The AIDS Law Project (ALP) welcomes those aspects of the 2010/2011 budget that deal with health tabled by Minister of Finance Pravin Gordhan on 17 February 2010.
Financing for HIV Treatment
We believe the 2010/2011 budget is a step forward in budgeting for the right to health. In particular, the allocation of additional resources to cover long underfunded health programmes, including programmes designed in line with the National Strategic Plan for HIV & AIDS and STIs, 2007 – 2011 (NSP), is an advance. The announcement that the Medium Term Expenditure Framework (MTEF) now provides sufficient funds to put 2.1 million people onto ARV treatment by the end of the 2012/2013 financial year (on the basis of the new ARV treatment guidelines), seems to be proof that this government is taking the targets of the NSP seriously. The previously announced addition of R5.4 billion to the Conditional Grant for HIV & AIDS has resulted in an increase of over 30% to prior MTEF allocations for the 2010/2011 and 2011/2012 financial years.
However, the rising allocations to ARV treatment reinforces the need for the National Treasury and the National Department of Health to be vigilant in ensuring these funds are stretched as far as possible. A new ARV tender process must be completed by June 2010 and the government must be prepared to use both its legal powers and its leverage as the largest ARV purchaser in the world to secure the lowest available prices from pharmaceutical companies. It is critical that the ARV tender introduces flexibility in the tender process to allow greater competition from generic manufacturers and take advantage of new developments in HIV treatment. A statement on the tender will be released by the Budget and Expenditure Monitoring Forum, of which the ALP is a founding member, early next week. (http://www.tac.org.za/community/BEMF).
Monitor Provincial Health Spending
For several years, the ALP has noted major discrepancies between provincial spending on health and nation al priorities. Insufficient amounts are allocated for health and there is insufficient monitoring and evaluation of provincial departments of health. Therefore, we also welcome Minister Gordhan’s statement that:
[T]o achieve the outcomes we have set ourselves in education and health we need better coordination and alignment between national policy imperatives and provincial budgets. A breakdown in this regard is a recipe for failure. We have to find a mechanism that balances the constitutional responsibility of provinces to determine their budgets with the constitutional entitlement of citizens to education and health services.
It is extremely positive to hear the Minister of Finance link constitutional duties and the rights to basic education and access to health care services to government’s decisions on resource allocation. We believe that where provincial budgeting practices create barriers to achieving the right of access to health care services, those practices must be challenged as unconstitutional and the National Treasury and National Department of Health must exercise its constitutional authority to ensure service delivery is not hindered. National Treasury appears to have developed a solid framework for funding health in the 2010/2011 financial year.
It is now up to the provinces to ensure that the funding from provincial treasuries allocates the additional necessary resources to both health and education from the provincial equitable shares. Stringent monitoring of provincial spending and the outcomes of provincial health programmes must be implemented and accounting officers held accountable as provided for in the Public Finance Management Act, 1999 (PFMA).
Parliament’s New Powers
Finally, we note Minister Gordhan’s statement that more public participation is necessary in the budget. The Money Bills Amendment Procedure and Related Matters Act, 2009 opens this door to some extent. We call on Parliament to take its role as a participant in the creation and passing of the national budget seriously and ensure that the Parliamentary Budget Office has the skills and resources to fulfil its constitutional obligation. In addition, civil society should be consulted at all stages in the process of developing the annual budget. The
ALP may release further statements in the coming weeks once more detailed interrogation and analysis of the budget is conducted.
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