Date: 29/06/2006
Source: Gauteng Provincial Government
Title: Mahlangu: HIV/AIDS Indaba
Address by MEC for Local Government, honourable Qedani Mahlangu, at the HIV/AIDS Indaba
Programme Director,
Health MEC Brian Hlongwa,
Executive mayors,
Speakers,
Municipal managers and councillors,
Salga Deputy Chaipersons,
Mayor Khumalo and Mayor Maila,
Nappwa representatives,
TAC representatives,
Dr Liz Floyd,
Aids activists and campaigners,
People of Gauteng,
Labour Movement;
Traditional leaders,
Distinguished guests;
Introduction
A fundamental challenge to every individual and institution in South Africa today is posed by the onslaught of the HIV and AIDS pandemic and the devastating impact it has had on the fabric of society. All of us must answer the question of how we will respond to this challenge. To do so we must build a clear understanding of the social, cultural, political and economic aspects of the pandemic.
Since the impact of the pandemic is multi faceted, our response must be multi sectoral. We must seek to transcend the divisions across sectors between spheres of government and between government, communities and civil society to build a common response that addresses the social impact of the disease.
Local government must be a central institution in our common response to the pandemic. It is the sphere of government closest to communities and has the capacity to unite the diverse actions of all stakeholders within a shared area of impact. To play its role effectively, local government must lead in the establishment of a multi sectoral approach which mainstreams Gauteng is committed to a multi sectoral approach to HIV/AIDS, spanning a range of government departments and sincere in its engagement with civil society organisations.
The reasons for this approach relate to the imperatives of preventing the spread of HIV, managing and treating AIDS and ameliorating the wider impact of the pandemic on society as a whole. Prevention rests on changing sexual behaviours and therefore influencing the social norms that shape these behaviours and the socioeconomic relations that under-gird them. The health care aspects of AIDS and other communicable diseases such as tuberculosis (TB) are complex ad not purely medical. Successful management and treatment require the support of families and local communities as well as changes in personal behaviour. Furthermore, the impact of AIDS is largely social and economic. It is felt in the family, the workplace the community. It alters the demographics of countries impacts on economic and developmental potential and creates unique challenges in terms of childcare. The extraordinary scale of the AIDS epidemic means that everyone will be affected and all potential resources need to be combined into an efficient and coordinated effort. The more wide ranging our response is the stronger the leadership and coordinating mechanism that is required.
A key aspect of our multi sectoral approach is a strong emphasis on building intergovernmental relations. In the last five years a total of R49,1 million was disbursed to Gauteng municipalities through Multi-sectoral AIDS Unit (MSAU) for localisation of HIV/AIDS plans. This is in response to what municipalities have been allocated in terms of their strategies and programme plans. Amongst other programmes these funds have enable the employment of HIV/AIDS co-ordinators in every municipality significantly enhancing our capacity to fight the epidemic and respond to its consequences.
Working together all three spheres of government have achieved a great deal in the recent period. While the challenges remain daunting some of the key successes that we have registered include:
* Political leadership is taking a stronger and more direct role in leading our campaigns against HIV/AIDS. The leadership displayed by municipal mayors, especially in respect of mass mobilisation and door-to-door work is a source of deserved pride the province. In most municipalities responsibility for co-ordinating the municipality's HIV/AIDS initiatives is placed in either the mayor or speaker's office.
* All the municipalities have in one way or another embarked on awareness campaigns notably mass education through World AIDS Day (WAD). 12 000 non-governmental organisations (NGOs) volunteers participated in WAD door-to-door campaigns. We estimate that during these and similar campaign more than 2,3 million people have been educated on HIV/AIDS prevention.
* Municipalities have also sought to mobilise ward and community structures and monitor and evaluate programmes at local and municipal levels. This work has been done as part of a collaborative effort between civil society and government to combat HIV/AIDS.
* At provincial level and in all municipalities HIV/AIDS councils have been established to bring together civil society, government and other stakeholders in a common programme of action. At provincial level the Premier chairs the HIV/AIDS council, while executive mayors are chairpersons of AIDS councils in most municipalities.
* All our municipalities have dedicated HIV/AIDS units and have developed policies, strategies, workplace plans and programmes. These include anti-discrimination policies, employee assistance programmes, prevention, care and treatment, anti-retroviral treatment (ART) and awareness campaigns.
* Many municipalities have begun to integrate HIV/AIDS into their operational policies and programmes, as well as encourage public participation on the issues posed by the pandemic.
