This South African grandmother cares for four Aids orphans, two of them her own grandchildren and two left behind when another granny died. (Photo Courtesy Kristy Siegfried/IRIN)

Six provinces may run out of anti-retroviral (ARV) drugs as a result of a financial shortfall experienced by the Department of Health totalling one billion rand.

"Health Minister, Dr Aaron Motsoaledi told us that there is an 'emergency fund' of five million rand. But we know that five million rand is a drop in the ocean for six provinces that have the HIV and TB problem. There is a shortfall of one billion rand", said Vuyiseka Dubula, Secretary-General of the Treatment Action Campaign (TAC). She was speaking at a media briefing of the recently-launched Budget and Expenditure Monitoring Forum (BEMF).

According to the BEMF, only three provinces do not expect treatment interruptions. These are the North West, Northern Cape and Western Cape.

Executive Director of the AIDS Law Project and member of the BEMF, Mark Heywood, said the shortfall is a major concern both for new and enrolled patients.

"It's estimated that probably 40 percent of people who need treatment are receiving treatment, which means there are still more people dying of AIDS than people receiving treatment. We're concerned that even for those people who've managed to get onto treatment up to this point, sustained access to treatment is now under threat", said Heywood.

According to a report compiled by the department's Integrated Support Task Team (ISTT), which was given to Health Minister Dr Aaron Motsoaledi, mismanagement is one of the reasons for this looming crisis.

"He (Minister Motsoaledi) confirmed our suspicions in terms of mismanagement, lack of planning and proper budgeting on health. As a result, in the Free State, one of the findings is that for three weeks in one hospital there haven't been ARVs. Is what's happening in Free State unique? No, it's not unique", said Dubula.

The BEMF is now calling for a unified approach that will include the private health sector to avert the situation.

"The private health sector is escaping the burden of responsibility for the AIDS epidemic. We are saying to Minister Motsoaledi, 'don't just talk about this NHI thing sometime in the future'. If you want to build a unified health service, start building it around the response to the AIDS epidemic and demonstrate through the response to the AIDS epidemic that something can be done that can be applied to other aspects of the provision of healthcare", suggested Heywood.

"We say to the Minister of Health and to (President) Jacob Zuma, 'it's not a choice, it's a duty that faces you', he said.

The BEMF was launched by various non-governmental organisations (NGOs) after the ISTT's report was "leaked" to Heywood. The ISTT was formed by government to probe ARV shortages in the Free State, which led to the imposition of a controversial moratorium that stopped the provision of ARVs to new AIDS patients late last year.