AIDS IN AFRICA - CAN THE HOSPITALS COPE

The costs of the medical care needs of AIDS patients are well above the average per capita expenditure on health care in many sub-Saharan African countries. These costs may become completely unaffordable as specific anti-viral drugs come onto the market, and the burden will fall on health networks, whose present strained budgets show no real signs of increase. In addition, pilferage, mismanagement and inefficiency continue at the few existing hospitals. As the total number and percentage of hospitalized patients with AIDS increases, the hospital networks (and the health services as a whole) risk collapse. The risks are of the same magnitude for both rural and urban hospitals - the former will not be able to deliver the necessary minimum quality of clinical standards, the latter will be flooded by too many patients. Achieving reasonable standards of hospital management and decentralization of curative care are critical targets for at least avoiding the risk that donors may be unwilling to finance specific anti-HIV drugs for these poor (and high-prevalence) countries.