TAC Statement on South African Elections
ANC Has Received an Unequivocal Mandate to Deliver on Health, Employment, Social Security, Education and Housing - Ordinary Citizens Have A Critical Role Between Elections
The Treatment Action Campaign (TAC) congratulates the African National
Congress (ANC) on its election victory. We also commend all the other
parties who demonstrated the vibrancy of democracy in our country.
Support for the ANC across the country represents an unequivocal
mandate from South Africa's citizens for the ANC government to deliver
meaningful social improvements in our lives. In the context of the
HIV/AIDS epidemic this means building a better public health care
system, improving government's response to the HIV epidemic by
energetically rolling out antiretroviral treatment, treating
opportunistic infections, increased social
security and improving and increasing HIV prevention efforts.
During the election campaign, President Thabo Mbeki visited many
communities across the country and learnt of hunger, homelessness and
ill-health. This work was commendable. We believe that a specific focus
on HIV/AIDS by ANC leaders during the election would have made a
significant impact on government efforts to prevent new infection,
eradicate stigma and to treat HIV/AIDS. TAC did not make the 2004
election about HIV/AIDS because we accepted the good faith of the change
in government policy, the increased allocation of resources and the
beginning of antiretroviral roll-out in key provinces. We refused to
give succour to parties who wanted to make HIV/AIDS a party-political
issue. However, we welcome the common view among all the major
opposition parties that a comprehensive treatment and prevention
strategy is required for HIV/AIDS. We urge the ANC to call all parties
together in Parliament and to form an all-party group on HIV/AIDS to
ensure that legislation, regulation and constituency needs are addressed
by all legislators.
It would be tragic if government believed that its increased majority at
the polls is a justification for the unnecessary confusion and
confrontation on HIV/AIDS between 1999 and 2003. In fact, a majority of
TAC members voted for the ANC. Two recent scientific reports should
alert the new ANC government, all other political parties, the private
sector, labour and all of civil society to the crisis that unfolds
In April 2004, the South African Medical Journal published a report
based on registered deaths between 1998 and 2003. These statistics are
taken from the Department of Home Affairs registers. The total number of adult
deaths for this period increased by 68%. After taking into account
population growth and improved registration, the increase in premature
death is at least 40%. Women aged 20-49 years were worst affected with
190% increase in registered deaths. The scientists conclude: "The
uncertainty about the precise number of AIDS deaths should not allow
people to dismiss the impact of HIV/AIDS on mortality. There has been a
massive rise in the total number of adult deaths in the last 6 years.
Given the ages at which these additional deaths occurred and the change
in the cause of death profile, they can largely be attributed to
HIV/AIDS. Such rises in the mortality should renew Government's resolve
to implement the comprehensive plan to prevent and treat HIV/AIDS as
rapidly as possible."
AIDS-related illnesses and deaths are increasing along with new HIV
infections. Just as with deaths, new infections show that women and
girls are at greatest risk. The first national population study of youth
aged 15-24 by the Reproductive Health Research Unit at Wits University
showed that 10.2% of all young people age 15-24 are already infected
with HIV. At age sixteen 2% of boys and 4% of girls are already infected
with HIV. Among the 10% of youth who have HIV, 77% are women. The study
showed dramatic awareness and knowledge on HIV/AIDS transmission. This
is commendable and is due largely to the efforts of government and many
civil society actors. But the majority of youth do not believe that they
are personally at risk of HIV infection.
These facts call for:
- Leadership and community mobilisation at every level to prevent HIV infection and to treat HIV/AIDS.
- Massive health and treatment literacy campaigns that actively encourage voluntary counselling and testing for HIV.
- Openness about HIV/AIDS to reduce stigma and discrimination.
There has been real progress in many areas of life over the last ten
years. Yet, for millions of poor people the quality of public
health-care has worsened. A combination of factors can explain this: the
impact of HIV/AIDS on the health system; lack of training of personnel;
profiteering by private hospitals, medical scheme administrators and
pharmaceutical companies. Bad political management of health-care at
national level has also played a role.
