Memorandum to Minister of Health and all provincial MECs for health
Save Lives - Publish the Implementation Plan Timetable Now!
4 November 2004
In the next few days TAC members in Katlehong will bury Zandile Mazwani, a young woman of 33 from Gauteng. Zandile set an example to others by living openly with HIV. She died of an AIDS-related illness because she could not access antiretroviral (ARV) treatment timeously. She could not do so even though she was living in Gauteng, which, with the Western Cape, has one of the most wide-reaching ARV treatment programmes in the country.
Zandile is one of thousands who will be buried this weekend because of AIDS. We are marching today because many, many other lives continue to be lost unnecessarily to AIDS. Most of these people are young all of them had hopes, ambitions, friends and families. They died because they were too poor and could not afford to buy life-saving medicines, nor could they speedily access them through our public health system.
Why are we going to court?
TAC regrets that yet again we are involved in a fight with the Minister of Health and her national department. Yet again, we face the Minister in a courtroom, litigating for our lives. It is all tragically unnecessary.
Almost a year ago we welcomed the adoption and publication of the Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa (Operational Plan). Today all we ask is that government makes sure that its own policy works to save lives. Government must publish the timetable with targets for implementing the Operational Plan.
This is not a favour that we are asking from the Minister. Our Constitution says that everyone "has the right of access to any information held by the state". This constitutionally recognised right places a duty on government to promote and not deny access to life-saving information. It is our right to have information about how the Operational Plan will be implemented, particularly because it is necessary to save lives. In a democratic society such as ours, access to information is not simply a desirable goal but a right.
In November 2003 when the Operational Plan was adopted and published, it referred to an implementation timetable called Annexure A. The Operational Plan states that Annexure A is "a detailed schedule for the next six months that describes the tasks that need to be accomplished in parallel in order for this plan to work". It also states that "if one or two steps are not completed on time, the whole programme may be jeopardized". Further, it says that there is a "task list associated with every chapter of this plan". But to date, the detailed schedule of tasks (implementation plan) has not been made public.
Because the Operational Plan referred to the implementation plan timetable as Annexure A, we asked the Minister on 20 February 2004 to release Annexure A. Since then we have made several formal and informal requests for the Minister to make the implementation plan timetable publicly available. But it was only some seven months later in September 2004 when her department informed us in an affidavit signed by the acting Director-General (DG) of Health that Annexure A was a draft that had not been adopted by Cabinet, MinMEC or the task team that drew up the Operational Plan. The acting DG has said on oath that all references to Annexure A in the Operational Plan were made in error.
In our replying affidavit we responded by saying that we accept in good faith that the acting DG is telling the truth. We also said that had the Minister displayed a modicum of conscientiousness, she would have told us the true status of Annexure A much earlier. Because she did not tell us and because her department did not respond to our request for access to information, we were forced to bring legal proceedings. Now that we have been advised of the status of Annexure A, we will not persist in asking for its publication. This is because our case has always been about access to the approved implementation plan timetable.
We have wasted our time and money is bringing this case to court. Because of the delinquent and reprehensible behaviour of the Minister, we are asking the High Court to hold her to account by making her pay our wasted legal costs. But the real cost of the delays caused by the Minister and her department must be measured in human lives. The cost to real lives has been enormous.
The goodwill that we have shown to the Minister and her department by accepting the acting DGs word does not, however, mean that we have given up our fight to get access to the implementation plan timetable. We continue to call on the Minister to make it available immediately. If such a timetable does not exist, we repeat our call for the Minister to explain why this is so and call on her speedily to develop such a timetable and make it publicly available. Cabinet should also ask the Minister why she has not made the implementation plan timetable publicly available as late as one year after it adopted the Operational Plan.
Progress in implementing the Operational Plan
The TAC welcomes the progress that has been made in implementing the Operational Plan. Currently, close to 15 000 people are accessing ARV treatment at public health facilities across the country. For them there is hope. We also welcome that there are now over 1500 public health facilities that are implementing mother-to-child HIV transmission prevention programmes. Again there is hope.
We are not interested in fighting government. We commend the efforts of many political leaders, health department managers and health care workers in provinces such as the Western Cape and Gauteng who are showing that ARV treatment can be implemented successfully and with some speed in the public health system. We also commend the Free State for publishing detailed information about its ARV treatment programme on a regular basis. In publicly releasing their implementation plans, these three provincial governments have shown that sharing information does not hinder their work.
We recognise the challenge of implementing the Operational Plan, particularly given the shortage of public health care workers. Nevertheless, Gauteng and the Western Cape have shown that with appropriate political leadership, progress can still be made despite. But this progress is in stark contrast to the very slow pace of implementation in Limpopo, Mpumalanga and the Eastern Cape.
Access to health care services should not depend on where you live. All people in our country have the same right of access to ARV treatment. The Operational Plan recognises that "implementation must be equitable." It states that "[e]quity can be achieved by placing greater resources, both human and financial, at the disposal of historically underserved districts." The plan also says that the key determinant of ensuring that funds are spent against designated tasks and activities "will be adherence to the operational plans developed by each province, and demonstrated implementation progress against a set of key performance indicators." Indeed, the Cabinet itself ordered the department to develop "provincial implementation plans, a schedule for rollout across district hospitals and health centres and a forecast of staffing requirements" and referred to provincial operational plans that should be based on "the district health systems within each province."
However, despite numerous requests by the TAC, several provinces have refused to make their implementation plans publicly available. At this stage, we do not even know for sure if they have provincial implementation plans at all.
For us, a key part of the implementation plan timetable must involve a plan to make sure that all provinces share in the benefits of the Operational Plan. Without an implementation plan timetable plan, this will not happen. This is why we are also demonstrating today in Polokwane, Bisho, Cape Town, Nelspruit and Pietermaritzburg. We have said before that all provinces, especially resource-poor provinces, need help and leadership from the Minister and her department so that the Operational Plan will succeed in saving lives.
Publish an Implementation Plan Timetable Now!
The Minister has ridiculed the TAC and has accused us of having a hidden agenda. We have only one agenda to save lives. In our fight for the right to know and the right to live, we will use the constitutional rights guaranteed by our democracy. Where necessary, we will go to court.
When it comes to the Minister and her department, we want a partnership of action and equality, not a partnership to hide inaction and failure. Today we ask the Minister to make future legal action on this matter unnecessary by doing the following immediately:
Publish the implementation plan timetable, or if it does not exist, explain why and develop one immediately;
Ensure that all provinces release their implementation plans which must include business and human resources plans; and
Make public on a monthly basis information on the implementation of the Operational Plan, including publication of a list of public health facilities that are providing ARV treatment.
We also call on her department to:
Bring the tender process to an end and award the contracts for the supply of ARV medicines;
Develop a human resources plan for the public health sector that:
Addresses the need to treat health care workers with HIV/AIDS;
Increases the numbers of nurses, doctors, pharmacists, dentists, social workers, nutritionists, cleaners, managers and administrative staff in the public sector; and
Improves conditions of service for all health care workers;
Ensure that hospitals and clinics that have the capacity to implement ARV treatment can do so immediately, by supplying them with the necessary ARV medicines, and testing and monitoring equipment or services; and
Use television and radio to encourage everyone about the need to get counselled and tested for HIV, to practice safer sex and to get treated using ARV medicines wherever necessary.
We want to work together. Publish the operational plan timetable now and act to save lives. Our right to know is our right to live.