Kristin Palitza*

DURBAN, May 28 2006 (IPS) – Researchers say they are bracing for a sharp rise in the cost of public health services in South Africa within the next few years, due to HIV/AIDS. And, they warn that the country s health department might not be able to cope with its ever-growing responsibilities if government fails to increase the department s budget substantially.
Large numbers of HIV-positive South Africans are expected to develop AIDS-related diseases, as the country s high prevalence rates start manifesting themselves in illness and death, predicts the Health Economics HIV/AIDS Research Division (HEARD) of the University of KwaZulu-Natal, in the coastal city of Durban.

HIV patients might soon account for 60 percent to 70 percent of hospital expenditure in medical wards, says HEARD researcher Nina Veenstra.

Already, about half of all patients admitted to hospitals in South Africa seek care for HIV-related illnesses, while the numbers of HIV-positive patients in paediatric wards are even higher, she added. According to figures posted on the website of the Joint United Nations Programme on HIV/AIDS, adult HIV prevalence in South Africa is 21.5 percent.

As the numbers of AIDS patients grow, there will be a greater demand for skilled health workers, medication and hospital facilities.

According to researchers at the Cape Town-based Human Sciences Research Council (HSRC), a non-profit organisation partly funded by government, AIDS patients generally stay in hospital for a greater length of time than other patients because it takes them longer to recover from opportunistic diseases.
HIV-positive patients stay on average four times longer in hospital than non-HIV patients, explains HSRC President Olive Shisana.

Greater pressure on health facilities will impose a heavier financial burden on the country s public health care sector even as health workers suffer more stress from an increased workload. This is likely to prompt higher levels of absenteeism, low staff morale, and large numbers of health care workers quitting their jobs.

South Africa already suffers a shortage of health workers, due in large part to unattractive working conditions. Many posts for health workers remain vacant, notes a study by a national research organisation, the Durban-based Health Systems Trust (HST). (This organisation is funded by a range of national and international donors.)

According to the HSRC, these pressures will compromise the quality of HIV/AIDS care on offer.

The HST has already found that a number of sites where anti-retroviral drugs (ARVs) are dispensed have reached saturation level due to staff shortages.

HST researchers estimate that only 12 to 13 percent of all patients in need of ARV therapy are receiving it at present. Limited human resources capacity is the biggest constraining factor on further rollout of the ARV programme and must be addressed as soon as possible, state researchers Rob Stewart and Marian Loveday in the organisation s annual health review for 2005.

In addition, the already-limited number of health care workers will be further reduced through HIV-infection. According to an HSRC study, 13 percent of health workers who passed away between 1997 and 2001 died of AIDS-related diseases.

These findings are likely to receive attention this coming week, during the latest of the United Nations General Assembly Special Sessions (UNGASS) on HIV/AIDS.

In 2001, the assembly held its first special session on HIV/AIDS, in acknowledgement of the fact that while some progress in increasing access to HIV-prevention and treatment initiatives had been made, the programmes were still failing to reach those most vulnerable to HIV.

During the first UNGASS meeting, participants agreed on goals set out in a Declaration of Commitment on HIV/AIDS which was adopted by leaders from 189 countries. The declaration sets targets to halt and reverse the spread of the pandemic by 2010 through action by government and civil society.

Together with other countries, South Africa vowed to improve conditions for health care workers, and upgrade supply systems and financing plans concerning access to ARVs, testing facilities and care by 2005.

Delegations from South Africa will have to report back on progress in achieving these goals at the UNGASS+5 meeting, which will take place from May 31 to Jun. 2 in New York, five years after the General Assembly held its first special session on HIV/AIDS.

Taking action to improve South Africa s response to the pandemic will, in part, require hospitals to give health workers greater job satisfaction through better salaries and working conditions, says Elsje Hall, a researcher at the Pretoria-based Independent Research Services.

HST figures show that by 2009, an additional 3,200 doctors, 2,400 nurses and 765 social workers will be required to run the country s ARV programmes. This will translate into a substantial increase in personnel costs.

The supply of ARVs and drugs to treat opportunistic infections will also need to be increased, Hall adds.

The cost of full-scale ARV treatment is expected to come with a price tag of about 996 million dollars by 2008/2009, up from 179 million dollars in 2005/2006, according to the HST.

* Kristin Palitza is the editor of Agenda: a women s rights and gender media project based in Durban, South Africa