SA gets full marks for HIV treatment but a fail for condoms

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While South Africa has increased HIV spending at district level with stellar results, access to condoms has plummeted, according to the latest District Health Barometer (DHB). 

District health expenditure on HIV has more than doubled in the last decade, which is an indicator of “significant progress” in moving towards a primary health care-oriented system, according to the Health Systems Trust’s (HST) Candy Day, who was commenting on the 13th edition of the DHB. 

Published on Thursday evening by the HST, the report revealed that, as a percentage of total spending on HIV, district health service expenditure has jumped from 7.3% to over 20% over the past 14 years. 

But, consistent condom use “continues to be low” and can be linked the number of condoms distributed by government, which fell sharply over the past year. Between 2016/17 and 2017/18, the condom distribution rate dropped from an average of 48 to 36 condoms distributed per adult male per year

However, the researchers suggested that the rate may have been historically lower than reported and that this might be the most accurate estimate for condom distribution South Africa has ever had. They noted that this was because the data source for these statistics has recently changed and is now “more accurate than the recording done by facilities in the past”.

Day, who is a technical specialist for the HST, told Health-e News that the increase of district-level spending has been largely driven the country’s continuously expanding HIV treatment programme which remains the largest in the world. 

Over four million people access antiretroviral medication through the state - mostly at primary level - which has driven this positive shift in expenditure. 

“Primary health care is the level of care that is the closest to the community and therefore has an important role in responding to the immediate healthcare needs of the community and preventing further ill health,” according to the report. 

At a time when the feasibility of the government’s National Health Insurance (NHI) scheme is being routinely questioned, the report authors noted that this shift in spending is essential because primary health care is the “fundamental building block” and “heartbeat” of the NHI. 

“There is overwhelming international evidence that increased health expenditure is associated with better health outcomes – and [primary health care] plays a pivotal role in improving the health of communities.”

– Health-e News.

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