* According to the South African Cities Network (SACN), in the three metros in Gauteng ward councillors have provided leadership to communities on these issues. It is also positive that municipalities have gathered data on areas of high prevalence and significant impact.
* In terms of care and treatment the province has exceeded its targets. Home based care services are available in all municipalities.
Voluntary counselling and testing (VCT) sites have increased from 10 in 2001 to 202 in 2003. The Prevention of Mother to Child Transmission (PMTCT) programme has 117 functional sites in 83 clinics that provide antenatal care where more than 87 500 women attended. A total of 150 000 women have accessed PMTCT since 2001.
In general the people and government of our province are moving towards coordinated, multi sectoral response. This means that local government has had to take the lead in building partnerships in a manner that mobilises all local resources and community based initiatives towards common objectives.
A key element of our programme must be to build and strengthen the partnerships we have begun to establish at provincial level including through initiative such as the Workplace AIDS Indaba and the Traditional Health Practitioner Summit, held earlier this year. Partnerships with wider civil society, business and the international community have proved fruitful in many parts of the country. These partnerships can help leverage support in various areas including HIV/AIDS education, counselling, treatment and care, feeding schemes and so on. Faith-based organisations (FBOs) are a particularly important sector which can augment local government services with additional support and services. All faiths are now involved in education and awareness raising activities, and training for FBOs now includes the African Independent Churches (AIC).
Ekurhuleni and Johannesburg have established ward level relationships between themselves and HIV/AIDS service organisations. These partnerships serve to ensure that where access to municipal services is limited, partner organisations can intervene to augment service to the community. Informal communities’ initiatives started by a small group of dedicated individuals who respond to particular needs are an important source of strengthening our response to the epidemic. Another critical aspect of this work is the participation of people living with AIDS in all our activities, both directly and through their organisations.
Municipalities generally have established ward forums to promote public participation in municipal affairs, including on HIV/AIDS issues. Some municipalities like the West Rand District Municipality have reported training of people living with HIV/AIDS and provision of support to them.
4. Key challenges facing local government
Although municipalities have made significant progress in their responses to HIV/AIDS, a number of shortcomings and challenges have been identified.
The first is the lack of capacity in local government structures partly due to the new needs of local government which go beyond the traditional role of municipalities.
Secondly, there has been a lack of strategic planning around HIV/AIDS. Local government's ability to deal with this has been hampered by financial and technical constraints. Despite these stumbling blocks it is still the role of local government to deal with and plan intervention programmes for HIV/AIDS as they are the sphere of government closest to the public and its communities (SACN, 2004: 7). This means that they are best placed to develop bottom up and integrated approaches.
Issues of HIV/AIDS, gender and poverty alleviation programmes have not been properly responded to due to overly technocratic, sector led development. Planning and implementation have dealt with and focused on symptoms and not the underlying causes of the issue at hand. Community consultations need to take place practically and properly. Lastly, there has been limited consideration for institutional transformation and organisational development in the local government sphere. Related to these problems is that frequently there is limited understanding of HIV/AIDS as a development and governance issue among planners, together with sector specific implications of HIV/AIDS and the perspectives of municipalities' planning and implementation practices. A fully multi sectoral response is often retarded by an overly health sector oriented programme, which fails to take account of the social and economic complexity of the disease and its implications.
One of the challenges faced by local government is their inability to secure donor funding to respond to the HIV/AIDS epidemic. Most of the donor funding goes to provincial and national spheres of government and seldom get channelled to local level where implementation is crucial. As we move forward this as an issue needs to be addressed to allow local government to access funds. However, local government would also have to improve on its capacity to manager finances, so that channelling money to local government is not seen as risky.
Improving intergovernmental relations as part of the programme to mainstream HIV/AIDS interventions also remains a significant challenge facing municipalities. The building of networks between departments and external stakeholders will be vital if mainstreaming is to be successful. This means in particular that we need to overcome the mentality of competition between government agencies where the success of one is regarded as the failure of the other. The challenge of HIV/AIDS is so large that any success at any level needs to be welcomed and supported by all of us. It also means overcome the hierarchical approach sometimes adopted in dealings across spheres of government. Each sphere has a unique and important role to play and a 'big brother' approach can serve to undermine the contribution and challenges faces by each of us. In many respects the provincial spheres of government have not been adequately able to act in support of local government. There has also been an uneven willingness of sector departments to respond to municipalities with regards to their planning and implementation activities and/or to participate meaningfully.
