Date: 03/08/2003
Source: Ministry of Health
Title: Tshabalala-Msimang: South African AIDS Conference


INPUT BY THE MINISTER OF HEALTH, DR MANTO TSHABALALA-MSIMANG, AT THE SOUTH AFRICAN AIDS CONFERENCE, Durban, 3 August 2003

Programme Director, Distinguished and Invited Guests, Ladies and Gentlemen, it is a privilege and an honour for me to introduce to you His Excellency, the Deputy President of South Africa, Mr Jacob Zuma.

Director of ceremonies, His Excellency, The Deputy President of South Africa, Mr Jacob Zuma, The Deputy Minister of Health, MECs, Conference Chair, Members of SANAC and the Provincial AIDS Councils.

The Deputy President is the leader of government, and in particular, he is the champion of all our activities in government relating to HIV and AIDS.

As we come to this conference today, government is accused of doing nothing about the spread of HIV/AIDS in our country. Let me tell you that nothing could be farther from the truth than this statement.

Our achievements in our multisectoral response to AIDS speak for themselves.

* We are implementing the 5-year strategic plan for AIDS which emphasises prevention; treatment, care and support; fighting against stigma and discrimination; and investing in research and disease surveillance;

* We have reduced the prevalence of syphilis from 9% to 3% from 1999 to 2001

* To date we have introduced approximately 1,600 counselling and voluntary testing sites throughout the country. Government continues to expand these services to include other sectors

* In 2001, out of its own concern and initiative, government introduced the programme for the prevention-of-mother-to-child-transmission of HIV;

* A recent survey showed that there are approximately 450 home-based care programmes across the country

* We purchase and distribute condoms free of charge. In 2003, we are spending R123m on this programme, which sees to the distribution of approximately 22 million male condoms and 100,000 female condoms every month

* Recently, our health system has been accused of being in Intensive Care Unit

* Our health care system is certainly better that the one we inherited from the apartheid regime

* There are more people enjoying universal access to basic health care services now, especially women and children

* We have built 701 new clinics, and expanded 249 existing clinics;

* Yes it is true that those who had a first world health care system while the majority of South African had nothing, are feeling the squeeze

* Through our national drug policy we have expanded access to quality and affordable medicines even to the private sector

* Government has set aside approximately R2.7 billion in the next 3 years for the Hospital Rehabilitation and Revitalisation programmes;

* The establishment of the National Health Laboratory System in 2002 was an important step in consolidating laboratory services;

* The NHLS recently developed a new CD4 testing method that would cost approximately 10% of the current costs of CD4 tests;

* Where drug stock-outs was a reality only 3 years ago, pharmaceutical managers in the provinces now report less than 5% drug unavailability over a one-year period

* The opening up of our borders in 1994 meant new opportunities for South Africans, and the health sector has certainly felt the effect of this brain drain

* In an effort to counteract some of these trends, the government dramatically increased the remuneration packages for health workers

* The community service for a growing number of health worker categories, but starting with doctors, aims to bring to the public sector some of the benefits of the state subsidised health professional training in our academic institutions

Yes, partly because of HIV and AIDS, there is pressure in the system and our health workers are experiencing increased workloads, and we are attending to that.

Earlier this year during my budget speech, I announced that Government has set aside R500 million to attract and retain health workers in rural areas of South Africa.

We are finalising the negotiations on how this money will be distributed, but as much as we appreciate our medical doctors in the public service, the money cannot be spent on one category of workers.

We've got to think of the lone professional nurse that is running a clinic at Kwadukuza and has no one to relieve her when sick or during weekends.

Some say that providing ARVs is as simple as administering an aspirin. We say, no, this is not true. Whilst ARVs have an important role in the management of AIDS disease, their administration needs one to take into account a whole variety of factors.

For example, to provide a comprehensive PMTCT programme requires the following interventions:
* Integrating PMTCT into antenatal care services;
* Providing counselling and voluntary testing;
* Setting up an infrastructure for HIV testing and quality control;
* Counselling on safe infant feeding practices;
* Providing formula feed and managing its logistics;
* Providing multivitamins
* Treatment of all opportunistic infections;
* Providing the Nevirapine tablet; and
* Post-delivery follow-up on the baby-mother pair
* Training of health care workers on PMTCT and infant feeding.

Another illustration, Programme Director, concerns the provision antiretrovirals for post-exposure prophylaxis for survivors of sexual assault.