TAC calls for the Cabinet and Parliament to pay special attention to
transforming and improving the national Ministry of Health and
Provincial Health Departments. Increased investment in public
health-care will improve the hiring and retaining of nurses, doctors and
pharmacists and the rollout of antiretroviral treatment. HIV/AIDS will
be one of the great tests of delivery for the ANC government in its next
term. TAC invites the government to participate in the national People's
Health Summit to be hosted by the TAC, the Rural Doctors Associatioin,
health unions and the Eastern Cape Council of Churches in June 2004.
Finally, we believe that it is critical and feasible for government to
increase social budgets substantially, albeit responsibly, and to tackle
poverty through the introduction of a Basic Income Grant. The ANC
commitment to increased investment in public works is commendable and
will improve the lives of many people who are unemployed.
To achieve delivery, it will be necessary for ordinary citizens to
become more involved in social action. Partnership, constructive
criticism and watchfulness from civil society are critical to successful
delivery and ensuring that the ANC's massive election victory is turned
into a better life for all. In this, we join the people's contract.
[END OF STATEMENT ON ELECTIONS]
Report on TAC Public Meetings to Mobilise for Treatment Rollout - February to April 2004
The TAC welcomed the adoption of an operational care and treatment plan
that included the provision of antiretrovirals on 19 November 2003. The
Western Cape immediately made plans to rollout and had over 1000 people
on treatment by February 2004. However, it became clear in early 2004,
that all other provinces were not proceeding because the Minister of
Health was obstructing the rollout of the plan, primarily by failing to
purchase an interim supply of antiretrovirals -- while a lengthy tender
process for the medicines was being followed -- to distribute to
hospitals and clinics that were ready to rollout. Following the
Minister of Health's obstructions, the TAC proceeded with a public
mobilisation campaign to highlight government's intransigence, as well
as litigation. The public mobilisation campaign consisted of holding
open meetings in cities across six provinces and inviting senior
provincial representatives to account for the rollout in their provinces.
While it is too early to claim that this strategy has been entirely
successful, there have been concrete results. Gauteng has started
antiretroviral treatment in five hospitals and there are as yet
unconfirmed reports that Kwazulu-Natal has also started. Pressure from
the TAC also contributed to announcements by Free State and North-West
provinces that rollout would proceed. The publicity caused by the public
meetings and the threat of a court case resulted in the Minister of
Health conceding to the TAC's demands and agreeing to purchase an
interim supply of antiretrovirals. Nevertheless, the precise extent of
the rollout at this stage is difficult to determine, but it is certainly
not extensive. Progress in Limpopo, Mpumalanga and the Eastern Cape
remains unacceptably slow. The TAC will have to monitor provinces
closely over the next few months and possibly renew public pressure
coupled with the threat of litigation to ensure the rollout proceeds
This document briefly describes the public meetings held from February
to April by the TAC. Meetings are listed in chronological order.
Over 1000 activists packed the Johannesburg City Hall on 25 February.
Speakers included Molefe Tsele, General Secreatry of the SACC,
Zwelinzima Vavi of COSATU, Chez Milane of FEDUSA, a health worker from
Vaal and two TAC activists who live with HIV.
Critically, the meeting was attended by Mbazima Shilowa, the Gauteng
Premier, Gwen Ramakgoba, the MEC for health, Ram Saloojee, the chair of
the Health Portfolio committee and a range of other health department
officials - who listened to all the speakers. Shilowa promised to
introduce treatment as soon as possible at facilities that have
capacity, at least in the major hospitals in the Province. The TAC met
with him for 20 minutes afterwards, and he also instructed health
officials to meet with the TAC to plan joint work. By all accounts, the
Premier has stuck to his word so far.