Perhaps part of the problem is the lack of common definition of mainstreaming (SACN, 2004: 20). Without a clear understanding between all stakeholders mainstreaming could easily become a rhetorical notion, devoid of programmatic dimensions.
The absence of local information on HIV/AIDS prevalence rates and statistics and how these will have an influence on development priorities will also need to be addressed as a key constraint on our work in fighting the pandemic.
5. Way forward
We must build on the foundation laid over the past five years that municipalities and it is therefore important to develop detailed plans for the next five years. Such plans can provide a focus for better co-ordination both at the intergovernmental level and between all spheres of government and partners.
Amongst the critical factors that would define a successful programmatic response to the pandemic are:
* A multi sectoral and intergovernmental approach to our work.
* A concerted and conscious education programme to drive change in sexual behaviours including influencing social norms that shape behaviour.
* The empowerment of vulnerable groups such as women. This has to recognise that AIDS is not simply a health issues it is a social, economic and political issue.
* Leadership at the highest political level should continue to be present and visible in the fight against HIV/AIDS. In particular, mayors and councillors must take the lead.
* All potential resources need to be combined into an efficient coordinated effort. The more wide ranging the response, the stronger the leadership and coordination mechanism is required.
More specifically, the elements of our programme over the next few years would have to include the following important areas which will form the basis of our debate at the indaba on which basis we will develop a framework for our programme going forward.
Improving multi sectoral intervention and co-ordination
One of the main challenges in the fight against the AIDS epidemic is the shortcomings about co-ordination between different role players. Local government would have to find ways to strengthen its ability and capacity to act as facilitator to form and establish current and future partnerships.
This has to be coupled with a more strategic management of the existing expertise at local level in order to make better impact. In addition, all stakeholders would have to agree on their individual roles vis a vis the multi sectoral AIDS response. Lastly, co-ordination and integration of planning and action between local and provincial government would be crucial in making this multi sectoral approach successful.
Strengthening HIV/AIDS councils and units
All Gauteng municipalities have established HIV/AIDS units and have developed policies, strategies, workplace plans and programmes. However, some of these units have no dedicated staff assigned to functional areas and tend to lack on funding. As such, there are still gaps in the capacity of municipalities to coordinate responses as many are understaffed perhaps with the exception of the metros. In many cases, HIV/AIDS programmes are add ons to existing responsibilities of assigned staff within the units. Furthermore, policies and strategies are not adequately integrated into decision making and budgeting processes. Perhaps one of the tasks of the Indaba is to review the role and clarify the HIV/AIDS councils, including the constitution of the councils.
Funding of non-governmental organisations (NGOs)
It has been acknowledged and accepted that NGOs and organisations of civil society can play a major role in the fight against AIDS. There is a need for municipalities to fund organisations of civil society in order to support the work they do and we therefore need to develop a framework for such funding. This would help to ensure that throughout the province we develop a common approach, even if the details and modalities may differ from region to region. In addition, municipalities may need to be equipped on how to manage and administer NGO funding. This process has to be standardised.
Mobilising communities
Community and social mobilisation gets people to take action to address HIV prevention, AIDS care and social support in their personal lives, families, local communities or workplaces. It is driven by activism, volunteerism and a sense of social responsibility. For any programme to work successfully from the planning to the implementation phase, it is important that those who will be affected by the programme are involved in the process from the start. It also has to be recognised that community responses are crucial in fighting HIV/AIDS. They are immediate, direct, flexible and are driven by community members.
Responses are directed at local needs, reflect local forms of organising and acting and make use of available resources. Local government would have to ensure that real community participation takes place.
It is important to reflect on the successes that municipalities have achieved on the door-to-door education campaigns. These campaigns have reached a large number of people and there impact has been significant.
Enhancing HIV/AIDS workplace programme
The extent of the impact of AIDS on local government employees is already significant. It is therefore suggested that a starting point for local government would be to define its response to HIV/AIDS in the municipal workforce within the context of transformation, including quantifying the impact this would make on local government's ability to continue to provide services. The extent to which the workplace programme is meeting the needs of the municipal staff would need to be reviewed to allow improvement. Alongside this review a sharing of best practices across municipalities and provincial government would also be valuable.
