O.R. Tambo (EC) and uMgungundlovu (KZN) Districts
Giving power to the community: Community monitoring of HIV/AIDS and TB spending in two districts in South Africa
CEGAA, with the Treatment Action Campaign (TAC), is strengthening the capacity of the TAC's community health activists in monitoring local service delivery, budgeting and expenditure for HIV/AIDS and TB at district level. This Budget Monitoring and Expenditure (BMET) project is supported by the Open Society Institute (OSI) and International Budget Partnership (IBP).
|Banner displayed at a public hearing in Lusikisiki, Eastern Cape Province, November 2010
In 2009, CEGAA and TAC developed a joint partnership project on budget monitoring and expenditure tracking (BMET) for health, HIV/AIDS and TB in the O.R. Tambo (Eastern Cape) and uMgungundlovu (KwaZulu-Natal) districts. The project was aimed at increasing the efficiency and effectiveness of spending, leading to enhanced service delivery supporting budget processes at local or district level. This work entailed building the capacity of citizens/communities and district health/local government officials to engage with budget processes and strategic planning, and monitoring budget allocations and their execution for HIV/AIDS and TB services.
Specific activities included:
- Capacity-building for people living with HIV/AIDS and/or TB (PLWHA&TB) and community monitors to assess district budgets and delivery of services;
- Community monitoring of, and participation in, district budget processes, and evaluation of quality of health care services delivered through community surveys, and;
- Building working partnerships between CSOs, district and provincial health management and local government.
The Survey Report forms part of the community monitoring exercise, which involved evaluation or assessment of health care services for PLWHA&TB, through community surveys. This assessment was designed to assess HIV/AIDS and TB patients’ experiences of accessing health care services at local health facilities. It also sought to measure patients’ satisfaction with the HIV/AIDS and TB services provided in their community, whilst simultaneously trying to identify government’s challenges and achievements in delivering the services.
The information gathered provided baseline data required to understand prevailing levels of service delivery with regard to accessibility, availability and quality of health care for people living with HIV/AIDS and/or TB. The project also sought to develop necessary recommendations for responding to patient and health facility needs as identified by both citizens and government health workers participating in the survey.
Results and follow-up activities of this research were designed to ensure that overall district health targets on HIV/AIDS and TB are improved, with an increased number of AIDS and TB patients receiving quality services from government facilities.
CEGAA and the TAC have shared information on this project with the Budget and Expenditure Monitoring Forum (BEMF), a group of civil society organisations that monitors the National Strategic Plans on HIV/AIDS and STIs (better known as the NSPs). Our work with the BEMF has generated interest for budget monitoring work among other civic organisations, with Forum members proactively seeking to learn from the CEGAA/TAC pilot project for application in their own work settings. For example, the Free State HIV/AIDS Coalition (FSHAC) approached CEGAA to assist them with skills-building on budget monitoring and provision of technical support. The Coalition recognises that budget monitoring can assist them in alleviating many problems identified at community and clinic levels, where there are shortages of drugs and long waiting lists for ARVs.
CEGAA and the TAC issued a joint statement summarising and commenting on national AIDS policy and funding upon the release of Budget 2010 (February 2010).
Our BMET team continues to build the capacity of TAC members in the monitoring of district-level spending and service delivery for HIV/AIDS and TB. The current phase of the work in uMgungundlovu and Lusikisiki features refresher training for community monitors on budget monitoring, deepened community monitoring of healthcare service provision, and systematised advocacy strategy development to address challenges identified through community surveillance.
Similar projects are being implemented in the TAC’s new focus districts: Khayelitsha (Western Cape), Mopani (Limpopo), Gert Sibande (Mpumalanga), and Ekurhuleni (Gauteng). We are also building relationships with the Free State HIV/AIDS Coalition towards monitoring the spending on HIV/AIDS and TB in their province.
To advance the expansion of BMET work in South Africa, CEGAA supports the TAC with capacity-building and technical support, in order to equip more districts with relevant skills, through:
- Training, advice, planning, and assistance in understanding government's budget processes, structures and systems so that the TAC BMET teams can effectively engage with government when necessary for the benefit of the BMET project.
- Pre-empting external challenges that might hinder the progress of the project, by helping the teams to effectively communicate with and manage BMET stakeholders, and to monitor and adjust the BMET work-plan in line with external and internal developments to achieve envisaged BMET targets, deadlines and objectives.
- Applying a participatory research approach in developing the teams’ knowledge of basic research methods and mastering data collection and management.
- Analysing data, report-writing, and disseminating the survey results to fulfill our BMET objectives.
- Co-monitoring project progress beyond its research component, through effective engagement with government officials at different levels, and fine-tuning systems to ensure sound implementation.
Experiences from the pilot sites will also be shared through joint planning activities and exchange visits between sites. For example, the TAC BMET Community Health Advocates (CHAs) responsible for the implementation of the project in KwaZulu-Natal and Eastern Cape provinces visit the new district teams periodically to share their own experiences and work with them on community-level monitoring. The TAC and the FSHAC will identify other local organisations for additional support in other provinces.