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Date
: 02/03/2004
Source: Ministry of Health
Title: M Tshabalala-Msimang: Progress in implementation of
comprehensive HIV and AIDS plan
STATEMENT BY MINISTER OF HEALTH, DR MANTO TSHABALALA-MSIMANG, ON
PROGRESS IN THE IMPLEMENTATION OF THE COMPREHENSIVE PLAN FOR
MANAGEMENT, CARE AND TREATMENT OF HIV AND AIDS
2 March 2004
When we started working on the implementation of the Comprehensive
Plan for Management, Care and Treatment of HIV and AIDS as approved
by Cabinet, we made an undertaking to report to South Africans on
all the milestones we are taking in implementing the Plan.
There have been a number of statements and briefing of various
stakeholders on the Plan. Today we would like to use this
opportunity to have broader discussion on the Plan to ensure a
better understanding of all its elements and what it seeks to
achieve.
You will notice that we do not talk about an anti-retroviral (ARV)
roll-out plan because this programme is not limited to that. It is
a Comprehensive Plan that emphasises the centrality of prevention
in response to HIV and AIDS. It emphasises the strengthening of the
national health system that is able to provide continuum of care
and sustain a series of interventions aimed at mitigating the
impact of the disease.
We have visited a total of 110 facilities in all districts to
assess their capacity and develop urgent action plans to close gaps
where they exist. There will be another round of visits towards the
end of this month to determine progress in strengthening the
capacity of these facilities.
Recruitment of the necessary extra personnel is underway both at
national level and in various provinces. For medical posts in
particular, we have decided to target doctors who did community
service last year and those currently in this programme to ensure
that they are retained within the public service. Training
guidelines have been developed and some provinces have started
training.
We have increased Voluntary Counselling and Testing sites to ensure
that people get tested. Those who test positive can be assessed
through CD4 count and viral load tests to determine the stage of
the progression from HIV to AIDS. Testing protocols have been
developed and are in line with treatment protocols. The National
Health Laboratory Service (NHLS) provides the bulk of the
laboratory services. Initially, 18 laboratories have been
identified to service the first 53 service points in all districts
of the country. This capacity should be increased in line with
demand and workload.
There are a number of interventions available for people with a CD4
count of above 200. These include counselling and psycho-social
support, encouraging healthy lifestyles and provision of
nutritional support. Tender for procurement of supplement meals for
those who is food insecure is in place and an extra R4 million has
been allocated to increase volumes. Micronutrient supplementation
is also going to be provided. These services are important as they
cover the vast majority of people living with HIV. As you know the
majority of people living with HIV have not progressed to a CD4
count of 200 and below where antiretroviral therapy may be
needed.
The plan also encourages the use of traditional medicines as one of
the options available to patients. We have invested more that R6
million to the Medical Research Council (MRC) to assist in the
research and development to ensure quality and safety of these
medicines. The MRC will also be a key partner in the development of
a research programme for the Plan as a whole.
Those people with a CD4 count of 200 and below or have symptoms
will have an option of antiretroviral therapy. Yesterday we adopted
ARV treatment guidelines, which have been developed through a wide
consultation with both local and international experts on this
field. They cover the use of ARVs in a wide range of circumstances
including treatment for infants, for pregnant women, tuberculosis
(TB) co-infection and for adults who have previously been exposed
to ARVs.
To make these drugs available, we have over the past two weeks
called on suppliers to express interest in supplying the drugs. The
suppliers are also invited to a briefing session that is scheduled
for 9 March where detailed documentation on the Request for
Proposals will be made available. Proposals submitted will be
shortlisted and qualifying suppliers will provide quotations that
should form the basis for negotiating best possible contract. We
hope that the qualifying suppliers will support this biggest HIV
and AIDS programme in the world by offering the most competitive
prices.
The guidelines ensure a robust, efficient and reliable drug
distribution system has been developed. This includes the inventory
management, patient prescription information and financial
management. The standard operating procedures for labelling and
dispensing are being finalised. Specifications for a tracker system
that will electronically track the movement of stock are being
drawn. These are measures we have to put in place to prevent theft
of these drugs with a very high market value.
An integrated patient information system with electronic patient
records and paper-based backup system has been developed and will
use a unique patient identifier. We are in the process of
purchasing computer and information technology (IT) equipment and
training staff on the patient information system, which should be
up and running in April. This should enable us to track patients
throughout the health system and ensure that appropriate services
and correct treatment is provided.
To ensure safe and effective use of ARV and other AIDS-related
treatment, we are setting up a pharma-covigilance programme with
support units in Medunsa and Free State University. These units
will also assess the burden of drug-related morbidity and mortality
in patients with HIV and AIDS in order to develop measures to
minimise their impact.
Critical to the success of this programme is a strong communication
and social mobilisation campaign that educate and inform the
general public and potential service users. From this month,
Khomanani service providers will begin to deliver information
leaflet and posters on additional services being added to various
interventions that have been underway over the past years. We are
going to advertise in the print media and about R5 million has been
set aside for vibrant radio and television advertising campaign to
support the programme.
This is a major initiative ever taken against HIV and AIDS. We are
implementing it amid a major transformation and strengthening of
the health system as a developing country. We are convinced that we
presented a good Plan to Cabinet and with the support of various
stakeholders, including the media, we are determined to ensure that
it is successfully implemented.
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