Research, monitoring and evaluation
Ongoing research work by all stakeholders including institutions of higher learning in partnership with local government would be required if government is to succeed in improving our understanding of the issues involved and how it responds. A conscious effort would have to be made to identify priority areas for local government research on HIV/AIDS. In addition, monitoring and evaluation systems would have to play a crucial role in assessing progress and impact of programmes including the development of benchmarks and indicators for success.
Indigent burial
We are already experiencing very high numbers of death due to AIDS and mortality rates are directly correlated with levels of poverty, necessitating an approach to the cost of burial which ensures that the poor are afforded the dignity that is the constitutional right of all South Africans. Thus, indigent burial policy or at least guidelines would have to be discussed by local government to ensure that there is some policy clarity on this matter.
Assessing and countering AIDS' impact on municipal services
Municipalities' understanding of their role in addressing the social and economic consequences of HIV/AIDS in communities and at the workplace is important. For instance, housing and other basic services have more than one role to play when it comes to intervention purposes. If provided properly they can provide a cushion to affected households and infected individuals. Most importantly, local government needs to recognise the efforts made by other external stakeholders. Their participation and contribution in the fight against HIV/AIDS is crucial and needed. Community initiatives must not be seen as an alternative to local government in terms of aid and service delivery rather, they should be seen as a complement.
Expanding Joint Children's Services, community and Home-Based Care
Programmes which aim to foster care and support in the home or at the level of the community can be important levers in building a multi sectoral approach. Various sector departments need to work with municipalities in up scaling these programmes, which include the Joint Children's Services Programme and Home Based Care programmes. Given the provincial government's commitment to the programme of Bana Pele and the significant impact of HIV/AIDS on children, including through the emergence of large numbers of child headed households; a co-ordinated and inter-sectoral approach is required. Home-based care should be viewed as one of the several options available to local and provincial authorities in response to HIV/AIDS. Without their involvement excess burden will fall upon the shoulders of families already overburdened by poverty, unemployment, ill health etc. For home-based care to be effective it needs constant support and input from the public health, welfare and education system.
Integrated Development Planning (IDP) processes
The IDP offers a platform for engagement across all government spheres and other stakeholders in the future development of the specific area. It is also an ideal platform on which community members can voice their concerns, either affecting them directly or indirectly. Programmes aimed at HIV/AIDS intervention should form part of IDPs, where institutional arrangements and development are specified through the engagement between development role-players and stakeholders.
Although these interventions strategies should be informed by broad national or provincial strategies, the definition of support intervention will need to occur on a case by case basis, to align with the particular area context. However, for this to succeed local government would have to develop its own capacity, and that of community leaders, for proper situational analysis of HIV and AIDS, in order to create a basis for proper planning and intervening strategies. The role of community development workers (CDWs).
The Gauteng Provincial Government (GPG) has put mechanisms in place to ensure that the community has better access to the services provided by municipalities, namely the deployment of CDWs.
The primary role of CDWs is to bridge the gap between the services delivered by government and the people's access to these services. CDWs are linked to the ward committees in the areas where they are deployed to help increase and encourage public participation and participatory democracy. They help ward committees to ensure that there is an increase in people taking part in the issues that have an effect on them. Government would have to define the role of CDWs in relation to AIDS. In addition, support to CDWs would be required if they are expected to play some role with regard to this problem.
Conclusion
On this basis, key challenges facing local government and how local government can possibly respond to these challenges were highlighted. We hope that the final outcome of this summit would assist in setting the local government agenda on HIV/AIDS for the next five years.
Experience of the last five years has shown that initiatives and intervention programmes are not without challenges. The problem of capacity, largely attributable to the old apartheid system of unequal distribution of resources has become a major stumbling block among most local government structures. The processes of transformation, restructuring and amalgamation have been necessary to strike balance and create the necessary capacity within the local government structures.
The report has also indicated that financial and technical constraints are commonplace in many local government structures and many are still unable to secure donor funding to respond to the problem of HIV/AIDS.
In terms of policy and strategy, despite various challenges such as lack of capacity and a clear strategic plan the province views the HIV/AIDS problem in a serious light. This is demonstrated by the integration of HIV/AIDS programmes in its strategic priorities for 2005 to 2009.
The role of communities especially participation in various government initiatives is equally important. It is highlighted in the report that communities have the responsibility to address prevention, care and social support I their personal lives, families, local communities and workplaces. To this end, community responses are crucial in fighting HIV/AIDS.
Let me thank the official from the Department who have worked tirelessly in preparing for this summit.
I thank you!
