Address by Minister of Health Mantu Tshabalala-Msimang at the Global World HIV and AIDS Alliance conference, University of Zululand

Programme Director
MEC of Health
Mayor of Zululand Municipality
Rector and Vice chancellor of University of Zululand
Honoured guests
Ladies and gentlemen

Disparities across countries and among nationalities still exist and South Africa is no exception. As a relatively new democracy the government is committed to reducing these gaps and disparities which have a negative impact in our society and provide a favourable environment for poverty related diseases like HIV and AIDS and tuberculosis (TB) and malaria as well as non-communicable diseases and cases of trauma and violence.

In responding to these challenges, we are committed to forming effective partnerships amongst sectors, leaders and countries with a primary aim of finding country specific solutions where local community attitudes, cultural practices and knowledge are observed and respected. This approach is critical and has to guide countries to craft appropriate multi-sectoral response to HIV and AIDS.

The need to develop a broad spectrum of cross-cultural partnerships is supported by the fact that the area between culture and HIV is under researched. Countries need the involvement of universities to ensure that our policies and programmes are based on credible research findings. Academics are better placed to provide such support and their research should extend socio-economic and cultural aspects of this challenge.

Universities have the capacity and infrastructure to research and build capacity within and across their borders to ensure that we deal with challenges of HIV and AIDS in a comprehensive and holistic manner while ensuring quality and sustainable intervention in our communities. With the current complexities in the spread and pathogenesis of HIV infection, no one can claim the monopoly in understanding prevention, support, care and management of HIV and its sequel. Universities therefore have to tailor their research capabilities to accommodate this.

The challenge of data management, for instance, remains a gap when monitoring implementation of programmes and their impact at various levels. The Global HIV and AIDS Alliance has a potential of sharing best practices with alliance members. As an alliance partner, we pride our selves with the progress and involvement of the University of KwaZulu-Natal particularly in the area of research in traditional medicine.

The challenge of improving health outcomes is felt by developed and developing countries. There is commitment among African countries to work towards achieving the Millenniums Development Goals (MDGs) and Global HIV and AIDS Alliance of Universities needs to find its niche in this regard. There is also a need to ensure that our development partners honour their commitment to increase development assistance to support developing countries to meet these goals. This assistance should be properly coordinated and provided in the true spirit of partnership and respect for sovereignty of nations.

In the area of HIV and AIDS, our effort as Government of South Africa and the Department of Health is aimed at intensifying prevention interventions and provide quality care, support and all forms of treatment to all qualifying HIV positive patients in an equitable manner. After about three years of stabilisation, the annual survey of prevalence of HIV amongst pregnant women attending public sector antenatal clinic has for the first time indicated that there is decrease in the prevalence of HIV in the country. The 2006 antenatal survey results show a decrease in the prevalence of HIV amongst pregnant women from 30,2% in 2005 to 29,1% in 2006.

The survey indicates that this decline is mainly amongst people under the age of 20 years followed by those between 20 and 24. The decline in the under 20s from 15,9 % in 2005 to 13,7% in 2006 in particular suggests a possible reduction in number of new infections (incidence) in the population. These findings require that we intensify our interventions and continue to work towards our ultimate goal of a society that is free of HIV infection. As part of these interventions, we have more than 4 000 sites that provide voluntary counselling and testing and about 90% of public health facilities provide services for Prevention of Mother-To-Child-Transmission of HIV. The guidelines for the PMTCT programme are currently being reviewed in consultation with stakeholders with the aim of improving the programme.

As you may know, we continue to provide free health services for pregnant and lactating women, children under five years and people with disabilities. Primary healthcare is free to everyone and no person is refused health care on the basis that he or she cannot pay. People are being encouraged to adopt healthy lifestyle including good nutrition to delay progress from HIV infection to development of AIDS defining illnesses. For the first time in history, the World Health Organisation (WHO) held a global meeting looking at the role of nutrition in the response to HIV and AIDS and acknowledged the role of South Africa in highlighting this element of the HIV and AIDS response by holding this meeting in Durban.

Understanding our peculiar conditions as Africans, we are highlighting the need for research and development of traditional medicine which, according to the WHO, is used by almost 80% of people on our continent. The WHO Afro regional director, Dr Louis Sambo, advised that and I quote: "Countries should embrace traditional health practitioners as partners in the health system. The proximity of these practitioners to the community makes them a reliable resource to support families and individuals."

This is exactly what we are doing in South Africa with the recent milestone being the passing of the Traditional Health Practitioners Act by our Parliament. This Act allows for the establishment of a statutory council for traditional health practitioners to regulate this practice. Programme Director, treatment of opportunistic infections is available in almost every public health facility. The cumulative total of patients who started anti-retroviral (ARV) treatment was estimated at 300, 000 at the end of June 2007. A total of 342 facilities have been accredited to implement this treatment including 10 Correctional and seven South African National Defence Force (SANDF) centres and more sites are being accredited to further expand access.

Lack of adequate health professionals still remains a key challenge in expanding the number of sites. However, the department is implementing various strategies to address the challenges of human resources for health by improving the overall working conditions for health workers. We have increased the budget for the Hospital Revitalisation Programme to R1,9 billion this year to finance 46 hospital revitalisation projects across the country. These projects are not limited to improvement of the infrastructure, but they also include the supply of necessary equipment and improvement of management capacity to ensure efficient running of our hospitals. We believe that this programme has a significant impact in improving working environment for health workers.

We are also reviewing remuneration packages for health workers. We have already signed an agreement with health unions that should lead to nurses receiving salary increases of between 20-88%. These salary adjustments are in addition to the 7,5% salary adjustment agreed upon at the end of the public service strike in June. Efforts are also underway to open nursing colleges at, amongst others, Dora Nginza Campus in the Eastern Cape, Bona Lesedi at Leratong Hospital and the Coronation Nursing College at the Chris Hani Baragwanath -Gauteng province. Three new campuses were established at Madadeni, Prince Mshiyeni and Port Shepstone for a four-year nursing diploma in KwaZulu-Natal province.

There is a need to continuously improve the health system to ensure that it is able to respond to the overall health care needs of our people. Part of this effort is to ensure that private healthcare is affordable and accessible. There is an urgent need to address inequities between the public and private sector. The private sector spends about R66 billion to service about seven million while the rest of our population depends on estimated R59 billion spent through the public sector.

We have already had an engagement with all role-players in the private health sector and the emerging view is that there is need for government to play its regulatory role to curb the escalating cost in this sector. As government, we are committed to play our stewardship role in responding to the health challenges facing our country including the challenge of HIV and AIDS. We are also committed to work with all partners because we believe that it is only through partnership amongst various sectors and partners that we curb the spread of HIV infection and reduce the impact of AIDS on our society.

Thank you

Issued by: Department of Health
2 October 2007