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MECs for health must be held accountable for delivery of NSP targets
and state of Provincial health systems

On World AIDS Day, December 1st 2013 the Treatment Action Campaign
(TAC) will not be celebrating. We recognize that we have made very
significant progress in the fight against HIV. But medicines
stock-outs, corruption, mismanagement and an apparent lack of
political will to deal with these problems are undermining our
struggle against HIV.

The official World AIDS day event, hosted by the South African
National AIDS Council (SANAC), will take place in Piet Retief in
Mpumalanga. At this event hundreds of TAC members will conduct a
silent and respectful protest while government relaunches the HIV
Counselling and Testing Campaign (HCT) in the same area. While we
support the HIV Counselling and Testing (HCT) campaign, we feel
attention must be drawn to the serious problems in the health system
in Gert Sibande. It will not help people to know their status if they
cannot get access to ARV treatment, counseling or quality health care.
We cannot celebrate while clinics do not have stock of essential HIV
and TB medicines, while hospitals run out of food and important
equipment, and in a district where there is a death causing shortage
of health workers.

It is not surprising that this district has the highest HIV
prevalence in South Africa? But TAC wants to know what is going to be
done about it now.

We acknowledge the positive leadership that continues to be shown by
Health Minister, Dr Aaron Motsoaledi. Over two million people are
receiving antiretroviral treatment in South Africa and all indications
are that the rate of new infections is on the decline – although it
remains shockingly high at around 1,000 new infections per day.

However, we cannot turn a blind eye to the crumbling public health
systems in most of our provinces. The Minister and the national
government must do more to ensure that provinces deliver quality
healthcare services to our people. Failing Health MECs like MEC Sicelo
Gqobana from the Eastern Cape, MEC Hope Papo from Gauteng, and MEC
Candith Mashego from Mpumalanga must be held accountable for their
indifference and lack of commitment to the struggles faced by people
needing health care in their provinces. Their lack of political will
undermines the fight against HIV and threatens to undo many of the
gains we’ve have made since 2009.

While much of the focus will be on Mpumalanga, TAC will also be
holding public events leading up to and on World AIDS Day in the
Eastern Cape, Kwa-Zulu Natal, Limpopo, and the Western Cape. We will
be holding provincial MECs for health in all these provinces
accountable for the work they have done, or failed to do, in the
struggle against HIV.

The following issues are of particular concern across provinces:

1. Medicine stock-outs

Between September and October 2013, the Stop Stock-outs Project (SSP)
undertook a national telephone survey to quantify the extent of ARV,
TB and vaccine stock-outs. More than one in five facilities reported a
stock out or shortage of ARV and/or TB medicines in the last three
months. Six out of the nine South African provinces had more than 17%
of their facilities reporting shortages. Mpumalanga, Limpopo and the
Free State fared the worst with an unacceptable 25.9%, 40.8% and 53.8%
respectively. The full report can be found here
http://stockouts.org/uploads/3/3/1/1/3311088/stock_outs_a_national_crisis.
pdf.


Medicine stock outs and shortages lead to patients taking partial
doses of their treatment, interrupting it or defaulting treatment
altogether. Medical consequences and costs to the health system and
patients can be grave, including drug resistance, decreasing immunity,
increased risk of opportunistic infections and transmission of HIV and
TB, ultimately leading to more illness and death. In 20% of affected
facilities patients were sent home or referred elsewhere without
medicines, adding to travel costs for already deprived people.

2. Crumbling health systems

In many provinces the public health system is plagued by corruptionand mismanagement.
Doctors and nurses have to work under extremely
difficult conditions. Often, essential equipment is not available and
buildings are insufficient. Many health workers are paid months late.
Many posts remain vacant.

TAC and SECTION27 have recorded the unacceptable state of the Eastern
Cape health system in our recently published report ‘Death and Dying
in the Eastern Cape’ (online at http://www.ECHealthCrisis.org
). However, the Eastern Cape is not the only province that is
struggling and similarly shocking reports could be written about
Limpopo, Mpumalanga and Gauteng.