Issued by: Department of Local Government, Gauteng Provincial Government
29 June 2006
Source: Gauteng Provincial Government
Title: Mahlangu: HIV/AIDS Indaba
Address by MEC for Local Government, honourable Qedani Mahlangu, at the HIV/AIDS Indaba
Programme Director,
Health MEC Brian Hlongwa,
Executive mayors,
Speakers,
Municipal managers and councillors,
Salga Deputy Chaipersons,
Mayor Khumalo and Mayor Maila,
Nappwa representatives,
TAC representatives,
Dr Liz Floyd,
Aids activists and campaigners,
People of Gauteng,
Labour Movement;
Traditional leaders,
Distinguished guests;
Introduction
A fundamental challenge to every individual and institution in South Africa today is posed by the onslaught of the HIV and AIDS pandemic and the devastating impact it has had on the fabric of society. All of us must answer the question of how we will respond to this challenge. To do so we must build a clear understanding of the social, cultural, political and economic aspects of the pandemic.
Since the impact of the pandemic is multi faceted, our response must be multi sectoral. We must seek to transcend the divisions across sectors between spheres of government and between government, communities and civil society to build a common response that addresses the social impact of the disease.
Local government must be a central institution in our common response to the pandemic. It is the sphere of government closest to communities and has the capacity to unite the diverse actions of all stakeholders within a shared area of impact. To play its role effectively, local government must lead in the establishment of a multi sectoral approach which mainstreams Gauteng is committed to a multi sectoral approach to HIV/AIDS, spanning a range of government departments and sincere in its engagement with civil society organisations.
The reasons for this approach relate to the imperatives of preventing the spread of HIV, managing and treating AIDS and ameliorating the wider impact of the pandemic on society as a whole. Prevention rests on changing sexual behaviours and therefore influencing the social norms that shape these behaviours and the socioeconomic relations that under-gird them. The health care aspects of AIDS and other communicable diseases such as tuberculosis (TB) are complex ad not purely medical. Successful management and treatment require the support of families and local communities as well as changes in personal behaviour. Furthermore, the impact of AIDS is largely social and economic. It is felt in the family, the workplace the community. It alters the demographics of countries impacts on economic and developmental potential and creates unique challenges in terms of childcare. The extraordinary scale of the AIDS epidemic means that everyone will be affected and all potential resources need to be combined into an efficient and coordinated effort. The more wide ranging our response is the stronger the leadership and coordinating mechanism that is required.
A key aspect of our multi sectoral approach is a strong emphasis on building intergovernmental relations. In the last five years a total of R49,1 million was disbursed to Gauteng municipalities through Multi-sectoral AIDS Unit (MSAU) for localisation of HIV/AIDS plans. This is in response to what municipalities have been allocated in terms of their strategies and programme plans. Amongst other programmes these funds have enable the employment of HIV/AIDS co-ordinators in every municipality significantly enhancing our capacity to fight the epidemic and respond to its consequences.
Working together all three spheres of government have achieved a great deal in the recent period. While the challenges remain daunting some of the key successes that we have registered include:
* Political leadership is taking a stronger and more direct role in leading our campaigns against HIV/AIDS. The leadership displayed by municipal mayors, especially in respect of mass mobilisation and door-to-door work is a source of deserved pride the province. In most municipalities responsibility for co-ordinating the municipality's HIV/AIDS initiatives is placed in either the mayor or speaker's office.
* All the municipalities have in one way or another embarked on awareness campaigns notably mass education through World AIDS Day (WAD). 12 000 non-governmental organisations (NGOs) volunteers participated in WAD door-to-door campaigns. We estimate that during these and similar campaign more than 2,3 million people have been educated on HIV/AIDS prevention.
* Municipalities have also sought to mobilise ward and community structures and monitor and evaluate programmes at local and municipal levels. This work has been done as part of a collaborative effort between civil society and government to combat HIV/AIDS.
* At provincial level and in all municipalities HIV/AIDS councils have been established to bring together civil society, government and other stakeholders in a common programme of action. At provincial level the Premier chairs the HIV/AIDS council, while executive mayors are chairpersons of AIDS councils in most municipalities.
* All our municipalities have dedicated HIV/AIDS units and have developed policies, strategies, workplace plans and programmes. These include anti-discrimination policies, employee assistance programmes, prevention, care and treatment, anti-retroviral treatment (ART) and awareness campaigns.
* Many municipalities have begun to integrate HIV/AIDS into their operational policies and programmes, as well as encourage public participation on the issues posed by the pandemic.
