longer view HIV and AIDS as a priority. Whatever the reason is the fact is that some regions of the world, especially southern Africa, are still in the tight grip of AIDS. As donors withdraw or reduce support, these governments need to fill the short-fall in funding.
“The resources needed for ARV scale-up will have to increase. The countries themselves in Africa have an important role in there to put money for the HIV fight. But the economic crisis has also hit Africa and several of them see the possibility to increase their budget to compensate for the international funding decrease as reduced. In most of the other low-income countries it’s simply impossible to replace the international funding on the short-term. For the moment there is about 75% of the HIV funding that is paid from international sources”, says Philips.
With the help of Pepfar and the Global Fund, which gets its money through pledges from rich countries, about three million people in poor nations now have life-prolonging antiretrovirals. But five million more are still in need. Waning donor support spells gloom for them. People living with AIDS say this is all the more reason that poor nations have to up their health budgets.
“In Kenya, the commitment to health care is about 8% - 9% only. We still urge our governments and we still fight so that our governments take care of our lives. While this is happening, our President (and) our Prime Minister are earning more money per month than the British Prime Minister, and yet the standard of living in Kenya is way below the standard of living in the UK. Why should they vote themselves so much money when we are dying? Our argument is we want our governments (and) our politicians to be committed to the health of the people”, says Jimmy Gidey, an AIDS activist from Nairobi, Kenya.
The African Union held a heads of state summit in Uganda this week. It was expected that it will pronounce on making progress towards reaching targets they adopted in 2001 in the Abuja Declaration to increase health spending to 15%. Host leader, president of Uganda, Yoweri Museveni, said “Africa has struggled to get resources”. He urged heads of states and governments to “look for multiple and cheaper ways to deliver health services”.
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