3. Civil society side-lined in NHI discussions

The introduction of National Health Insurance has the potential to be
a massive step forward for the provision of quality healthcare for all
in South Africa. However, we are deeply concerned with the many delays
in publishing further policy documents that would explain how NHI is
to be funded.

We are also deeply concerned with the lack of consultation with civil
society – in general, but more particularly in the areas where NHI
is being piloted. In areas like Gert Sibande, Tshwane, Umgungundlovo
and OR Tambo, where TAC has a significant presence, public
consultation about the NHI pilot projects has been minimal. Meaningful
community engagement will be essential to the success of NHI.

4. TB prevention and integration still not addressed

The purchase of Gene Xpert machines to speed up the diagnosis of TB
has been a significant step forward in our struggle to bring the TB
epidemic under control. Alone, however, it will not be enough. More
than two years after a policy document on the decentralization of
MDR-TB was published, provinces are struggling to implement this
policy. This means that many MDR-TB patients are not diagnosed, and
not optimally treated once diagnosed. The laxness from provinces in
implementing this policy is unacceptable.

Furthermore, very little progress has been made on the health
emergency that is TB in prisons. It is almost exactly one year since
the Constitutional Court stated categorically that the government has
a duty to take concrete measures to prevent TB in our prisons. But
while new TB guidelines for diagnosing and treating TB in prisons have
been published, these guidelines do not go nearly far enough. Our
prisons are overcrowded and therefor an ideal setting for the spread
of TB. We need aggressive measures to ensure that overcrowding in
prisons is reduced and that sufficient infection control measures are
implemented in all correctional facilities. We have seen no indication
that the Departments of Correctional Services, of Justice, or of
Public Works are willing to take on this serious problem.

For all these reasons TAC says that World AIDS day 2013 does not give
us reason to celebrate. It is a time to step up our commitment, not
pat our backs. SANAC must identify where we are failing and address
urgent measures to solve these problems. If we do not do this then the
success of South Africa’s precious National Strategic Plan on HIV,
STIs and TB will be threatened.

Below is a list of TAC World AIDS Day events and associated media
contacts from across the country.

· MPUMALANGA

TAC volunteers and our allies will walk in silence from Kampville
stadium to Pony Club in Piet Retief at 9h00 to protest against
stock-outs; demand civil society involvement and consultation on
implementation of NHI, functioning district AIDS councils and health
service delivery.

For more information, please contact Sthembiso Masina on 082 4893499,
Thobile Maseko on 078 6313972 or Patrick Mdletshe on 072 1826833

Comrades from TAC Gauteng will be travelling to Mpumalanga to join in
the silent protest.

· LIMPOPO

TAC Limpopo will be protesting against ongoing medicines stock-outs
and demanding health system strengthening at the provincial World Aids
Day event in Polokwane. The event starts at 11h in Seshego stadium.

For more information contact Solanga Milambo on 072865771

· KWA-ZULU NATAL

TAC Kwa-Zulu Natal , together with the Council of Churches and Natal
Museum, will be raising awareness around safe sexual practices and
condom use on Monday 2 December at the Natal Museum in
Pietermaritzburg. The event starts at 8h30. On Wednesday 4 December,
TAC will support the Midlands Hospital in Pietermaritzburg with a full
day programme promoting testing and screening for HIV and TB.

For more information on both events contact Mzamo Zondi on 082 268
2531.

· WESTERN CAPE

TAC, MSF and the Zip Zap Circus present the WAD youth concert on
Saturday 30 November. The event, called “the future is in your
hands”, will kick off at 11am at OR Tambo Hall in Mew May,
Khayelitsha.

For more information contact Mandla Majola on 076 609 8818

· EASTERN CAPE

TAC Eastern Cape will be protesting against medicines stock-outs and
demanding health systems strengthening at three events spread across
the province:

· Youth Dialogue at Ngqeleni - OR Tambo. For more info, contact
Noloyiso Ntamehlo on 083 487 1814

· HCT and Wellness campaign at Buffalo City – East London. For
more info, contact Thandeka Faleni on 0739604267

· HCT campaign at Makana Municipality. For more info, contact Andile
Konjwa on 0737479745