Newsletter
 

20 May 2004

Mobilise to Build a Better Public Health Service: Resolutions of TAC National Executive Committee Meeting - 14 to 15 May 2004

KEY DATES

  • People's Health Summit - 2 to 4 July, Regent Hotel, East London

  • International Day of Action Against the Bush Administration: Invest in Health-Care Not War, Stop Blocking Access to Generic Antiretrovirals - 21 June

The TAC National Executive Committee (NEC) conducted its second meeting of 2004 on 14-15 May in Cape Town. The main points of discussion concerned the:
  • Progress of the antiretroviral treatment rollout;

  • Plan to hold a People's Health Summit from 2 to 4 July which will launch a campaign for an equitable and unified health-care system. The summit will have the following objectives:

    • Assess the antiretroviral treatment rollout;

    • Identify how to build greater involvement of communities with the delivery of health services, with emphasis on the antiretroviral rollout;

    • Ensure that national, provincial and local governments comply with their constitutional obligations to ensure that all people in South Africa have access to health care services that respect their autonomy and dignity;

    • Highlight the health inequities between the public and private sectors, between rural and urban areas, and between provinces; and

    • Examine the Eastern Cape's derelict public health-care system; and

    • Continued undermining of access to generic medicines by the Bush Administration.

Progress of the Antiretroviral Rollout
KEY POINTS

  • The TAC welcomes the progress made by the Northern Cape, Mpumalanga and Free State on the rollout.

  • Limpopo Province is the least co-operative of all provincial governments and no discernable progress has been made in this province towards providing treatment.

  • Communication from government, especially the National Department of Health, is poor, rendering accurate information on numbers of patients on treatment and which facilities are providing treatment very difficult to determine.

  • Lack of national leadership on the rollout has also resulted in confusion over whether or not there are drug shortages. Allegations of drug shortages have been made by national government. These allegations could very well be true, but they cannot be confirmed by the TAC despite our efforts to resolve the matter.  But whether or not actual shortages exist, the impact of the confusion is that fewer patients are being put on treatment in response to anticipated stock shortages.

  • Voluntary counselling and testing needs to be offered on a routine basis, especially at facilities offering antiretroviral treatment.

  • The rollout in Gauteng is proceeding, but the TAC is receiving numerous complaints from patients that the distances to travel to the five facilities offering treatment are large and there is a lack of communication between departments within facilities resulting in patients with AIDS not being referred internally to the antiretroviral programme.

  • Treatment literacy efforts from TAC and other AIDS organisations need to be substantially increased.

A report was presented to the NEC on progress of the antiretroviral treatment rollout. It was noted that there has been substantial progress on the rollout in a number of provinces. Western Cape, Gauteng, the Northern Cape and Kwazulu-Natal have all begun prescribing antiretroviral medicines to patients. There has also been progress in Mpumalanga and the Free State. The TAC welcomes this progress and the positive attitude demonstrated by the Northern Cape and Mpumalanga provincial governments in particular.

It was also noted that public messaging on AIDS has improved. Reasonably coherent and informative adverts, under the Khomanani brand, are being run on radio and television encouraging people to get tested and treated. Nevertheless, there is much room for improvement. For example adverts should include information on exactly which clinics are rolling out antiretrovirals so that patients know where to go. Also, messaging is nowhere near saturation, as it needs to be, and the messaging from the LoveLife brand continues to be confusing and inaccessible to many communities. More than ever, there is a need for treatment literacy to be rolled out to communities. In this regard, the TAC has conducted a comprehensive training course to produce 120 treatment literacy practitioners in Western Cape, Eastern Cape, Gauteng and Kwazulu-Natal. These practitioners are beginning to assist the rollout by improving treament literacy training and access to information in districts where antiretroviral treatment is being rolled out. This is in addition to the TAC's ongoing treatment literacy awareness programmes. However, our efforts and those of other organisations are small compared to what has to be done.

Insufficient National Leadership and Lack of Communication

It became apparent during discussions on the report that there continues to be insufficient leadership and communication from National Government on the programme. This lack of leadership means that some provincial governments, especially Limpopo, continue to fail to demonstrate political will or progress with  implementing the programme. Communication from most provincial health departments also needs to improve. This poor communication renders it very difficult to determine accurate numbers of patients on treatment countrywide or even per province. It is also difficult to determine accurately which health facilities have begun to provide treatment. This makes it hard for organisations like the TAC to assist with implementation of the treatment plan and to ensure that government complies with its constitutional obligations.

The TAC NEC therefore resolved to make an effort to discuss this issue with provincial governments, failing which the organisation will reluctantly make use of the Access to Information Act. Limpopo Province, in particular, will be targeted by the TAC for its obstructive lack of communication. In this regard, it was noted that the National Department of Health still has not made available Annexure A of the operational treatment plan and all subsequent timetables for the implementation of treatment, despite an Access to Information request by the TAC.  

