The Fiscal Dimension of HIV/AIDS in Botswana, South Africa, Swaziland, and Uganda

Elizabeth Lule, Markus Haacker

Description

HIV/AIDS continues to take a tremendous toll on the populations of many countries, especially in sub-Saharan Africa. In some countries with high HIV prevalence rates, life expectancy has declined by more than a decade and in a few cases by more than two decades. Even in countries with HIV prevalence of around 5 percent (close to the average for sub-Saharan Africa), the epidemic can reverse gains in life expectancy and other health outcomes achieved over one or two decades.
This volume highlights work conducted under the umbrella of a World Bank work program on "The Fiscal Dimension of HIV/AIDS," including country studies on Botswana, South Africa, Swaziland, and Uganda. It covers four aspects of the fiscal dimensions of HIV/AIDS:
First, it aims for a comprehensive analysis of the fiscal costs of HIV/AIDS, with a wider scope than a costing analysis focusing on only the policy response to HIV/AIDS.
Second, it embeds the analysis of HIV/AIDS costs in a discussion of the fiscal context, and interprets these costs as a quasi-liability, not a debt de jure, but a political and fiscal commitment that binds fiscal resources in the future and cannot easily be changed, and very similar to a pension obligation or certain social grants or services.
Third, it develops tools to assess the (fiscal dimensions of) trade-offs between HIV/AIDS policies and measures that take into account the persistence of these spending commitments.
Fourth, most of the fiscal costs of HIV/AIDS are ultimately caused by new infections, and this study estimates the fiscal resources committed (or saved) by an additional (or prevented) HIV infection. Building on these estimates, the analysis here is able to assess the evolving fiscal burden of HIV/AIDS over time.

Sujets

• Health

Informations

• Publié par: world-bank-publications
• Publié le: 17 novembre 2011
• Nombre de lectures: 29
• EAN13: 9780821388082
• Langue: English
• Poids de l'ouvrage: 7 Mo

Extrait

The Fiscal Dimension of HIV/AIDS
in Botswana, South Africa,
Swaziland, and Uganda
Elizabeth Lule and Markus HaackerTHE FISCAL DIMENSION OF
HIV/AIDS IN
BOTSWANA, SOUTH
AFRICA, SWAZILAND,
AND UGANDATHE FISCAL DIMENSION OF
HIV/AIDS IN
BOTSWANA, SOUTH
AFRICA, SWAZILAND,
AND UGANDA
Elizabeth Lule and Markus Haacker© 2012 International Bank for Reconstruction and Development / International Development Association or
The World Bank
1818 H Street NW
Washington DC 20433
Telephone: [phone]
Internet: www.worldbank.org
1 2 3 4 14 13 12 11
This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and
conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive
Directors or the governments they represent.
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denominations, and other information shown on any map in this work do not imply any judgment on the part of The
World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries.
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ISBN (paper): 978-0-8213-8807-5
ISBN (electronic): 978-0-8213-8808-2
DOI: 10.1596/978-0-8213-8807-5
Library of Congress Cataloging-in-Publication Data
Lule, Elizabeth.
The fiscal dimension of HIV/AIDS in Botswana, South Africa, Swaziland, and Uganda / by Elizabeth Lule and Markus
Haacker.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-8213-8807-5 — ISBN 978-0-8213-8808-2 (electronic)
1. AIDS (Disease)—Economic aspects—Africa, Southern. 2. AIDS (Disease)—Economic aspects—Uganda. 3. HIV
infections—Economic aspects—Africa, Southern. 4. HIV infections—Economic aspects—Uganda. 5. HIV infections—
Government policy—Africa, Southern—Finance. 6. HIV infections—Government policy—Uganda—Finance.
I. Haacker, Markus. II. Title.
RA643.86.A356L85 2011
362.196’979200968—dc23
2011039281
Cover design: Critical StagesContents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii
Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Country Summaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Conclusions . . . . . . . . . .33
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Notes . . . . . . . . . . .54
References. . . . . . . . . .55
2 Botswana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
II. The Impact of HIV/AIDS in Botswana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
III. HIV/AIDS and Public Finance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
IV. Modeling the Fiscal Dimension of HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81
V. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100
VI. Annex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109
3 South Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113
I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113
II. The Impact of HIV/AIDS in South Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114
vvi Contents
III. Stocktaking: HIV/AIDS and Public Finance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129
IV. Projecting the Fiscal Costs of HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .146
V. HIV/AIDS as a Fiscal Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .156
VI. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165
VII. Annex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .168
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169
References . . . . . . . .174
4 Swaziland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .181
I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .181
II. The Impact of HIV/AIDS in Swaziland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183
III. Stocktaking—HIV/AIDS and Public Finance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .195
IV. The Fiscal Dimension of HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .208
V. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .223
VI. Annex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .226
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .226
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .231
5 Uganda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235
I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235
II. The Impact of HIV/AIDS in Uganda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .236
III. HIV/AIDS and Public Finance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .244
IV. The Fiscal Dimension of HIV/AIDS 254
V. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .270
VI. Annex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .273
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .275
References. . . . . . . . .278
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .281
Figures
O.1 Botswana: Fiscal Costs of HIV/AIDS (2010–30) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7