21 October 2004
Government is committed to reporting regularly on the implementation of the comprehensive plan, and we are proud to report on the progress being made.
The Comprehensive Plan for the Management, Treatment and Care of HIV and AIDS adopted in November last year flows from our five-year Strategic Plan (2000 – 2005). Our approach emphasizes the centrality of prevention in response to HIV and AIDS and the importance of strengthening of the national health system so that we can provide a complete continuum of care and sustain a series of interventions to mitigate the impact of HIV and AIDS and other diseases.
Cabinet received a progress report on the implementation of the Plan which indicate progress on each aspect of the comprehensive plan. It indicates that a number of activities have been undertaken to strengthen the national health system and those which are part of the continuum of care provided in the context of the plan.
Progress is being made and important milestones reached on:
Strengthening the health system
We introduced a scarce skills and rural allowance in February 2004, improved conditions of work in the public sector and signed a memorandum of understanding with countries such as the UK to manage the staff losses in the public health sector and improve recruitment and retention of key health personnel.
A national human resources plan is being developed which will outline further initiatives and should be ready for implementation by early next year
Hospital and clinic infrastructure is being improved to allow for effective service delivery in the public health care sector. 30 hospitals are currently part of the hospital revitalization programme. Two new hospitals have been completed under the programme and four more will be completed during this financial year.
Each province is modernizing its fleet of ambulances and recruiting additional EMS personnel.
The drug procurement and distribution system is being strengthened. Provinces have secured drugs and other commodities through an interim procurement process while the main tender is being finalized.
To ensure a sustainable drug supply to support the long-term implementation of the plan, a tender was advertised earlier the year and the adjudication process is expected to be finalized at the end of October.
A tender has been advertised this month for a drug tracking system to track the movement of drugs from manufacturer to patient and monitor drug availability. The system will drastically reduce drug loss through theft.
A national health care management system is being developed focusing on patient linked data and a unique identifier system for each patient. Computer equipment has been installed at various public health facilities to strengthen information management.
The national health laboratory service has certified 250 laboratories nationally. Of these 20 have been selected to perform CD4 tests and seven laboratories to perform viral load tests.
A process of accrediting public health facilities where anti retroviral treatment (ART) will be provided commenced in January 2004. The Department had a target of establishing at least one service point in each of the 53 districts in the country by March 2005. 50 of the 53 health districts have at least one service point providing a comprehensive service to people living with HIV and AIDS. A total of 102 of the 113 facilities identified by provinces to provide comprehensive HIV and AIDS services have been accredited.
Prevention activities have been significantly strengthened through our Khomanani Communication Campaign, increased distribution of barrier methods (condoms), promotion of Voluntary Counselling and Testing and treatment seeking for sexually transmitted infections (STIs), as well as interventions to reduce the risk of mother to child transmission (PMTCT).
We have noted a significant reduction in STIs over the last few years due to our communication interventions and related programmes for truck drivers and commercial sex workers. Condoms distribution has increased from 33 million per month to 45 million since June 2003. Funding for female condoms is increasing and the number of VCT service points nationally increased from 1500 at the end of the previous financial year to 3 072 by the end of September 2004.
Key strategies to improve care and treatment include the provision of anti-retroviral drugs and the treatment of opportunistic infections including TB. By the end of September 2004, 11 253 people were receiving anti-retroviral treatment (ART) and the number is increasing.
It is important to note that the target of 53 000 patients on treatment by March 2005 was an estimate based on the prevalence estimates made by the Actuarial Society of South Africa (ASSA). ASSA has recently revised their estimates downwards.
A 24-hour telephone help-line has been established to provide information relating to HIV and AIDS to patients, community members and health care providers. The help-line receives 5000 daily which is handled by 70 people who work 4 shifts. The number of home and community based care as well as hospices are expanding.
Support groups for people with chronic diseases of lifestyle have been established in 6 provinces. These groups play an important role in facilitating adherence to treatment. Most of these groups are affiliated to Non Governmental Organizations involved in home-based care, peer education and counseling and HIV and AIDS education
The public health system provides nutritional supplements to those who need it. We allocated R7 million during 2003/04 to purchase nutritional supplements
Quarterly monitoring reports on progress in relation to the Plan has been initiated. Ongoing monitoring to measure the outcomes and impact of interventions is critical for the success of implementing the plan. Good information procedures as well as guidelines on ethics, intellectual property and copyright to safeguard public sector information are being developed.
A governance framework for the research programme for the Plan has been developed in partnership with the Medical Research Council.
Challenges
As we make progress we are also learning and identifying challenges which we are addressing:
The number of people on ART is lower than anticipated at this stage. We are investigating the reasons for this and will adjust our interventions accordingly. The communication activities to promote awareness through Khomanani amongst others have been intensified
We anticipate that the introduction of the Community Health Workers Programme in February 2004 and expansion of home-based care projects should also increase the uptake over time.
With regard to human resources, the provision of health services is labour-intensive and a range of both clinical and management skills are required to deliver quality health care. The migration of health personnel and the shortage of staff in especially rural and remote areas are of particular concern to us. We have implemented interventions to address the migration of health workers to other countries and the shortage of health professionals in rural areas.
Health laboratory services are in place but we are still experiencing difficulties in keeping turn around time to less than six days, monitoring quality assurance and transportation systems for specimens and patients.
Regarding nutritional interventions, there is a shortage of dieticians and nutritionists in many public health facilities and it is necessary to strengthen the referral system between the Departments of Health and Social Development for those patients who are food insecure.
Partnership
The successful implementation of Comprehensive Plan for the Management, Treatment and Care of HIV and AIDS depends on a partnership with all sectors of society. We are proud that one year after Cabinet took its decision to adopt the plan, we can report progress that gives cause for hope.
Reasonable progress is being made under difficult circumstances. Plans are being developed and implemented to meet the challenges that have been mentioned. This, together with people’s health seeking bahaviour and other barriers to care means that we cannot guarantee that we will reach the estimate stated in the plan.
However, what we will do is to increase access progressively and equitably in the short to medium term so that anyone who needs care or treatment can get it. In addition we will increase our preventative activities because we need to ensure that the 40 million South Africans that are negative, remain negative and healthy.
Issued by: Dr Kamy Chetty (Acting Director General), The Department of Health
For more information contact: Samantha Bloem (Acting Chief Director: Communication), 082 339 8578