On the 5th of March, a public meeting was was held at the Makhado Show
Ground in Louis Trichardt (Limpopo Province). Two hundred activists came
together to discuss the rollout. Speakers from the health department
promised they would come but did not. The office of the MEC for health
in Limpopo said that " the MEC would have liked to come to the meeting
but he is busy." Last minute attempts to get speakers also produced no
results at all. Nevertheless, the meeting proceeded and the TAC in
Limpopo is committed to ensuring that treatment is rolled out in this
About 1000 activists packed the Cape Town City Hall on 8 March. Speakers
included Vuyani Jacobs, John Vellenhoven and Zackie Achmat all of whom
live with HIV and take antiretroviral treatment. Tony Ehrenreich from
COSATU gave the trade union's backing to TAC's pressure on the Minister
of Health. Dr. Fareed Abdullah of the Western Cape Department of Health
described the rollout in the Western Cape, saying that over 2000 people
were already on treatment and the department's goal was to have
approximately 45 sites started within a year and 5,000 people on
treatment. He committed to putting every child with AIDS on treatment in
the Western Cape within a year.
Also, on 21 March, NACOSA Western Cape, Triangle Project, Hope World
Wide, Sizophila, Positive Muslims and TAC organised a seminar for people
with HIV/AIDS at Jameson Hall on the University of Cape Town. About 800
people attended. The meeting examined the needs of the rollout programme
and treatment literacy. It was addressed Dr. Fareed Abdullah and Dr.
Nearly a thousand people attended the public meeting held on 16 March at
Durban City Hall, started.
The meeting was opened by observing a moment of silent to remember all
comrades and fellow South Africans who have died of AIDS, most of them
without access to antiretroviral treatment.
The chairperson for the day, Sbu Khanyile, welcomed welcomed and
acknowledged the presence of different NGO, doctors and nurses.
Mama Ritta, explained how she lost two children, one in 1998 and the
second in 2000, because they had no access to affordable treatment. She
had difficult times and was stigmatised and isolated in her community,
so she decided to stand up and joined TAC.
Cecelia Hlabisa told the meeting that her child is on treatment through
the TAC Treatment Project. Her child was sick and confined to in bed
before going on treatment but now her daughter can walk and smile. Her
daughter was also present.
Dr Kim Langley from Stanger Hospital spoke next and made an inspiring
speech in favour of treatment.
The fourth speaker was Zodwa Ndlovu, a TAC activist and a nurse by
profession. She spoke about the frustrations felt by nurses working in
HIV/AIDS. She explained that they need proper training and resources.
There was disappointment that MEC for Health, Dr Zweli. Mkhize,
cancelled at the last minute. He sent apologies and sent the Durban
District Health Manager, Mr D.M. Msiza. He simply apologised and said he
had no mandate to speak on behalf of the KZN Department of Health.
Instead he spoke on general issues such as the antiretroviral training
held for two days by doctors and co-ordinators.
Mark Heywood, TAC's National Treasurer spoke on the national treatment
plan and shared information on what is happening in other provinces. He
expressed sadness that the KZN Premier and the MEC for Health were not
present and asked, "Where is the political commitment and leadership".
The meeting resolved to seek an urgent meeting with the MEC of Health
and to ask him to announce a rollout date.
A public meeting was held on 18 March 2004 at the Queenstown
Multi-Purpose Centre.It was attended by at least by 500 people, most of
them people with HIV/AIDS (PWAs) from rural communities.The programme
was well structured with PWAs sharing their experiences. The government
was represented by Nomalanga Makwedini,
HIV Director for the Eastern Cape Provincial Department of Health.
Meeting attendents demanded the date for the provision of
antiretrovirals stating that they already know the date for the
elections. As expected the director failed to give the date but at least
acknowledged the importantance of antiretrovirals.
