Lancet commentary concludes that prevention and treatment in South Africa are affordable and desirable

Graham McKerrow, HIV i-Base

A commentary in The Lancet says that in relative terms, South Africans are among the world’s big spenders on health care, and that universal HIV prevention and treatment in the country is both affordable and desirable. [1]

Josef Decosas of the international, child-focused development organisation Plan International, writes that in 2000 South Africa spent 8.8% of its gross national product (GNP) on health, which placed it in 17th position among the nations of the world, just ahead of Belgium. Most of South Africa’s health care costs are paid for with private money; government spending on health amounts to only 3.7% of GNP.

Decosas considers a report by Nathan Geffen and colleagues at the University of Cape Town, which calculates the bill for a comprehensive healthcare response to HIV similar to that in Brazil. [2] By 2015, the most expensive year of their calculation, universal public provision of prevention and treatment would cost 20.3 billion rand (£1.6 billion) – about 1.74% of GNP. This would include the treatment of opportunistic infections and the provision of antiretroviral therapy. It would represent at 50% increase in public spending relative to GNP, from 3.7% to 5.4%.

ARVs would account for 99% of the additional cost, while universal provision of voluntary counselling, HIV testing, control of STDs and prevention of mother to child transmission are “surprisingly inexpensive” and could be achieved “without a perceptible increase in healthcare spending”.

Decosas says the report takes great care in calculating costs including allowing for training and improvements to infrastructure. The report also outlines certain costs that would be incurred by not responding to the epidemic with universal provision of treatment and care, but the authors did not include these “savings” in their overall estimate of costs.

Nevertheless, Geffen and colleagues write in their conclusion that the Government would save seven billion rand on hospitalisation and orphan costs that it is already committed to meet. They also estimate that the use of generic drugs could save a further four billion rand. They write that costs peak in 2015 and then drop and level off after that.

“A 50% increase in the budget for public health care in relation to the GNP over 12 years seems feasible,” writes Decosas, ”but the other hurdle is to convince politicians that this increased spending will do any good… The Government now has another piece of information to support the expansion of the public health response to AIDS. Let us hope it uses it.”


  1. Decosas J. HIV prevention and treatment in South Africa: affordable and desirable. The Lancet, 361: 1146-7
  2. Geffen N, Natrass N, Raubenheimer C. The cost of HIV prevention and treatment interventions in South Africa. CSSR working paper no 28, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa, 2003.


Links to other websites are current at date of posting but not maintained.