I recently posted about the possible North-South conflict over AIDS spending that might emerge when donors discover that South African taxpayers (i.e. relatively wealthy South Africans) are getting a reprieve while the global fund releases scarce millions of dollars for AIDS treatment in that country — rather than to a country with less domestic fiscal capacity.
But, as Albert Van Zyl’s recent post on the Open Budgets Blog indicates, and I probably should have emphasized, AIDS expenditures have been growing quite substantially in absolute terms and as a share of the overall national budget. He shares responses from a range of South African civil society organizations including a nice analysis from the Centre for Economic Governance and AIDS in Africa. They highlight the growing pressure of AIDS expenditures on the overall AIDS budget:
The HIV and AIDS programme continues to receive the largest resources in the 2012/13 health budget: 33.5 per cent of the total national health budget in 2012/13, increasing to 35.9 per cent in 2013/14, and to 37.6 per cent in 2014/15. This is the second-highest allocation in the health sector. The Hospitals, Tertiary Health Services and Human Resource Development Programme receives 61.4 per cent of the total health budget in 2012/13, but interestingly, the budget proportion for this programme decreases in the medium term (59 per cent in 2013/14 and 57 per cent in 2014/15) as the proportion for HIV and AIDS escalates. We should assess more closely whether HIV and AIDS is crowding out other health expenditures, as this affects the overall mobilisation and utilisation of funding for health in general.
The political scientist in me wonders when this too will become an overt political conflict. Recent scientific studies have shown that Anti-retroviral therapy, which accounts for much of the AIDS bill, is good for prevention as it reduces the likelihood of transmission. But that reality could get lost on people who begin to observe different levels of health care and expenditure allocation based on their sero-status, especially as the AIDS bill takes on a larger and larger share of the overall budget.
What I’d add to this is the observation that as more patients shift to 2nd-line therapies the cost of treatment will likely increase substantially as the 2nd-line ARVs are generally less available as “generics.”