A public meeting was held at City Hall on 18 March. About 200 people
attended. There are only two active branches and there is no physical
office in Port Elizabeth so this turnout was expected. The meeting was
entirely organised by volunteers. Dr. Pailman from the Provincial
Department of Health gave an overview of sites for antiretroviral
rollout. She mentioned that the department is waiting for drugs but
emphasised that in the meantime they need a working relationship with
TAC as they recognise TAC's skills in Treatment Literacy and community
Ncumisa Nonongo gave an overview of the treatment plan emphasising that
the government committed to start to distributing antiretrovirals by
the end of 2003 but up to now no rollout has taken place. The Public
Service Accountability Monitor presented the budget of the government
and pointed out that there was no provision for antiretroviral rollout.
Speakers living openly with HIV demanded the expected date of
antiretroviral rollout from Dr Pailman but she could not give it. She
promised to involve people with HIV in monitoring of patients who are
taking antiretrovirals. She also promised to call upon TAC when they are
ready to rollout.
On 25 March, a meeting was held in the capital of Limpopo, Polokwane.
Over 200 people attended the meeting. There was lively singing and,
branches had developed their own locally remixed songs. Attempts to get
the MEC for Health or a person from his department were unsuccessful.
First the provincial department promised to he would come but it was
postponed apparently because the MEC was busy. However his absence did
not dampen the spirit of the meeting.
The meeting discussed what the TAC should be doing in Limpopo to make
sure that the rollout is successful. It was pointed out that there is
nothing much that is happening in terms of the rollout. Some of the
identified hospitals are said not to have counselling rooms, unreliable
laboratory access and small pharmacies. Many people raised their
concerns that Limpopo health department is not moving fast enough to
address these issues.
The meeting resolved to:
- Write a letter to the MEC requesting a meeting and an update on the antiretroviral rollout in Limpopo
- Picket outside the provincial health department if the response to the above letter is inadequate
- Clarify the issue of NAPWA and TAC to members
- Hold another public meeting soon to get an update
On 26 March TAC held its biggest event yet in the rural town of
Lusikisiki, Eastern Cape. Lusikisiki serves one of the poorest rural
areas in South Africa, but it is home to a fledgling antiretroviral
project administered by Medecins Sans Frontieres, with a strong TAC
presence and office. The approximately 40 people on treatment in public
facilities in Lusikisiki constitute all the people currently on
treatment through the government treatment programme in the Eastern Cape.
The meeting started at the townhall where Akhona spoke. About 1000
people marched through Lusiksiki main Street. The march stopped at the
taxi rank and the hospital where Nolusapho and other spoke. The district
manager, who is hard to track down for any meeting, and district
pharmacist had been waiting there from 10h00 until the crowds arrived at
Unfortunately the MECs office and the HIV directorate had sent an
apology the day before that they would not be able to attend. This
dampened the spirit slightly, but not much.
The main speakers were Mzimkhulu Zibi of SADTU, about six people with
HIV, Thembi Ntlangulela, the district manager and Mandla Majola of TAC.
Nozibele Mditshwa was critical of the MEC who says that uneducated
people should not get ARVs. She is uneducated and ARVs have saved her
life. When elections come everyone is equal. Even if we are uneducated
we can vote. Why should we not be equal when it comes to medicines. The
called on the MEC to announce the date of antiretroviral rollout before
Thembi repeated the now old information of having one site per district
municipality and not knowing when the drugs will come. Phase one should
have started last year and phase two now etc.
Mandla emphasised that the Eastern Cape is always the last area to
implement programs and that little leadership was coming from the MEC.
In election time every village can have a voting station, why not a
clinic. He also pointed out that antiretrovirals are cheaper because of
TAC's battles with drug companies.
A public meeting was held in the Mdantsane Indoor Sports Centre on 29
March. Over 700 people attended. The Department of Health in the
district excused themselves from the meeting by saying that their
comments at the Queenstown meeting applied to the whole Eastern Cape
The meeting took the following resolutions:
- Release a statement expressing disappointment that the provincial department did not send any representatives
- Request a meeting with the MEC of Health
- If no adequate response is received to a request for a meeting with the MEC, take further urgent actions with the advice and support of the National Office.
