South Africa's antiretroviral (ARV) treatment programme has been pushed into crisis by poor budgeting decisions, financial mismanagement and a lack of monitoring and evaluation of HIV programmes.
Rapid expansion of the ARV programme in 2008 slowed significantly in 2009, said Mark Heywood of the AIDS Law Project, one of 11 organizations making up the newly formed Budget and Expenditure Monitoring Forum (BEMF).
Forty percent of HIV-positive people in need of treatment were still not getting it, and "sustained access to treatment is now under threat" Heywood told journalists in Johannesburg on 22 September.
The Forum plans to put pressure on the national departments of health and finance to provide better oversight of health expenditure in the country's nine provinces, and ensure that there are no further moratoriums on ARV treatment, such as in Free State Province in late 2008.
Vuyiseka Dubula of the Treatment Action Campaign (TAC), another member of BEMF, noted that long waiting lists for patients to start ARV treatment, drug stock-outs and mismanagement of health budgets were occurring in five other provinces besides Free State.
The activist forum attributed the problems to insufficient budgetary allocations for HIV/AIDS programmes and the mismanagement of provincial health department budgets.
"The national health department needs to give the provinces adequate support to budget properly," Dubula said.
In a statement, the BEMF also pointed out that a lack of publicly available information about the numbers of patients on ARV treatment, women receiving prevention of mother-to-child transmission (PMTCT) services, and the volumes of ARV drugs being purchased made it difficult to assess the government's progress towards targets set out in the National Strategic Plan (NSP) for HIV and AIDS.
The TAC and the AIDS Law Project, in their own investigations and anecdotal reports, had uncovered numerous stories of people in desperate need of ARV treatment being turned away from government hospitals.
The national Minister of Health, Aaron Motsoaledi, admitted to reporters last week that South Africa might not achieve the NSP target of reaching 80 percent of people in need of treatment by 2011.
"If we don't meet the 2011 target, we condemn hundreds of thousands of people to death and displace the costs to families and other parts of the health system," said Heywood. "It doesn't make sense, from a fiscal or a health point of view."
Motsoaledi has announced an emergency fund of R5-million (US$676,550) for provinces struggling to provide ARVs, but a shortfall of R1-billion ($123 million) in the ARV programme for 2009 has been identified by civil society as well as Motsoaledi.
In letters sent to Motsoaledi and the Minister of Finance, Pravin Gordhan, on September 10, the BEMF requested more funding for the ARV programme as well as better monitoring to ensure that funds allocated to provinces for HIV/AIDS programmes are not diverted to cover other costs like the salaries of health workers.