Date: 02/03/2006
Source: Department of Health
Title: Tshabalala-Msimang: Consultation on UN processes - Declaration of Commitment on HIV and AIDS
Speech by the Minister of Health, Dr Manto Tshabalala-Msimang, at the National Consultation on UN Processes - Declaration of Commitment on HIV and AIDS, Kopanong, Benoni
Greetings
It is a great pleasure for me to welcome you to this national consultative meeting which is part of a review of the progress we have made as a country in relation to the Declaration of Commitment on HIV and AIDS adopted by the United Nations General Assembly Special Session on HIV and AIDS (UNGASS) in 2001.
We would also like to use this opportunity to begin the process of drawing up a roadmap towards universal access to HIV and AIDS prevention, care and treatment.
The revised 2006 Guidelines for the UNGASS Indicators recommend that the Composite Index Questionnaire be completed by key informants from diverse groupings or organisational background. The South African environment is one where extensive consultation takes place in virtually all aspects of socio, cultural and political activity. In the context of existing structures such as the South African National AIDS Council, consultation regarding HIV and AIDS is taking place on an ongoing basis and is presented in this report.
Right upfront, I would like to apologise that the document we are discussing this morning has been made available to you at this meeting. We have had major challenges in getting inputs from various organisations in all the sectors of the response to HIV and AIDS that received the initial draft report. In fact as we meet here today, many of these organisations have not provided their inputs and we hope that this meeting will assist us in ascertaining the views of various role-players.
There are number of questions we have to answer as a collective here which will inform the perspective we take in the final report that will be submitted to the UN. These questions are listed in the Composite Index section of the report.
These questions relate to a number of issues which, in our view, are covered in the National Strategic Framework for HIV and AIDS and sexually transmitted infections (STIs) for 2000-2005 and the Comprehensive Plan for Management, Care and Treatment of HIV and AIDS adopted by Cabinet in 2003.
The first set of questions relates to whether we have set up national structures that facilitate and coordinate a multi-sectoral response to the challenge of HIV and AIDS. The second set seeks to establish whether we have policies or strategies in the area of prevention interventions including social mobilisation and communication, access to essential preventive commodities such as condoms and prevention of mother-to-child transmission of HIV.
There are also questions relating to issues of Human Rights. We have to indicate whether we have laws that protect our people including people living with HIV and AIDS from discrimination; and whether we have policies that ensures progressive realisation of the equal right of access to prevention and care for women, men and vulnerable groups.
In the area of care and support, we are asked whether we have policies to facilitate comprehensive care and support, ensure access to HIV and AIDS related medicines and cater for the needs of vulnerable children.
I think we will all agree that South Africa has policies and programmes on all the areas that the United Nations wants us to report on as it will be reflected in presentations that will be made later this morning.
Our view is that the debate on HIV and AIDS in this country is mainly about the degree of success or the pace of progress in the implementation of these policies. The UN does not require us to agree on our perception on the pace of progress for the purposes of this reporting. As a democratic country, we will continue to engage on the issues relating to the delivery of services as it is happening now during this period of local government elections. We are confident that the people of South Africa will continue to express their faith in the African National Congress as the only organisation capable of taking this country to a better future including better health.
The questions in the Composite Index capture the major elements of our comprehensive national response to HIV and AIDS, which should guide our individual action towards a common strategic direction as a country. Our objective and subjective views on the pace of delivery, informed by our ideological, historical and socio-economic background, should therefore not derail us from achieving what the United Nations requires of us from this meeting.
We have to pool together our efforts and complement each other in order to achieve universal access to prevention, care and treatment programmes. In terms of our Constitution, Universal Access means that we progressively make quality services available in an equitable manner to ensure that all South Africans who choose to utilise any of these services can have a reasonable access to them.
It is critical that when we conduct a review of this nature, we locate it within the appropriate historical context. The historical fact is that South Africa is a relatively new democracy. It is a country that is emerging from a history of social disruption and racial and gender discrimination, associated with inequitable distribution of resources. These inequities resulted in a bimodial society that reflects on the burden of disease with poverty related diseases such as HIV and AIDS, tuberculosis (TB) and malaria affecting the previously disadvantaged communities.
The first few cases of HIV and AIDS were identified in the 1980s. But it was not until leadership from the National Liberation Movement, led by the African National Congress in 1992 that there was a tangible effort to develop a programme to raise awareness in society.