There have also been reports of medicine shortages. In this regard, the TAC has contacted suppliers of two antiretrovirals used extensively in the public sector programme, stavudine (d4T) and lamivudine (3TC). The suppliers have confirmed to us that they do not have stock shortages. One supplier in particular (a generic company) indicated that Government had not ordered its stavudine, despite the medicine being registered and available for supply without any chance of patent infringement.   

To date, government has not indicated what steps (if any) it has put into place to ensure a sustainable supply of medicines.  In addition, key licensing agreements between certain patent-holding pharmaceutical companies and generic companies have not been concluded, meaning that the state has not been able to access certain registered generic antiretrovirals.  Of equal concern is the fact that some licensed products have yet to be registered by the Medicines Control Council.

The TAC has enough material to publish a detailed report on the treatment rollout, but because of the lack of communication from government we are unable to confirm all our information, some of which is contradictory. The report will be presented to the next SANAC meeting. A detailed report on the antiretroviral rollout will be published at the People's Health Summit and from thereon, regular updates will be published.

People's Health Summit
KEY POINTS

  • The ARV treatment rollout presents an opportunity to build and strengthen the public health care system.

  • The People's Health Summit will take place from 2 to 4 July at the Regent Hotel in East London.

  • The Summit will galvanise TAC, government, labour, business and civil society to invest more money in the public health care system and transform the inefficient, expensive and exclusive private health care system.

The TAC together with the Rural Doctors Association (RUDASA), the Eastern Cape Provincial Council of Churches (ECPCC), Public Service Accountability Monitor (PSAM) and the South African Democratic Nurses Union (SADNU), will host the first People's Health Summit at the Regent Hotel, East London from 2 to 4 July. Many parts of the South African public health care system are in a dire state. The system experiences staff shortages, high patient rationing, inadequate in-service training of health-care workers and poorly stocked health facilities. The situation is particularly bad in the Eastern Cape, where the conference will be held. These problems are aggravated by inequalities between the severely underfunded public health care system and the overfunded and  inefficient private health care system as well as inequalities between provinces and urban and rural areas. The antiretroviral programme will be poorly  implemented if these problems are not addressed, but the treatment rollout also presents an opportunity to address these problems.

Government, including the Minister of Health, and leading researchers on the health-care system will be invited to address the summit. But health-care workers at the frontline of the health care system and patients experiencing the difficulties of the system will be the conference's main voices.

The campaign for a unified people's health service will be the next phase of the TAC's work. This will be an ongoing campaign, but it is the logical continuation of the TAC's work. It is also essential for ensuring the success of the antiretroviral treatment rollout. A detailed statement on the People's Health Summit will be released within the next week.

Call for International Day of Action to Tell the Bush Administration: "Invest in GLOBAL Health - Not War!"
KEY POINTS

  • Bush Adminstration is undermining access to generic antiretroviral medicines.

  • Bush Administration is using President's AIDS Fund (PEPFAR) to undermine reproductive health rights and condom access programmes.

  • World attention and resources are being diverted to war in Iraq instead of the world's real security problems: AIDS, TB,  Malaria, malnutrition, poverty and inequality

The TAC NEC is deeply disturbed by actions of the Bush Administration which we believe undermine access to generic antiretrovirals, reproductive rights education programmes and condom access and education programmes. We are further disturbed by the manner in which the Bush Administration is diverting international attention away from global health and poverty by continuing to conduct an unlawful war in Iraq. Hundreds of Billions of dollars are being spent on war instead of investing resources in the biggest threats to human security today: AIDS, TB, Malaria, malnutrition and poverty. The Bush Adminstration's promised billions to alleviating the HIV epidemic are barely materialising, while the Global Fund to Fight AIDS, TB and Malaria remains underfunded. Therefore, the TAC NEC will call for an international day of action on Monday 21 June to demand of the Bush Administration: Invest in GLOBAL Health - Not War! A detailed statement on this will be released in the next two weeks.

Mobilising Districts for a Better Health System

The TAC NEC recognises the need to strengthen the organisation at the district level so as to ensure local health service delivery is improved. To facilitate this, the TAC will be investing more resources into its volunteer-driven branch programmes and starting two more offices at district level. It is our objective to ensure that the Pietermaritzburg, Stanger, Mandeni, Khayelitsha, Tshwane, Lusikisiki and Queenstown districts become models for the rest of the country on antiretroviral treatment rollout, treatment literacy and community-driven improvements to the health-care system.

Additional Key Resolutions of the Meeting

  • Continue to monitor Competition Commission settlement agreements to ensure that Boehringer Ingelheim and GlaxoSmithKline comply with their legal obligations to license generic pharmaceutical companies

  • Meet with the Medicines Control Council to determine why registration of a number of essential medicines - antiretrovirals in particular - is taking an unexpectedly long time.

  • Release a detailed report and the resolutions of a meeting of the leaders of the People with HIV/AIDS Sector in TAC.

    [ENDS]