Achieving the health Millennium Development Goals (MDGs) including the scaling up of HIV-treatment requires increased domestic resources, better coordinated funding flows as well as an overall focus on health systems' strengthening (Taskforce on Innovative International Financing for Health Systems, 2009). In South Africa, the respectable 7.3% of GDP spent on health care masks a highly unequal distribution of resources between the public and private health systems. Approximately 3% of GDP is spent within the public sector where the majority poor access care. The remainder is spent in the private sector where the minority rich – about 15% of the population – access health care primarily via voluntary health insurance. It is this former highly constrained public system that is faced with the majority of the burden of responding to the HIV-epidemic. Given the inadequate public health sector resourcing, plans are underway to implement a National Health Insurance (NHI) system. The broad vision is to focus efforts on rebuilding the public health sector to the point that it once again becomes the provider of choice for the majority. The research explores the affordability of equitable access to antiretroviral therapy (ART) in South Africa by and beyond 2020, within the context of the proposed National Health Insurance system.
CREHS Policy Brief, November 2009, 2 pp.