Over the past 11 years, much has been achieved in addressing these historical challenges and meeting the basic needs of shelter, clean water and sanitation, food security, the provision of health and other social services. The economy continues to experience growth. However, the gap between the few central actors in that economy and the majority at the periphery is still too wide. The people in the periphery are the ones most at risk of infections and of succumbing more quickly to diseases than the well-nourished and affluent communities.
Much progress has been made in addressing particularly the challenge of HIV and AIDS since the emergence of democracy in our country. Prevention programmes have been scaled up to unprecedented levels. Through the implementation of the Comprehensive Plan, there are service points in every district for the provision of a range of interventions including prevention, nutrition, management of opportunistic infections and treatment with antiretroviral.
The investment in the health system through infrastructural upgrades, the improvement in commodity stock management, information management systems, the improved human resources management and capacity development, the strengthening of laboratory services and referral system is being increased significantly.
Most of these interventions are funded from the government fiscus. The HIV and AIDS budget allocation channelled through the Health Department increased from R264 million in 2001 to R1.5 billion in 2005. This led to the UN Secretary General Kofi Annan commending the country for substantial increase in budgetary allocation in his report to the UN General Assembly Special Session on AIDS in 2003.
Three years later, we are gathered here to consider our input to the second report on global progress in responding to HIV and AIDS since the adoption of the Declaration of Commitment on HIV and AIDS in 2001. As the world prepares to discuss this matter during the sitting of the UN General Assembly in May this year, South Africa has been honoured by an invitation from the World Health Organisation (WHO) and the Joint UN Programme on HIV/AIDS (UNAIDS) to serve in the Global Steering Committee.
This is the Committee tasked with identifying key obstacles to the scaling up of comprehensive and integrated prevention, treatment, care and support programme. The Minister of Health of South Africa chairs a working group on financing of HIV and AIDS programme in this Committee.
The expenditure particularly on prevention programmes is making a difference on the ground. Most of the surveys indicate a very high level of awareness about HIV and AIDS amongst our people ranging between 92-98%.
This is as result of the awareness campaigns which encourage particularly young people to abstain from sex and to be faithful to one partner. These messages are critical in improving our moral fibre and building strong families that are free of violence and abuse of women and children.
We also provide free, high quality condoms for prevention of sexually transmitted infections including HIV infection and re-infection as well as unwanted pregnancies. Male condom distribution has increased from 270 million in 2003 to 346 million in 2004; and female condom distribution doubled from 1,3 to 2,6 million, during the same period.
There is a need to sustain the positive sexual behaviour that is emerging amongst the youth into early adulthood and beyond. As part of our activities to mark 2006 as "the year of accelerated HIV and AIDS prevention", government will intensify its interventions targeted at particular risk groups including people between ages of 25-29 years. There is a need to also intensify interventions aimed at improving the socio-economic status of women, people living in informal settlements and other vulnerable groups.
We have doubled the number of health facilities providing voluntary counselling and testing (VCT) from 1 500 in 2002/03 to more than 3 700 in 2004/05. The number of people that have utilised these services also increased two-fold from 691 000 in 2002/03 to more than 1,3 million in 2004/05.
There are many services that we provide as Government to delay the progression from HIV infection to development of AIDS defining illnesses and to maintain optimal health for people living with HIV and AIDS. We firmly believe that delaying this progression is the critical area where we need to make maximum impact.
We have engaged in the Healthy Lifestyle awareness campaign encouraging people to exercise regularly and to eat nutritious food particularly vegetables and fruits and this is supported by initiatives to promote community vegetable gardens and food security. At least 374 000 people have also benefited from the provision of nutritional supplementation within the Comprehensive Plan.
We provide rigorous treatment of opportunistic infections and most of our facilities have the capacity to deal with these illnesses. We have developed a TB Crisis Management Plan which we will be formally unveiled during the World TB Day on 24 March.
We are mobilising extra resources to ensure tangible improvements in at least four districts and two provinces facing most challenges in terms of prevalence of TB and low cure rates.
We are also encouraging the use of African traditional medicines that are effective in alleviating symptoms associated with HIV and AIDS by boosting the immune system. We are working with the Medical Research Council and other scientific institutions and individual scientists in the research and development of these medicines.
More than R3,4 billion has been allocated for procurement of antiretroviral drugs for the period to the end of 2007. An accumulative number of people initiated on antiretroviral therapy in the 204 accredited sites in the country were more than 100 000 by December 2005. Accredited health facilities are evaluated on the basis of their capacity to render quality service and detect complications arising from side effects associated with antiretroviral drugs.