* According to the South African Cities Network (SACN), in the three metros in Gauteng ward councillors have provided leadership to communities on these issues. It is also positive that municipalities have gathered data on areas of high prevalence and significant impact.
* In terms of care and treatment the province has exceeded its targets. Home based care services are available in all municipalities.
Voluntary counselling and testing (VCT) sites have increased from 10 in 2001 to 202 in 2003. The Prevention of Mother to Child Transmission (PMTCT) programme has 117 functional sites in 83 clinics that provide antenatal care where more than 87 500 women attended. A total of 150 000 women have accessed PMTCT since 2001.
In general the people and government of our province are moving towards coordinated, multi sectoral response. This means that local government has had to take the lead in building partnerships in a manner that mobilises all local resources and community based initiatives towards common objectives.
A key element of our programme must be to build and strengthen the partnerships we have begun to establish at provincial level including through initiative such as the Workplace AIDS Indaba and the Traditional Health Practitioner Summit, held earlier this year. Partnerships with wider civil society, business and the international community have proved fruitful in many parts of the country. These partnerships can help leverage support in various areas including HIV/AIDS education, counselling, treatment and care, feeding schemes and so on. Faith-based organisations (FBOs) are a particularly important sector which can augment local government services with additional support and services. All faiths are now involved in education and awareness raising activities, and training for FBOs now includes the African Independent Churches (AIC).
Ekurhuleni and Johannesburg have established ward level relationships between themselves and HIV/AIDS service organisations. These partnerships serve to ensure that where access to municipal services is limited, partner organisations can intervene to augment service to the community. Informal communities’ initiatives started by a small group of dedicated individuals who respond to particular needs are an important source of strengthening our response to the epidemic. Another critical aspect of this work is the participation of people living with AIDS in all our activities, both directly and through their organisations.
Municipalities generally have established ward forums to promote public participation in municipal affairs, including on HIV/AIDS issues. Some municipalities like the West Rand District Municipality have reported training of people living with HIV/AIDS and provision of support to them.
4. Key challenges facing local government
Although municipalities have made significant progress in their responses to HIV/AIDS, a number of shortcomings and challenges have been identified.
The first is the lack of capacity in local government structures partly due to the new needs of local government which go beyond the traditional role of municipalities.
Secondly, there has been a lack of strategic planning around HIV/AIDS. Local government's ability to deal with this has been hampered by financial and technical constraints. Despite these stumbling blocks it is still the role of local government to deal with and plan intervention programmes for HIV/AIDS as they are the sphere of government closest to the public and its communities (SACN, 2004: 7). This means that they are best placed to develop bottom up and integrated approaches.
Issues of HIV/AIDS, gender and poverty alleviation programmes have not been properly responded to due to overly technocratic, sector led development. Planning and implementation have dealt with and focused on symptoms and not the underlying causes of the issue at hand. Community consultations need to take place practically and properly. Lastly, there has been limited consideration for institutional transformation and organisational development in the local government sphere. Related to these problems is that frequently there is limited understanding of HIV/AIDS as a development and governance issue among planners, together with sector specific implications of HIV/AIDS and the perspectives of municipalities' planning and implementation practices. A fully multi sectoral response is often retarded by an overly health sector oriented programme, which fails to take account of the social and economic complexity of the disease and its implications.
One of the challenges faced by local government is their inability to secure donor funding to respond to the HIV/AIDS epidemic. Most of the donor funding goes to provincial and national spheres of government and seldom get channelled to local level where implementation is crucial. As we move forward this as an issue needs to be addressed to allow local government to access funds. However, local government would also have to improve on its capacity to manager finances, so that channelling money to local government is not seen as risky.
Improving intergovernmental relations as part of the programme to mainstream HIV/AIDS interventions also remains a significant challenge facing municipalities. The building of networks between departments and external stakeholders will be vital if mainstreaming is to be successful. This means in particular that we need to overcome the mentality of competition between government agencies where the success of one is regarded as the failure of the other. The challenge of HIV/AIDS is so large that any success at any level needs to be welcomed and supported by all of us. It also means overcome the hierarchical approach sometimes adopted in dealings across spheres of government. Each sphere has a unique and important role to play and a 'big brother' approach can serve to undermine the contribution and challenges faces by each of us. In many respects the provincial spheres of government have not been adequately able to act in support of local government. There has also been an uneven willingness of sector departments to respond to municipalities with regards to their planning and implementation activities and/or to participate meaningfully.
