TAC report

TAC report “does not address all elements of the Plan” – government

Imagine what happens when an organisation with a direct interest on a particular subject assumes a position of an “objective” watchdog within the same field. The problem becomes even more complicated if that organisation has a very narrow view of the wide-ranging and complex challenges within that area. The report of the Treatment Action Campaign on the implementation of the Comprehensive Plan for Management, Care and Treatment of HIV and Aids represents this scenario.

Firstly, the report does not address all elements of the Comprehensive Plan as adopted by Cabinet. Because of the refusal to accept the comprehensive nature of this Plan, the report fails to objectively analyse and contextualise the overall efforts of the Department of Health to implement every element of the Plan.

The Plan emphasises the centrality of prevention in our national response to HIV and Aids. In the absence of a cure for HIV and Aids, the Plan requires government to sustain and scale up prevention interventions. The report does not address itself to this matter. It therefore overlooks many interventions including the recent re-launch of newly branded government condoms. It ignores the dramatic 80% increase in the distribution of these high quality male condoms from 150 million in 1997 to 270 million in 2003.

The report omits the fact that we have increased the budget for the HIV and Aids communication campaign – Khomanani Caring Together – from R90 million in the past two years to R165 million for the next two years.

Together with Soul City Institute, Khomanani is distributing 11 million copies of the “HIV and Aids and Treatment” booklet as part of the Comprehensive Plan. This is probably the largest public health education drive of its kind.

The 49-page booklet is printed in all 11 official languages and contains detailed information on how HIV is transmitted and how it can be prevented; knowing your HIV status and the holistic management of HIV and Aids including details about what is anti-retroviral treatment (ART) and when and how it should be taken.

The report raises a real challenge we are facing with regard to acquiring adequate numbers of trained personnel to support implementation. However, it fails to unpack the complexity of this problem including the inadequate numbers of certain health professional categories in the country, limited number of people trained or experienced in HIV and Aids care and treatment as well as the difficulties in recruiting and retaining health professionals to rural and underserved areas.

We are engaging our academic institutions on increasing the output of scarce health professional categories including pharmacists. We are introducing a mid-level health worker category to complement some of the functions including medical and pharmacist assistants. We have launched the community health worker programme and streamlined their training to enable them to provide comprehensive support to families affected by Aids and other health and social problems, directing them to various government social support services.

Supplement meals to the value of R7 million have been ordered to support those who are food insecure. About R6 million has been transferred to the Medical Research Council for research into traditional medicine with preliminary findings indicating that these medicines are providing relief for people living with Aids. They are widely available, affordable and have simple regimens.

We have a target of establishing a service point in every district in the country within this financial year and a service point in every local municipality within five years. Eight months before the end of the financial year (March 2005) can we be judged to have failed to meet our targets?

We already have 52 health facilities accredited to provide services outlined in the Comprehensive Plan with provinces like Mpumalanga already having a service point in all of its districts. We have extended laboratory networks to service these facilities. These laboratories have conducted more than 11 800 CD4 count tests in April and another 18 000 in May. CD4 tests are necessary to determine the progression of the disease and whether antiretroviral treatment can be made available subject to an endorsement by a medical officer.

The process of finalising the tender for a long-term supply of antiretroviral drug to support this Plan is underway. We had more than 40 companies that expressed interest in supplying these drugs. We short-listed them to eight (8).

The shortlisted suppliers should by the end of this month submit quotations to the Department for the tender to be awarded to successful companies by the end of next month.

This process has been necessary for us to achieve our main objective, which is a sustainable supply of ARVs at the best possible prices. The tender should facilitate a significant increase in accessibility of these drugs from about 6000 people who were accessing them through a temporary supply measure by last month.

As we intensify our response to HIV and Aids, we take note of the Global HIV and Aids Epidemic report released by UNAids this week indicating an increase in HIV prevalence rate in almost every region of the world. The report requires that we do not overlook the rate of new infections as the main indicator of progress in curbing HIV and Aids.

No single intervention can singularly resolve the complex challenge of HIV and Aids. In assessing the degree of our success or failure, we have to look at the total picture including the complex nature of HIV and Aids and our overall burden of disease; the capacity of our health systems, and the distribution of resources within the current inequitable world order. Unfortunately, a single-issue interest group is not capable of making this objective assessment.

Manto Tshabalala-Msimang is the Minister of Health and member of the ANC National Executive Committee This is taken from ANC Today, Volume 4, No. 27, 9″”15 July 2004