1. 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

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 happy However, most patients (64%) interviewed were happy with the quality of health services they received! not happy Notably, some patients were not happy with waiting times (21%) and the current quality of service received (17%) not happy 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

10. Acknowledgments PHW, OSI NY & OSF-SA

11. 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