How much does the AIDS levy contribute to Zimbabwe's health budget? Is it helping the country to achieve its Abuja Declaration targets, which require it to spend 15% of its annual budget on health? To answer these questions, we conducted research on the National AIDS Trust Fund (NATF), which receives the levy, and the National AIDS Council, which administers the fund. This work was implemented under the Regional network for equity in health for east and southern Africa (EQUINET) theme work on fair financing for health, co-ordinated by Health Economics Unit, University of Cape Town.
The study consisted of a review of existing literature, which formed the basis of our budget analysis, and additional information that was collected from focus group discussions and interviews with key informants. Interviews were held with various stakeholders involved in the provision of finance, including the Ministry of Health and Child Welfare, the Ministry of Economic Development, the Ministry of Finance, the Department of Social Welfare, the Zimbabwe Revenue Authority, the Central Statistics Office and the National AIDS Council. Data on the beneficiaries of the AIDS levy was also gathered by interviewing people living with HIV (PLWH), community members, schools, and heads of non-governmental organisations (NGOs) and households. Current data on financing was reviewed, including the inventory of donor assistance to Zimbabwe for 2005. Two provinces were randomly sampled for the in-depth assessment of spending on AIDS levy.
The study revealed that the contribution of the AIDS levy has so far been insignificant. Furthermore, it is not a stable source of funding due to high levels of inflation in Zimbabwe. Inequities exist in the allocation of funds from the AIDS levy according to province, the most extreme case being Matabeleland South province, which had the highest HIV prevalence but received the second-lowest allocation. Unfortunately, many households already have to pay for health services themselves, so the AIDS levy has simply become an additional tax burden.
Fixed costs, such as vehicles, and variable costs, such as care activities, accounted for most of the expenditure at the NAC Head Office in 2005, with anti-retroviral drugs (ARVs) making up the bulk of the care expenditure. For the theme areas, the overall cost per beneficiary per year was US$6 for the NAC Head Office, US$1.63 for a Provincial AIDS Action Committee (PAAC) and US$1.41 for a District AIDS Action Committee (DAAC). The figures show that PAACs and DAACs, where most patient care takes place, are severely under-funded, and that Head Office is over-spending. Overall, the results revealed that the NAC Head Office was more of an implementer than a co- ordinator of the multisectoral response to the HIV/AIDS epidemic in Zimbabwe. The low figures confirm reports that Zimbabweans who are infected and affected by HIV/AIDS have yet to benefit from the AIDS levy.
If inflation is controlled for, the AIDS levy is a noble idea, which can be sustainable if it involves the community in funding AIDS interventions and reduces donor dependence. It is a best practice that can be replicated in other African countries that are resource constrained. At present, donors or partners need to offer more financial support to the NAC. The NAC could also mobilise more resources by reducing fixed and variable costs in those areas that are not the 'core business' of the NAC.