Perhaps part of the problem is the lack of common definition of mainstreaming (SACN, 2004: 20). Without a clear understanding between all stakeholders mainstreaming could easily become a rhetorical notion, devoid of programmatic dimensions.
The absence of local information on HIV/AIDS prevalence rates and statistics and how these will have an influence on development priorities will also need to be addressed as a key constraint on our work in fighting the pandemic.
5. Way forward
We must build on the foundation laid over the past five years that municipalities and it is therefore important to develop detailed plans for the next five years. Such plans can provide a focus for better co-ordination both at the intergovernmental level and between all spheres of government and partners.
Amongst the critical factors that would define a successful programmatic response to the pandemic are:
* A multi sectoral and intergovernmental approach to our work.
* A concerted and conscious education programme to drive change in sexual behaviours including influencing social norms that shape behaviour.
* The empowerment of vulnerable groups such as women. This has to recognise that AIDS is not simply a health issues it is a social, economic and political issue.
* Leadership at the highest political level should continue to be present and visible in the fight against HIV/AIDS. In particular, mayors and councillors must take the lead.
* All potential resources need to be combined into an efficient coordinated effort. The more wide ranging the response, the stronger the leadership and coordination mechanism is required.
More specifically, the elements of our programme over the next few years would have to include the following important areas which will form the basis of our debate at the indaba on which basis we will develop a framework for our programme going forward.
Improving multi sectoral intervention and co-ordination
One of the main challenges in the fight against the AIDS epidemic is the shortcomings about co-ordination between different role players. Local government would have to find ways to strengthen its ability and capacity to act as facilitator to form and establish current and future partnerships.
This has to be coupled with a more strategic management of the existing expertise at local level in order to make better impact. In addition, all stakeholders would have to agree on their individual roles vis a vis the multi sectoral AIDS response. Lastly, co-ordination and integration of planning and action between local and provincial government would be crucial in making this multi sectoral approach successful.
Strengthening HIV/AIDS councils and units
All Gauteng municipalities have established HIV/AIDS units and have developed policies, strategies, workplace plans and programmes. However, some of these units have no dedicated staff assigned to functional areas and tend to lack on funding. As such, there are still gaps in the capacity of municipalities to coordinate responses as many are understaffed perhaps with the exception of the metros. In many cases, HIV/AIDS programmes are add ons to existing responsibilities of assigned staff within the units. Furthermore, policies and strategies are not adequately integrated into decision making and budgeting processes. Perhaps one of the tasks of the Indaba is to review the role and clarify the HIV/AIDS councils, including the constitution of the councils.
Funding of non-governmental organisations (NGOs)
It has been acknowledged and accepted that NGOs and organisations of civil society can play a major role in the fight against AIDS. There is a need for municipalities to fund organisations of civil society in order to support the work they do and we therefore need to develop a framework for such funding. This would help to ensure that throughout the province we develop a common approach, even if the details and modalities may differ from region to region. In addition, municipalities may need to be equipped on how to manage and administer NGO funding. This process has to be standardised.
Mobilising communities
Community and social mobilisation gets people to take action to address HIV prevention, AIDS care and social support in their personal lives, families, local communities or workplaces. It is driven by activism, volunteerism and a sense of social responsibility. For any programme to work successfully from the planning to the implementation phase, it is important that those who will be affected by the programme are involved in the process from the start. It also has to be recognised that community responses are crucial in fighting HIV/AIDS. They are immediate, direct, flexible and are driven by community members.
Responses are directed at local needs, reflect local forms of organising and acting and make use of available resources. Local government would have to ensure that real community participation takes place.
It is important to reflect on the successes that municipalities have achieved on the door-to-door education campaigns. These campaigns have reached a large number of people and there impact has been significant.
Enhancing HIV/AIDS workplace programme
The extent of the impact of AIDS on local government employees is already significant. It is therefore suggested that a starting point for local government would be to define its response to HIV/AIDS in the municipal workforce within the context of transformation, including quantifying the impact this would make on local government's ability to continue to provide services. The extent to which the workplace programme is meeting the needs of the municipal staff would need to be reviewed to allow improvement. Alongside this review a sharing of best practices across municipalities and provincial government would also be valuable.