- Brances must broaden work with other organisations so that the messages of treatment and prevention can be spread to them.
Over 700 people crammed into the Nalsville Hall in Nelspruit for a
public meeting on 7 April. The MEC for Health was invited, but she sent
a director from the Provincial Department of Health in her place. He,
however, refused to speak or answer any questions, claiming he was just
there to listen. The central question that he was asked was: when is
rollout beginning in Mpumalanga? The attendants were disappointed with
the attitude of the provincial health department. The TAC has received a
complaint from a member of the public who claimed that the personal
assistant to the MEC for Health told her that it would be lucky if
treatment were available before 2008. TAC Mpumalanga finds this
unacceptable and will step up its campaign in this province within the
next few weeks until treatment is rolled out.
[END OF PUBLIC MEETINGS]
TAC Sends Letters to Some MECs for Health Expressing Concern About Slow Pace of Rollout - Requests Updates on Progress
The TAC has sent letters to the MECs for Health in Limpopo, Mpumalanga,
North-West, Northern Cape and Eastern Cape provinces expressing concern
about the slow pace of the treatment rollout and requesting updates on
progress. Below is the letter sent to Mpumalanga. Similar ones were sent
to the other provinces.
7 April 2004
Ms Busi Coleman
MEC for Health: Mpumalanga
7 Government Boulevard, Building 5
Riverside Park, Extension 2,
Per fax: (013) 766-3471
Dear Ms Coleman
IMPLEMENTATION OF THE OPERATIONAL PLAN FOR COMPREHENSIVE HIV AND AIDS
CARE, MANAGEMENT AND TREATMENT FOR SOUTH AFRICA IN MPUMALANGA
1. In November 2003, the Treatment Action Campaign (TAC) welcomed the
release of the Operational Plan for Comprehensive HIV and AIDS Care,
Management and Treatment for South Africa ("the Operational Plan"). In
our view, the Operational Plan is the product of discussions that had
been taking place for over 18 months and is the culmination of several
years of work in the area of HIV/AIDS prevention and treatment. We view
the Operational Plan as a useful practical vision, which if implemented
urgently and reasonably, could potentially save the lives of many people
living with and affected by HIV/AIDS.
2. While we have also welcomed the initial public provision of
antiretroviral (ARV) treatment in the Western Cape, KwaZulu-Natal and
Gauteng, as well as the Free State's commitment to begin providing ARV
treatment on 1 May 2004, we note with concern that Mpumalanga has
neither begun providing ARV treatment nor has it committed to any
particular date upon which public health facilities will begin
dispensing ARV medicines. This is particularly disconcerting given the
2.1 Mpumalanga has set up a Provincial Steering Committee and a
Provincial Accreditation Team.
2.2 12 treatment sites in Mpumalanga have been identified by your
offices, and thus far six (two in each of three health districts) have
been accredited by the National Department of Health (NDoH) as having
the requisite capacity to provide the interventions listed in the
2.3 Project facilitators have also been appointed at each of the 12
identified treatment sites.
2.4 According to a presentation made by your offices to the NDoH on 4
March 2004, health care workers were trained earlier in the year whilst
a second round of training was due to take place in March 2004.
2.5 There are no obstacles to the procurement of ARV medicines:
2.5.1 To ensure the provision of ARV treatment pending the finalisation
of the formal tender process for the procurement of ARV medicines, the
health MinMEC decided on 23 March 2004 to procure such medicines in the
interim through a national price quotation system. According to the
NDoH, the formal tender process will be completed only by June or July 2004.
