Strengthening Monitoring of South Africa’s HIV Response

South Africa runs the world’s largest HIV program. R4D has helped the government to ensure domestic and donor resources are spent on the right interventions, in the right places.

The Challenge

Roughly 7 million South Africans are living with HIV, and more than a quarter million get infected each year. To control the epidemic, South Africa continues to scale up a range of treatment and prevention interventions, as well as to increasingly integrate HIV financing and service delivery with those for TB, the country’s number one killer. This requires increasing investment by government and development partners, especially the US Government’s PEPFAR program and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The vast need for HIV and TB resources demands that every rand (or dollar) be used as efficiently as possible, and that spending be routinely and transparently tracked to inform program planning and promote accountability at the national, provincial, and local levels.

The Opportunity

Rigorous expenditure tracking helps South Africa and its partners to transparently account for whether their spending conforms to policies and budgets, reaches the intended beneficiaries, and achieves high-quality results. Each of the main funders – government, PEFPAR, and the Global Fund, who together account for more than 90 percent of HIV and TB spending – monitors their investments and, to some extent, links them to health and service delivery indicators. However, they categorize their spending differently, hindering routine expenditure analysis across all three. Moreover, the quality and completeness of routine expenditure data remains variable across funders and provinces. Better data and broader availability of analytic skills will inform more effective routine oversight of HIV investments, enhance planning by and among the funders, and enable more rapid shifts in resource allocation so that resources flow to the most needed and impactful interventions.

Our Work

During 2011–18 R4D supported South Africa’s National Department of Health, PEPFAR, and the Global Fund to analyze their HIV and TB spending, improve resource tracking through better generation and use of expenditure data, and inform planning and oversight of the disease responses. We helped to produce a series of HIV and TB expenditure reviews, covering financial years 2011/12 through 2016/17, which informed the South African HIV and TB Investment Case, government and donor planning and resource allocation decisions, and the country’s Global Fund funding requests. Findings from these reviews were presented at the International AIDS Economics Network (IAEN) pre-conferences in 2016 and 2018.

R4D also worked to bolster program oversight by training experts from the National Department of Health, Centre for Economic Governance and Accountability in Africa (CEGAA) and Health Economics and Epidemiology Research Office (HE2RO) to clean, consolidate, and analyze government and donor expenditure data, as well as collaborating with HE2RO and CEGAA to design and validate automation tools to make more efficient the routine analysis of government spending.

These activities were funded by the Global Fund, US Centers for Disease Control, and USAID.

Related Projects


South Africa


Centers for Disease Control and Prevention (CDC), The Global Fund, USAID


Abt. Associates, CEGAA - Centre for Economic Governance and Aids in Africa, HE2RO - Health Economics and Epidemiology Research Office



Fostering Digital Communities

We create and support global communities of innovators, funders and policymakers for continuous and iterative learning, knowledge generation, exchange and collaboration. Click on the logos below to explore our communities: