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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”





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:

  • 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.
  • 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.
  • A significant proportion of the population in these countries does not have easy access to the most basic medications for AIDS-related diseases.
  • 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.
  • 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.
  • 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:

  • 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
  • expanding the scope of private health insurance
  • providing external assistance to build the necessary health infrastructure and train the required personnel.

Contributor(s): Markus Haacker

‘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