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8 May 2011

Community and health facility budget advocacy issues around HIV/AIDS and TB service delivery at district level 5 th SA AIDS Conference. 8 May 2011. Some background observations. Budget and expenditure analyses indicate increased resources for HIV and AIDS

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8 May 2011

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  1. Community and health facility budget advocacy issues around HIV/AIDS and TB service delivery at district level 5th SA AIDS Conference 8 May 2011

  2. Some background observations • Budget and expenditure analyses indicate increased resources for HIV and AIDS • Massive growth in ARV treatment patient numbers • Remarkable improvement on absorptive capacity = government’s ability to spend • Exceptional leadership of the Provincial Offices of the Premiers: ECAC & KZN PAC • However, inadequate governmental information and financial management systems, Basic Accounting System (BAS) not fully utilised or understood by managers

  3. The problem: • Insufficient participation of citizens in budget policy planning and implementation monitoring • Lack of technical skills to monitor use of public funds at local level • Inadequate output monitoring at service delivery level • Translation of actual spending into real life impact? The intervention • CEGAA and TAC embarked on a pilot budget monitoring and expenditure tracking (BMET) project in O.R. Tambo (EC) and uMgungundlovu (KZN)Districts, to: • Build community & local government capacity to monitor health care provision from a budget perspective • assess quality of health care services for PLWHA&TB • identify key challenges and develop resolutions for improving service delivery • enhance social accountability • undertake/ support strategic advocacy activities for budgetary changes to improve HIV/AIDS and TB quality interventions.

  4. Some key findings from initial community and health facility survey • Most patients (82%, n = 405) reported that they received the health care services they needed in recent months (2010) • 17% did not receive the services they needed, due to, inter alia: AIDS treatment not available at clinic; long waiting queues (crowded facilities); long distance and transport • However, most patients (64%) interviewed were happy with the quality of health services they received! • Notably, some patients were not happy with waiting times (21%) and the current quality of service received (17%) • Interestingly most clinic and hospital health workers (57%, n = 26 staff teams) were not happy with the quality of health care service they provided due to a combination of reasons, such as: • Medical doctors not available on site; Shortage of general health staff (burnout); lack of basic necessities (stationery, patient forms, syringes, sputum bottles, etc ); limiting physical space.

  5. Reconfirming OLD budget advocacy issues and recommendations, in summary... Common issues from both community members (patients) and health facilities - issues beyond HIV/AIDS and TB funding: • Staff recruitment and capacity development: • Clarify roles and responsibilities of human resources between provincial and district health offices, and recruit more staff and build capacity AT HEALTH FACILITY LEVEL • Improved staffing will reduce staff attitudes, burnout and long queues • Treatment (systems and personnel): Improve / systematise the ordering and transporting process of all treatments from district depots to local facilities • Other support systems, not just ARVs: information management systems; active involvement of facility staff, clinic committees and hospital boards in planning & budgeting; provision of sufficient information, counselling, care and support, and respect for AIDS and TB patients • HIV prevention: Strengthen community level prevention efforts, DOH mobiles for deep rural areas? Strengthened school based strategies?

  6. Enforcing social accountability • Public hearings (“Izimbizo”) dominated by citizens giving testimonies of their own experiences of accessing health care • Active engagement between citizens and decision makers and/or service providers on issues that affected PLWHA&TB • The government officials and other stakeholders confirmed that the findings and recommendations were not new. • Acknowledgment of pitfalls in the health system and commitment to work towards resolving the issues. • Formation of Action Teams

  7. Acknowledgments PHW, OSI NY & OSF-SA

  8. Thank You! Nhlanhla Ndlovu Programme Manager Centre for Economic Governance and AIDS in Africa (CEGAA) www.cegaa.org nhlanhla@cegaa.org Tel: +27 -33-394-0845 Cell: +27-73-198-7219

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