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Counting the cost of HIV in Southern
Africa
Southern Africa
is the region with the highest rates of HIV infection in the world. An
estimated 9.4 million of the total population of 97 million were
HIV-positive in 1999. What impact will the HIV/AIDS epidemic have on the
provision of health services in the region? Is there any scope for
improving access to highly active antiretroviral therapy (HAART) in
low-income countries?
A study by the
International Monetary Fund warns that health services in southern
Africa are already over-stretched. The current cost of providing health
services to HIV patients accounts for a very large proportion of total
health expenditure for most countries in the region. As the number of
AIDS patients increases, the situation will deteriorate.
The ability of
the health sector to cope with the HIV/AIDS epidemic depends on the
availability of staff, facilities and finance. The total health
expenditure per capita ranges from US$ 9 in Malawi to US$ 203 in South
Africa. This corresponds to between 0.2 percent and 4.1 percent of per
capita health spending in the United States. Other important findings
include:
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Physicians are
extremely scarce in some parts of the region. In Malawi and
Mozambique there are as few as three doctors per 100,000 people.
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Health workers
are also affected by HIV/AIDS. Training would have to be expanded by
about 25 to 40 percent over the next decade just to maintain current
staff levels.
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A significant
proportion of the population in these countries does not have easy
access to the most basic medications for AIDS-related diseases.
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There is little
public health insurance. For six of the eleven economies covered,
private health insurance accounts for less than 10 percent of
private health expenditure.
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The number of
hospital beds needed for AIDS patients will exceed the total
currently available in Botswana by 2002, in Swaziland by 2004 and in
Namibia by 2005.
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Owing to
substantial reductions in the price of antiretrovirals, Botswana and
South Africa could provide HAART to a significant proportion of AIDS
patients. However, the prospects for other countries are very
limited.
The HIV/AIDS
epidemic is already a huge burden on the health sector in southern
Africa. As more people living with HIV are expected to fall ill over the
next decade, the situation is likely to become even worse. Maintaining
the quality of health services will require substantial investments in
health facilities and human resources, which will be impossible without
significant external aid. Policy-makers addressing the impact of the
disease on countries with few resources should consider:
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negotiating
reductions in drug prices - a cost of around $500 per patient per
year would greatly increase the number of those who can afford to
pay for treatment
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expanding the
scope of private health insurance
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providing
external assistance to build the necessary health infrastructure and
train the required personnel.
Contributor(s):
Markus
Haacker
Source(s):
‘Providing health care to HIV patients in southern Africa’ by Markus
Haacker, presented to the Royal Institute for International Affairs,
London (10th July, 2001) and forthcoming in 'The economics of essential
medicines', RIIA
Related source: 'The economic consequences of HIV/AIDS in Southern
Africa', IMF Working Paper 02/38, by M. Haacker, 2002
Funded by:
International
Monetary Fund
id21 Research
Highlight:
4 April 2002
Further
Information:
Markus Haacker
Room 8-515
International Monetary Fund
700 19th St NW
Washington DC
USA
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