SECTION27 is a public interest law centre that seeks to influence, develop and use the law to protect, promote and advance human rights. Our name is drawn from the section in the South African Constitution which enshrines everyone's right to health care, food, water and social security.
The Budget and Expenditure Monitoring Forum (BEMF) held its fourth meeting on 12 November 2010. It brought together over 30 people from 10 organisations. The forum considered the Integrated Support Team reports, the antiretroviral tender and the future cost of antiretroviral treatment in the public health system. The forum also heard updates on events in the public health system in Gauteng, Eastern Cape and Free State provinces. An update on the TAC/CEGAA community budget monitoring project was also presented.
More than a year after their finalisation and after many frustrated attempts by civil society organisations and the media to access them – including through the Promotion of Access to Information Act, 2000 – SECTION27 and the Rural Health Advocacy Project (RHAP) have finally been leaked copies of all the provincial reports compiled by the Integrated Support Teams (ISTs). Up to this point, the only report we have received officially is a consolidated report available here. This report is important, but lacks the necessary detail to allow civil society to engage with different challenges in different provinces.
The IST reports on each province were commissioned by the former Minister of Health, Barbara Hogan, in response to the massive budgetary shortfalls that over-whelmed provincial departments of health (PDoHs) in the 2008/2009 financial year, which reached crisis levels when the Free State Department of Health issued a moratorium on the initiation of new patients onto antiretroviral treatment in November 2008. After civil society pressure, that moratorium was finally lifted in February 2009.
The reports on this page are those of the Integrated Support Teams (ISTs) which have been provided to SECTION27 and the Rural Health Advocacy Project (RHAP). The IST reports were commissioned by the former Minister of Health, Barbara Hogan, in response to the massive budgetary shortfalls that over-whelmed provincial departments of health (PDoHs) in the 2008/2009 financial year, which reached crisis levels when the Free State Department of Health issued a moratorium on the initiation of new patients onto antiretroviral treatment from November 2008 to February 2009.
10 reports were commissioned in total, one for each provincial department of health and one for the National Department of Health – which we have not been able to access as of yet. In addition, a Consolidated Report was produced that pulled together findings from the individual department reports. These reports contain an honest, sobering assessment of the inadequate financial capacity of provincial departments of health that have led to the development of over R7.5 billion in provincial debt as of April 2009. The findings in these reports reveal fundamental failures in political and bureaucratic leadership, inappropriate financial management systems, inadequate monitoring and evaluation systems, and a failure to plan appropriately for human resources, amongst others.
The Department of Health has given the go-ahead for patients on antiretroviral treatment (ART) to be given three months supply of medicines instead of one month. The TAC and SECTION27 welcome this decision. It will be more convenient for patients because they will have to make fewer trips to their health facility. It will also reduce patient-load on the health system, particularly on health facility pharmacies given the shortage of pharmacists in the public health system. In a memorandum dated 2 July 2010, the Department of Health states, “There is no indication of any legislation prohibiting the supply of medicines for three months to any one patient. This practice should only be implemented once the patient has proved stable on the regimen.”
On Monday 31 May Business Day reported that because of the deepening financial crisis facing health services in the provinces the Minister of Health is discussing a “bail-out” of provincial departments of health by the Treasury. Treasury intervention is now vital to prevent the collapse of health services. But equally important is the resolution of the crisis facing financial management systems that led to the massive debt in the first place.