The report we are discussing today clearly demonstrates the challenges we are still facing in terms of monitoring and evaluation of our programmes. There are challenges in establishing the impact of the Prevention of Mother-to-Child Transmission of HIV programme and data collection for the Comprehensive Plan is still limited to:
* Accumulative number of patients assessed;
Accumulative number of patients initiated on treatment;
* CD4 counts and viral loads done and; * The number of accredited health facilities We are making efforts to expand the monitoring and evaluation programme to include patients lost, deaths, adherence, adverse events, antiretroviral treatment (ART) regimens adopted and be able to categorise it by gender and age groups. Discussions are also ongoing with both non-profit and for-profit private sectors to ensure the harmonisation of indicators.
We have to address the issue of shortage and uneven distribution of certain health professionals in the country. We are finding innovative ways to address the issue of human resources for health including the development of mid-level health worker category which includes medical, pharmacist and nursing assistants. All these interventions are within the framework of the Human Resources Plan for Health which will be launched on the World Health Day, 7 April.
We have met and even surpassed all the Declaration of Commitment on HIV and AIDS requirements on policy formulation and in terms of the management of HIV and AIDS programme. We have developed and are implementing policies on prevention, protection and promotion of human rights as well as interventions in the area of care and support.
The Constitution, various labour laws and the National Health Act promotes human rights and outlaws various forms of discrimination. Support and care for those affected by HIV and AIDS is expanding, through increased social grant registration and increases in the grants, as well as expanding home and community-based care programmes.
More than 61 000 community care-givers are providing support and service to those in need and more than 7 million vulnerable children are receiving child support grants, have free access to health services and education.
There is hope that our determination to address this challenge is beginning to render results. Overall HIV prevalence is no longer increasing as significantly as it was in the early 1990s. Particularly encouraging is that the prevention messages regarding abstinence, faithfulness and condom use are being taken to heart, especially by the young.
There is a need for all South Africans to increase their level of involvement and for all sectors to complement each other in addressing the challenge before us. It is only through active and meaningful partnerships that we can address the challenges posed by HIV and AIDS. All citizens should heed the call for a responsible sexual behaviour and adopt healthy lifestyle.
We are looking forward to a meaningful engagement today and we hope that we can find consensus on the issues being presented to us today.
Thank you.
Enquiries:
Solly Mabotha
Tel: (012) 312 0609
Cell: 083 678 9860
Issued by: Department of Health
2 March 2006
Source: Department of Health
Title: Tshabalala-Msimang: Consultation on UN processes - Declaration of Commitment on HIV and AIDS
Speech by the Minister of Health, Dr Manto Tshabalala-Msimang, at the National Consultation on UN Processes - Declaration of Commitment on HIV and AIDS, Kopanong, Benoni
Greetings
It is a great pleasure for me to welcome you to this national consultative meeting which is part of a review of the progress we have made as a country in relation to the Declaration of Commitment on HIV and AIDS adopted by the United Nations General Assembly Special Session on HIV and AIDS (UNGASS) in 2001.
We would also like to use this opportunity to begin the process of drawing up a roadmap towards universal access to HIV and AIDS prevention, care and treatment.
The revised 2006 Guidelines for the UNGASS Indicators recommend that the Composite Index Questionnaire be completed by key informants from diverse groupings or organisational background. The South African environment is one where extensive consultation takes place in virtually all aspects of socio, cultural and political activity. In the context of existing structures such as the South African National AIDS Council, consultation regarding HIV and AIDS is taking place on an ongoing basis and is presented in this report.
Right upfront, I would like to apologise that the document we are discussing this morning has been made available to you at this meeting. We have had major challenges in getting inputs from various organisations in all the sectors of the response to HIV and AIDS that received the initial draft report. In fact as we meet here today, many of these organisations have not provided their inputs and we hope that this meeting will assist us in ascertaining the views of various role-players.
There are number of questions we have to answer as a collective here which will inform the perspective we take in the final report that will be submitted to the UN. These questions are listed in the Composite Index section of the report.
These questions relate to a number of issues which, in our view, are covered in the National Strategic Framework for HIV and AIDS and sexually transmitted infections (STIs) for 2000-2005 and the Comprehensive Plan for Management, Care and Treatment of HIV and AIDS adopted by Cabinet in 2003.
The first set of questions relates to whether we have set up national structures that facilitate and coordinate a multi-sectoral response to the challenge of HIV and AIDS. The second set seeks to establish whether we have policies or strategies in the area of prevention interventions including social mobilisation and communication, access to essential preventive commodities such as condoms and prevention of mother-to-child transmission of HIV.