Research, monitoring and evaluation
Ongoing research work by all stakeholders including institutions of higher learning in partnership with local government would be required if government is to succeed in improving our understanding of the issues involved and how it responds. A conscious effort would have to be made to identify priority areas for local government research on HIV/AIDS. In addition, monitoring and evaluation systems would have to play a crucial role in assessing progress and impact of programmes including the development of benchmarks and indicators for success.
Indigent burial
We are already experiencing very high numbers of death due to AIDS and mortality rates are directly correlated with levels of poverty, necessitating an approach to the cost of burial which ensures that the poor are afforded the dignity that is the constitutional right of all South Africans. Thus, indigent burial policy or at least guidelines would have to be discussed by local government to ensure that there is some policy clarity on this matter.
Assessing and countering AIDS' impact on municipal services
Municipalities' understanding of their role in addressing the social and economic consequences of HIV/AIDS in communities and at the workplace is important. For instance, housing and other basic services have more than one role to play when it comes to intervention purposes. If provided properly they can provide a cushion to affected households and infected individuals. Most importantly, local government needs to recognise the efforts made by other external stakeholders. Their participation and contribution in the fight against HIV/AIDS is crucial and needed. Community initiatives must not be seen as an alternative to local government in terms of aid and service delivery rather, they should be seen as a complement.
Expanding Joint Children's Services, community and Home-Based Care
Programmes which aim to foster care and support in the home or at the level of the community can be important levers in building a multi sectoral approach. Various sector departments need to work with municipalities in up scaling these programmes, which include the Joint Children's Services Programme and Home Based Care programmes. Given the provincial government's commitment to the programme of Bana Pele and the significant impact of HIV/AIDS on children, including through the emergence of large numbers of child headed households; a co-ordinated and inter-sectoral approach is required. Home-based care should be viewed as one of the several options available to local and provincial authorities in response to HIV/AIDS. Without their involvement excess burden will fall upon the shoulders of families already overburdened by poverty, unemployment, ill health etc. For home-based care to be effective it needs constant support and input from the public health, welfare and education system.
Integrated Development Planning (IDP) processes
The IDP offers a platform for engagement across all government spheres and other stakeholders in the future development of the specific area. It is also an ideal platform on which community members can voice their concerns, either affecting them directly or indirectly. Programmes aimed at HIV/AIDS intervention should form part of IDPs, where institutional arrangements and development are specified through the engagement between development role-players and stakeholders.
Although these interventions strategies should be informed by broad national or provincial strategies, the definition of support intervention will need to occur on a case by case basis, to align with the particular area context. However, for this to succeed local government would have to develop its own capacity, and that of community leaders, for proper situational analysis of HIV and AIDS, in order to create a basis for proper planning and intervening strategies. The role of community development workers (CDWs).
The Gauteng Provincial Government (GPG) has put mechanisms in place to ensure that the community has better access to the services provided by municipalities, namely the deployment of CDWs.
The primary role of CDWs is to bridge the gap between the services delivered by government and the people's access to these services. CDWs are linked to the ward committees in the areas where they are deployed to help increase and encourage public participation and participatory democracy. They help ward committees to ensure that there is an increase in people taking part in the issues that have an effect on them. Government would have to define the role of CDWs in relation to AIDS. In addition, support to CDWs would be required if they are expected to play some role with regard to this problem.
Conclusion
On this basis, key challenges facing local government and how local government can possibly respond to these challenges were highlighted. We hope that the final outcome of this summit would assist in setting the local government agenda on HIV/AIDS for the next five years.
Experience of the last five years has shown that initiatives and intervention programmes are not without challenges. The problem of capacity, largely attributable to the old apartheid system of unequal distribution of resources has become a major stumbling block among most local government structures. The processes of transformation, restructuring and amalgamation have been necessary to strike balance and create the necessary capacity within the local government structures.
The report has also indicated that financial and technical constraints are commonplace in many local government structures and many are still unable to secure donor funding to respond to the problem of HIV/AIDS.
In terms of policy and strategy, despite various challenges such as lack of capacity and a clear strategic plan the province views the HIV/AIDS problem in a serious light. This is demonstrated by the integration of HIV/AIDS programmes in its strategic priorities for 2005 to 2009.
The role of communities especially participation in various government initiatives is equally important. It is highlighted in the report that communities have the responsibility to address prevention, care and social support I their personal lives, families, local communities and workplaces. To this end, community responses are crucial in fighting HIV/AIDS.
Let me thank the official from the Department who have worked tirelessly in preparing for this summit.
I thank you!
Issued by: Department of Local Government, Gauteng Provincial Government
29 June 2006
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