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

Community and health facility
budget advocacy issues around HIV/AIDS
and TB service delivery at district level
5th SA AIDS Conference
8 May 2011
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
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.
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.
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?
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
Acknowledgments
PHW, OSI NY & OSF-SA
Thank You!
Nhlanhla Ndlovu
Programme Manager
Centre for Economic Governance and AIDS in
Africa (CEGAA)
www.cegaa.org
[email protected]
Tel: +27 -33-394-0845
Cell: +27-73-198-7219