HIV/AIDS Policies and Absorptive Capacity in South Africa: Identifying the Bottlenecks, Unleashing the Capacity

Abstract

Rationale: HIV/AIDS funding has increased greatly over the last few years, both inside and outside South Africa. Nevertheless, there are signs that health systems are not able to benefit from these funds due to insufficient absorptive capacity. Absorptive capacity within the health financing context is referred to as the ability of the Department of Health to maximise the utilisation of the available funding, both domestic and international. It is argued that health systems in Africa with limited resources are already weak and overwhelmed and lack the capacity to introduce new programs without compromising existing ones. This is particularly the case with complex interventions such as antiretroviral treatment. Objectives: This research seeks to advance the existing body of knowledge of HIV/AIDS financing policies in relation to the absorptive capacity in the context of South Africa. The main aim is to identify specific bottlenecks experienced by the flow of public HIV/AIDS funding and clarify options to unblock them. The ultimate purpose is to provide strategic choices for the efficient allocation of HIV/AIDS funding. Methodology: The study constructs a conceptual framework for the study of absorptive capacity and bottlenecks encountered in the context of HIV/AIDS financing. The framework follows the flow of HIV/AIDS funding going from the National Department of Health, through the Provincial Departments of Health, to the final implementation of programs. It identifies five major areas where bottlenecks may arise: financial, human, physical and institutional (at the health system level) and structural (outside the health system). The study combines (a) quantitative budget analysis looking at expenditure and spending patterns, with (b) qualitative in-depth interviews exploring causes and consequences. The study applies the framework in two South African provinces: Western Cape and Free State. Results: The contributions are two-fold: (i) Conceptual: definition, construction of a conceptual framework, and approximation to a set of indicators of absorptive capacity and bottlenecks; (ii) South African case: assessment of absorptive capacity and major bottlenecks encountered nationally, and particularly in Western Cape and Free State. Disclosure: This study is part of the PhD of the author at the University of Cape Town. It is partly funded by the Spanish foundation Fundacion Carolina.