This programme includes the following services:
* Psychological counselling;
* STI prophylaxis;
* HIV testing;
* Emergency contraception;
* Medico-legal assessment of injuries
* Data management and registry;
* ARVs containing triple therapy; and
* Follow up for those who chose to use ARVs
* Forensic training.

Therefore, I submit, Mr Programme Director, that the provision of antiretrovirals in the public health sector is a subject that must be considered soberly, and government is doing so.

For example, government is carefully considering a report that was submitted by the Joint Task Team of the National Treasury and the Department of Health on expanding treatment for people infected with HIV, including the healthcare infrastructure requirements and cost implications.

But certainly, if the truth be told, the provision of antiretroviral drugs is not comparable to administering aspirin for a headache.

This is why we consider the accusation that the South African government is guilty of genocide very seriously.

This is an irresponsible statement and one that is also politically dangerous. We have a vast number of people in our country who are infected and affected by HIV and AIDS. We must engage each other to find solutions to this problem but not to play political games on such a sensitive and emotional subject.

Programme Director, I would like to express my appreciation for the many partners who are working with us in bilaterals with the Department of Health and through the South African National AIDS Council.

Since the inception of the Partnership Against AIDS Programme in October 1999, we have established partnerships with the following sectors:
* faith-based organisations
* youth
* women
* business
* labour unions
* the mining sector
* the disabled
* traditional healers and leaders
* sports fraternity
* the hospitality and also
* people living with HIV/AIDS

I would also like to appreciate the work we are doing with our international collaborating partners such as the UN system, and to recognise the contributions of some of the major donors. For example, during the year 2003, we received the following donations:

Donor: USAID
Amount 25 million US Dollars
Period: 2003

Donor: CDC
Amount: 3 Million US Dollars
Period: 2003

Donor: KFW
Amount: 9 million Euros
Period: 2003 - 2004

Donor: DFID
Amount: 30 million Pounds
Period: 2003 - 2008

Donor: Denmark
Amount: 100 m Danish Kronen
Period: 2002 - 2004

Donor: Belgium
Amount: 6.2 million Euros
Period: 2002 - 2007

Donor: Ireland
Amount: 4 million Euros
Period: 2001 - 2003

Donor: Japan
Amount: 1 million Rand
Period: 2003

Donor: EU
Amount: 26 million Rand
Period: 2002 - 2003

There is also the subject of political commitment of the government of South Africa, which I would like to address.

I will not do so because I think the Deputy President would be the most appropriate person to deal with the subject.

But I would like to inform you about the HIV and AIDS budget just for Department of Health. In the National Department alone, we budgeted R212m in 2001, R459m in 2002 and R666m in 2003. The total budget for government is R3.3bn in this MTEF.

In the final analysis, Programme Director,

* We will know we have succeeded when we have provided all South Africans with the information and tools to prevent them from contracting the HIV virus;
* We will know we have succeeded when we have been able to prolong the period from HIV to AIDS by supporting those who are infected with nutrition, nutritional supplements and natural medicines;
* We will know we have succeeded when we have mobilised all our resources and every sector in society to provide treatment, care and support to those who are infected and affected by HIV and AIDS;
* We will know we have succeeded when we can prevent the transmission of HIV from mother to child during childbirth;
* We will know we have succeeded when we society can treat people who are infected and affected by HIV and AIDS with compassion and to remove the stigma and discrimination associated with this disease
* We will know we have succeeded when we can unite as South Africans to discuss strategies to prevent and treat this diseases without influence from external agendas

Government is willing to work with all the stakeholders to work our pragmatic solutions to all the challenges confronting South Africa with regards to HIV and AIDS.

Kodwa asizukusebenzisana noo-funzelwe abazimisele ukulahlekisa abantu bonke boMzantsi.

Masisebenzisane sonke ukuze sixazulule iingxaki zokunakekelwa nokwelatshwa kwabo bonke abantu abahlaselwe yingculazi.

Masisebenzisane sonke ukuze siqeqeshe bonke oDokotela nabaHlengikazi noMphakathi uphela ukuze sonke sifunde ukuthi lesisifo kufanelwe selatshwe kanjani.

Masisebenzisane sonke ukuze silwisane nobumpofu, nendlala, futhi sondle bonke abantu abagulayo ukuze siqinise imizimba yabo khonukuze imizimba yabo ikwazi ukulwa nezifo ezifana nengculazi nesifo sofubo.

But in this partnership, we must respect our bona fides and treat each other respect.

Ladies and Gentlemen - let me now present to you His Excellency, the Deputy President of South Africa, Mr Jacob Zuma.

Issued by Ministry of Health
3 August 2003