Date: 01/11/2006
Source: Department of Health
Title: Madlala-Routledge: Panel discussion on HIV and AIDS


Address by Nozizwe Madlala-Routledge, Deputy Minister of Health, at the panel discussion on HIV and AIDS, University of Cape Town

The role of the public sector in fostering partnerships with the private sector in the provision of antiretrovirals (ARVS)

Chairperson, Professor Nicoli Nattrass, University of Cape Town,
Panellists: Mr Gary Ralfe, Managing Director of De Beers, Mr Robert Wilkinson of Butlers Pizza and Mr Zachie Achmat, Treatment Action Campaign (TAC),
Members of the media,
Distinguished guests,

We have come to a critical stage in the national response to the HIV and AIDS epidemic. South Africans are talking to one another and are making a commitment to work together to fight the epidemic that is threatening to roll back the gains of democracy. Government welcomes this opportunity to engage with the university community, students and academics. There is a role for all South Africans in this campaign. This is the sort of creative engagement that we need to address all aspects of HIV and AIDS, and I am looking forward to what we see as the way forward on the provision of ARVs by the private sector.

I am pleased to participate on this panel with a focus on the private sector for a change, though I hope to get ideas on the role of government in facilitating the provision by the private sector. Our Chief Director for HIV and AIDS, Sexual Transmitted Infections (STIs) and tuberculosis (TB) Directorate, Dr Nomonde Xundu, is here to support me. She is our expert and will answer all the difficult questions.

This evening's debate is on the role of the private sector in the provision of ARVs. I will be approaching this debate from government policy which encourages public-private partnerships (PPP). I will look at the role of the private health sector and that of the rest of the other sectors of business including non-governmental organisations (NGOs).

I am particularly pleased by the fact that Professor Nicoli Nattrass an eminent Professor of economics at this university is chairing this panel discussion. Her contribution to the understanding of the economics of HIV and AIDS has been particularly helpful in highlighting the cost of not treating people. Government especially in the developing world where State resources are limited, need to be helped to understand how not treating people with AIDS increases the disease burden and healthcare costs. Treating opportunistic infections has begun to cause a huge strain on the public health sector in our own country, South Africa.

Governments need to be helped to understand the impact of HIV on the economy not only in terms of reduced productivity and loss of skills, but also in terms of the impact of the disease on family incomes. Illness and death of breadwinners is compromising the welfare of the whole family. Caring for the ill and for orphaned children as well as the cost of funerals has a devastating effect on the household income. In the final analysis the cost of not treating HIV and AIDS far outweighs the cost of treatment.

The African Union (AU) has recognised that health is central to socio-economic development. To achieve economic development Africa needs to reduce its high disease burden. The achievement of the targets for Millennium Development Goals (MDGs) four, five and six that relate to health is therefore central to the achievement of the remaining MDGs.

Government regards business as an important partner. We also think that business has a responsibility to contribute towards the general well being of the workers and their communities. We are glad to see that business has begun to understand this role especially in the context of the HIV and AIDS pandemic. They have understood the impact of HIV and AIDS on the bottom line in terms of lost skills, absenteeism, low morale and low productivity and they are putting in place workplace treatment programmes. The Anglo American AIDS plan includes a workplace testing and treatment programme as well as a community partnership project to help accelerate the provision of comprehensive HIV and AIDS services in about 200 of South Africa's public clinics, especially in rural areas. This plan also includes fighting TB and malaria. The success of Anglo's workplace programme is well documented showing a high intake of voluntary counselling and testing (VCT) and workers volunteering for treatment resulting in higher morale, higher productivity and lower absenteeism.

Big business is looking at ways to assist small businesses cope with treatment costs and have set up a fund, to serve as a common pool from which small medium and micro enterprises (SMMEs) can draw for their employees. We support this concept.

We also support the concept of building a partnership with business such that we share resources. Where there is a State funded HIV clinic business can negotiate use of the facilities for their employees.

We are all infected or affected by HIV and AIDS and I wish to start by telling some of the ways I have been affected which I hope will highlight some of the challenges. I will then speak on some of the challenges the public sector faces before moving onto the role government is playing in the provision of ARVs by the private sector.

Two of my cousins died recently of AIDS defining illnesses.

1. Thandeka - HIV status known; disclosed to immediate family but very scared to disclose to the public because of stigma. I visited her in December 2004 and she was losing weight, had extremely sore feet and was recovering from pneumonia. She had been seen by a local General Practitioner (GP) who was treating the opportunistic infections but had not referred her to the HIV clinic at Port Shepstone Hospital. Thandeka was working for the South African Police Service (SAPS) and had medical aid cover but she was very anxious about that fact that her medical aid would soon be running out. She had used some of it for her daughter who had died recently and herself. I took Thandeka to see another GP who had opened an HIV clinic. When he saw her, he was visibly shaken by her condition and after calming her down he prescribed ARVs, which Thandeka took only for a day or two. She gave them up without going back to my GP friend to monitor her for side effects such as nausea in her case. Thandeka was concerned that the nausea was stopping her from eating which she was desperate about since she wanted to gain back her weight as quickly as possible so that the community would not look at her and guess she has AIDS. Her mother who depended on Thandeka was nursing and supporting her. In her desperation, she took Thandeka to a traditional healer who asked for R500 for a potion she gave her. Sadly, Thandeka died in January 2005.

2. Phyllis - HIV status known; no CD4 count done; not begun on treatment when I went to see her on a Saturday. I asked the doctor who was treating her opportunistic infections about starting her on antiretroviral treatment (ART). His answer was that they did not know what her CD4 count was and if he sent in for the test it would take it two weeks for the results to come back. Thereafter, he would refer her to the HIV clinic in Wentworth where they would put her on the programme after three weeks of training and observation. Phyllis died of cryptococcal meningitis the following Monday before her referral to the HIV clinic.

This illustrates some of the challenges experienced by government in provision of ARVs. There are issues of stigma stopping people from testing and seeking help at the early stages of the disease. Both my cousins did not disclose until near the final stages of the disease. In Thandeka's case, the GP she was seeing should have started her on treatment for HIV or referred her to the State facilities nearby. Similarly, in Phyllis's case, the hospital that was treating her for opportunistic infections should have encouraged her to get a CD4 test in order to determine if she qualified for admission into the ARV programme.

The role of government in provision of ARVs by business includes development of policy on HIV legislation, strategy and a comprehensive plan on HIV prevention, treatment, management and care. Government also has a role in the regulation of medicine pricing, testing, registration and procurement.

Government has developed strong public-private partnerships (PPP) in all the nine provinces. Some examples include two meetings a year with clinical experts in the private sector who advise government on treatment guidelines. The private sector has also provided training of staff and helped with recruitment. Some examples include the recruitment and placing of doctors and pharmacists. It has included also the training of pharmacy assistants.

These partnerships are important in helping the Department of Health deal with the challenges we face such as:

* The shortage of Human Resources (HR) and infrastructure - consulting space, in the facilities, training of personnel, accreditation of facilities, clinical support and drug supply chain management as well as social mobilisation and prevention of new infections. There is also an important role for the international organisations like the United Nations (UN) and the World health Organisation (WHO).

Government has created the environment for co-operation and partnerships. We must build on these and make contributions in the development of the new strategic plan and the work of the restructured South African National AIDS Council (SANAC). It is in through such partnerships and united action that we can conquer the HIV and AIDS epidemic.

Thanks!

Issued by: Department of Health
1 November 2006