There are also questions relating to issues of Human Rights. We have to indicate whether we have laws that protect our people including people living with HIV and AIDS from discrimination; and whether we have policies that ensures progressive realisation of the equal right of access to prevention and care for women, men and vulnerable groups.
In the area of care and support, we are asked whether we have policies to facilitate comprehensive care and support, ensure access to HIV and AIDS related medicines and cater for the needs of vulnerable children.
I think we will all agree that South Africa has policies and programmes on all the areas that the United Nations wants us to report on as it will be reflected in presentations that will be made later this morning.
Our view is that the debate on HIV and AIDS in this country is mainly about the degree of success or the pace of progress in the implementation of these policies. The UN does not require us to agree on our perception on the pace of progress for the purposes of this reporting. As a democratic country, we will continue to engage on the issues relating to the delivery of services as it is happening now during this period of local government elections. We are confident that the people of South Africa will continue to express their faith in the African National Congress as the only organisation capable of taking this country to a better future including better health.
The questions in the Composite Index capture the major elements of our comprehensive national response to HIV and AIDS, which should guide our individual action towards a common strategic direction as a country. Our objective and subjective views on the pace of delivery, informed by our ideological, historical and socio-economic background, should therefore not derail us from achieving what the United Nations requires of us from this meeting.
We have to pool together our efforts and complement each other in order to achieve universal access to prevention, care and treatment programmes. In terms of our Constitution, Universal Access means that we progressively make quality services available in an equitable manner to ensure that all South Africans who choose to utilise any of these services can have a reasonable access to them.
It is critical that when we conduct a review of this nature, we locate it within the appropriate historical context. The historical fact is that South Africa is a relatively new democracy. It is a country that is emerging from a history of social disruption and racial and gender discrimination, associated with inequitable distribution of resources. These inequities resulted in a bimodial society that reflects on the burden of disease with poverty related diseases such as HIV and AIDS, tuberculosis (TB) and malaria affecting the previously disadvantaged communities.
The first few cases of HIV and AIDS were identified in the 1980s. But it was not until leadership from the National Liberation Movement, led by the African National Congress in 1992 that there was a tangible effort to develop a programme to raise awareness in society.
Over the past 11 years, much has been achieved in addressing these historical challenges and meeting the basic needs of shelter, clean water and sanitation, food security, the provision of health and other social services. The economy continues to experience growth. However, the gap between the few central actors in that economy and the majority at the periphery is still too wide. The people in the periphery are the ones most at risk of infections and of succumbing more quickly to diseases than the well-nourished and affluent communities.
Much progress has been made in addressing particularly the challenge of HIV and AIDS since the emergence of democracy in our country. Prevention programmes have been scaled up to unprecedented levels. Through the implementation of the Comprehensive Plan, there are service points in every district for the provision of a range of interventions including prevention, nutrition, management of opportunistic infections and treatment with antiretroviral.
The investment in the health system through infrastructural upgrades, the improvement in commodity stock management, information management systems, the improved human resources management and capacity development, the strengthening of laboratory services and referral system is being increased significantly.
Most of these interventions are funded from the government fiscus. The HIV and AIDS budget allocation channelled through the Health Department increased from R264 million in 2001 to R1.5 billion in 2005. This led to the UN Secretary General Kofi Annan commending the country for substantial increase in budgetary allocation in his report to the UN General Assembly Special Session on AIDS in 2003.
Three years later, we are gathered here to consider our input to the second report on global progress in responding to HIV and AIDS since the adoption of the Declaration of Commitment on HIV and AIDS in 2001. As the world prepares to discuss this matter during the sitting of the UN General Assembly in May this year, South Africa has been honoured by an invitation from the World Health Organisation (WHO) and the Joint UN Programme on HIV/AIDS (UNAIDS) to serve in the Global Steering Committee.
This is the Committee tasked with identifying key obstacles to the scaling up of comprehensive and integrated prevention, treatment, care and support programme. The Minister of Health of South Africa chairs a working group on financing of HIV and AIDS programme in this Committee.
The expenditure particularly on prevention programmes is making a difference on the ground. Most of the surveys indicate a very high level of awareness about HIV and AIDS amongst our people ranging between 92-98%.
This is as result of the awareness campaigns which encourage particularly young people to abstain from sex and to be faithful to one partner. These messages are critical in improving our moral fibre and building strong families that are free of violence and abuse of women and children.
We also provide free, high quality condoms for prevention of sexually transmitted infections including HIV infection and re-infection as well as unwanted pregnancies. Male condom distribution has increased from 270 million in 2003 to 346 million in 2004; and female condom distribution doubled from 1,3 to 2,6 million, during the same period.
