Government funding of HIV-AIDS medical and social care

The provision of health and social care for people with HIV infection or AIDS and for initiatives aimed at the prevention of the spread of HIV infection has since 1988-89 relied heavily on ring fenced Central Government funding. In 1990/91 the total earmarked central funds available for English and Welsh Health Authorities, Local Authority Social Service Departments, and Scottish Health Boards, totalled £152.5 million. This substantial additional funding is guaranteed only on a short term basis and has to be moulded into general NHS and LASS funding to provide cost-effective health and social care for people with HIV infection or AIDS. The responsibility for the allocation of HIV-AIDS funding has been the separate responsibility of the Department of Health in England, the Welsh Office in Wales and the Scottish Home and Health Department in Scotland. The separation of decision making has led to the adoption of different distribution mechanisms. The consequences of the separate national systems of HIV-AIDS funding is examined in this paper. In England and Wales, Central Government allocations for health care have been based on numbers of AIDS cases alive, whilst prevention funding has been based on the regional population aged 15-34 years (in Wales a flat rate amount has been provided for prevention measures). In Scotland, overall HIV-AIDS funding made available to the Health Boards has involved a general grant distributed using a modified SHARE budget allocation formula with additional funding for three special AIDS Units providing treatment and care for people with HIV infection or AIDS. In England and Wales funds for statutory sector social care have been allocated following bids submitted by Social Service Departments to the Department of Health or Welsh Office. In Scotland there has been no specific HIV-AIDS grant provided by the Scottish Office to Social Work Departments. In addition, no Central Government funding for HIV-AIDS services has been made available to the local authority departments of Environmental Health, Education and Housing in either England, Scotland or Wales. After a discussion of some major issues concerning the feasibility of a standard system of national funding, the use of the joint planning and joint finance mechanism for HIV-AIDS funding and the monitoring of HIV-AIDS related expenditures, the authors conclude that there is a need to manage and evaluate the use of funds carefully. Have the substantial additional resources provided for people with HIV infection or AIDS been allocated equitably to provide cost effective care? The extent of monitoring of the use of funds and the evaluation of the cost-effectiveness of alternative care packages appears to be modest and of uneven quality.