A failure to ensure that costing and budgeting processes are properly managed from the start is likely to result in an NSP that is not fully implementable.

Given that the scale of South Africa’s HIV response is set to expand substantially over the next five years, the need to cost the NSP properly and then budget for its implementation to ensure the adequate, efficient and sustainable funding of interventions cannot be ignored.

Unfortunately, the government’s ability to do this in the past has been severely lacking. For example, the 2010 Mid-Term Review of the previous NSP was particularly critical of the way in which the NSP 2007–2011 was costed and budgeted. The review highlights incomplete costing, diverse and uncoordinated sources of funding, and the lack of coordinated budgets for implementation as significant challenges; these have resulted in a ‘scatter gun’ approach to the financing of the NSP.

We cannot afford to repeat these inefficiencies.

Ensuring that the NSP 2012–2016 is appropriately costed and then budgeted is not  simply about adhering to good financial management principles; it is about ensuring  that available resources are allocated and used in ways that ensures that the right to have access to health care services, as entrenched in section 27 of the Constitution,  is progressively realised. The Constitution makes it clear that “the state must take reasonable legislative and other measures, within its available resources, to achieve  the progressive realisation of (this) right”.

How do we ensure effective costing and budgeting?

• All aspects of the NSP 2012–2016 and the nine Provincial Operational Plans (POPs) must be costed.
• Provision must be made periodically to review the costing to allow for  adjustments  to  be  made  as  new  implementation  data  becomes available or as interventions are adjusted and revised.
• Contingencies must be put in place to ensure adequate budgets for the implementation of the NSP and nine POPs in 2012/13.
• Consideration must be given to the funding mechanisms to be used in transferring resources to departments and agencies responsible for implementing interventions.
• Government must consider options for sourcing additional resources, using those funds that are available more efficiently and reducing input costs – such as medicines and diagnostics – where possible.
• The way in which SANAC and other AIDS councils are financed must be reviewed; over the medium-term funding should be channelled through an integrated conditional grant.
• Aggregated implementation budgets must be developed at the national and provincial levels that clearly outline available resources, what they will be used for and who will be responsible for expenditure.
• SANAC must introduce a structure that will be responsible initially for costing the plans and then periodically reviewing this costing.
• Budget monitoring and expenditure tracking should form part of monitoring and evaluation (M&E) structures and processes.

Read SECTION27’s full submission on costing and budgeting in the first draft of the new NSP on www.section27.org.za.

Civil society will be watching

TAC and SECTION27 are members of the Budget and Expenditure Monitoring Forum (BEMF), a group of civil society organisations that monitors budgeting and expenditure for the NSP and health service delivery in the country. On 21 and 22 November, BEMF convened partners to look at the costing of the NSP and what is planned for provincial plans. The meeting aimed to capacitate civil society to better engage with and monitor the budgeting and expenditure process for the new NSP. The meeting also looked at the financing of our response and how we can better engage with the mobilisation of resources for HIV and AIDS. We will report back on this meeting in an upcoming issue.