There is a need to sustain the positive sexual behaviour that is emerging amongst the youth into early adulthood and beyond. As part of our activities to mark 2006 as "the year of accelerated HIV and AIDS prevention", government will intensify its interventions targeted at particular risk groups including people between ages of 25-29 years. There is a need to also intensify interventions aimed at improving the socio-economic status of women, people living in informal settlements and other vulnerable groups.
We have doubled the number of health facilities providing voluntary counselling and testing (VCT) from 1 500 in 2002/03 to more than 3 700 in 2004/05. The number of people that have utilised these services also increased two-fold from 691 000 in 2002/03 to more than 1,3 million in 2004/05.
There are many services that we provide as Government to delay the progression from HIV infection to development of AIDS defining illnesses and to maintain optimal health for people living with HIV and AIDS. We firmly believe that delaying this progression is the critical area where we need to make maximum impact.
We have engaged in the Healthy Lifestyle awareness campaign encouraging people to exercise regularly and to eat nutritious food particularly vegetables and fruits and this is supported by initiatives to promote community vegetable gardens and food security. At least 374 000 people have also benefited from the provision of nutritional supplementation within the Comprehensive Plan.
We provide rigorous treatment of opportunistic infections and most of our facilities have the capacity to deal with these illnesses. We have developed a TB Crisis Management Plan which we will be formally unveiled during the World TB Day on 24 March.
We are mobilising extra resources to ensure tangible improvements in at least four districts and two provinces facing most challenges in terms of prevalence of TB and low cure rates.
We are also encouraging the use of African traditional medicines that are effective in alleviating symptoms associated with HIV and AIDS by boosting the immune system. We are working with the Medical Research Council and other scientific institutions and individual scientists in the research and development of these medicines.
More than R3,4 billion has been allocated for procurement of antiretroviral drugs for the period to the end of 2007. An accumulative number of people initiated on antiretroviral therapy in the 204 accredited sites in the country were more than 100 000 by December 2005. Accredited health facilities are evaluated on the basis of their capacity to render quality service and detect complications arising from side effects associated with antiretroviral drugs.
The report we are discussing today clearly demonstrates the challenges we are still facing in terms of monitoring and evaluation of our programmes. There are challenges in establishing the impact of the Prevention of Mother-to-Child Transmission of HIV programme and data collection for the Comprehensive Plan is still limited to:
* Accumulative number of patients assessed;
Accumulative number of patients initiated on treatment;
* CD4 counts and viral loads done and; * The number of accredited health facilities We are making efforts to expand the monitoring and evaluation programme to include patients lost, deaths, adherence, adverse events, antiretroviral treatment (ART) regimens adopted and be able to categorise it by gender and age groups. Discussions are also ongoing with both non-profit and for-profit private sectors to ensure the harmonisation of indicators.
We have to address the issue of shortage and uneven distribution of certain health professionals in the country. We are finding innovative ways to address the issue of human resources for health including the development of mid-level health worker category which includes medical, pharmacist and nursing assistants. All these interventions are within the framework of the Human Resources Plan for Health which will be launched on the World Health Day, 7 April.
We have met and even surpassed all the Declaration of Commitment on HIV and AIDS requirements on policy formulation and in terms of the management of HIV and AIDS programme. We have developed and are implementing policies on prevention, protection and promotion of human rights as well as interventions in the area of care and support.
The Constitution, various labour laws and the National Health Act promotes human rights and outlaws various forms of discrimination. Support and care for those affected by HIV and AIDS is expanding, through increased social grant registration and increases in the grants, as well as expanding home and community-based care programmes.
More than 61 000 community care-givers are providing support and service to those in need and more than 7 million vulnerable children are receiving child support grants, have free access to health services and education.
There is hope that our determination to address this challenge is beginning to render results. Overall HIV prevalence is no longer increasing as significantly as it was in the early 1990s. Particularly encouraging is that the prevention messages regarding abstinence, faithfulness and condom use are being taken to heart, especially by the young.
There is a need for all South Africans to increase their level of involvement and for all sectors to complement each other in addressing the challenge before us. It is only through active and meaningful partnerships that we can address the challenges posed by HIV and AIDS. All citizens should heed the call for a responsible sexual behaviour and adopt healthy lifestyle.
We are looking forward to a meaningful engagement today and we hope that we can find consensus on the issues being presented to us today.
Thank you.
Enquiries:
Solly Mabotha
Tel: (012) 312 0609
Cell: 083 678 9860
Issued by: Department of Health
2 March 2006
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