2.5.2 This means that there is no bar to the procurement of ARV medicines
before the formal tender process is finalised. Provinces can purchase
ARV medicines to meet interim needs by making use of the national price
2.5.3 Copies of the correspondence in this regard were sent to the office
of the Premier. Kindly note that provinces are expected to inform or
confirm with the NDoH site readiness and patient numbers in order to
access an interim supply of ARV medicines.
2.6 Funds for the implementation of the Operational Plan in the fiscal
year 2004/2005, in the form of conditional grant allocations, have been
accessible since 1 April 2004. There are therefore no financial
barriers to procuring an interim supply of ARV medicines immediately.
2.7 Any delay in the provision of ARV treatment where it is medically
indicated will result in a significant number of deaths and/or loss of
life years of persons who should and could be on treatment.
3. The TAC is committed to ensuring that the Operational Plan is
reasonably and successfully implemented in all provinces. We would
therefore like to ascertain to what extent the Operational Plan has been
implemented in Mpumalanga and how, if at all, we can help you with its
urgent and continued implementation. We trust that we will be able to
assist your offices with community mobilisation, treatment literacy,
support and training at the six sites that have already been accredited.
4. Aside from these sites, please also advise what steps you will be
taking to increase the number of treatment sites over the next few
months so that in the short and medium term there are additional sites
that will be ready to administer ARV treatment.
We look forward to a mutually constructive and beneficial relationship.
Once again, we hope that we can be of assistance to you by providing
treatment literacy and community support at the six accredited sites as
well as at future designated sites.
We look forward to hearing from you shortly.
cc: Premier NJ Mahlangu
[END OF LETTER TO PROVINCES]
Malady of medicine
By Jonathan Berger and Fatima Hassan, Published in ThisDay, 20 April 2004
(Berger and Hassan are lawyers with the Law and Treatment Access Unit of
the AIDS Law Project and members of the TAC)
Your throat aches every time you swallow. Your doctor says you have
thrush and writes a prescription for fluconazole. But the clinic
pharmacy is out of stock. You are told to come back the next day.
You have used up all your sick leave and can't afford to take off
another day waiting in line for free medicines. It's two weeks to
payday. You have no money to purchase the drugs at your local
pharmacy. What do you do?
Right now you could be in luck. Your prescribing doctor, who also
dispenses medicines, may help out. But come the beginning of next
month, your doctor will no longer be permitted to dispense medicines
unless she or he is expressly licensed to do so.
Placing such restrictions on the dispensing of medicines clearly limits
access to essential medicines. So why then is government intent on
introducing a regulatory framework to license dispensing practitioners?
Why prevent doctors from performing such an important service?
Those seeking to regulate the practice recognise the important role
played by many dispensing practitioners. But they also acknowledge that
the right to dispense has often been abused. This has been possible
because the linkage of prescribing and dispensing creates perverse
incentives, with the prescribing doctor having a direct financial
interest in what he or she dispenses. This is not the case when doctors
prescribe and pharmacists dispense, as is the ordinary course of events.
The practice has sometimes resulted in the prescription of what's in
stock rather than what's actually needed, or even the prescription of
stock that's about to expire. More common and similarly problematic is
over-servicing, where medicines are prescribed simply to generate a
dispensing fee. Also, where doctors practice on a flat-rate fee that
includes both consultation and medicines, the perverse incentive may be
to prescribe cheaper - and possibly inappropriate - medicines to cut
costs and boost profits.
Such practices have to be stopped. Simply put, there is a need to
separate prescribing and dispensing wherever possible, only permitting
the practice where it can be shown that the service is indeed required.
This is what the new law seeks to achieve. The Medicines Act now
requires that health practitioners apply for licences before they can
dispense medicines - inconvenient perhaps, but not particularly problematic.
This approach is endorsed by the World Health Organisation and practised
in many countries. Why then are dispensing practitioners so outraged?
As is often the case, the devil is in the detail. Take the application
form for a license as an example. In specifying the geographical area
to be serviced, applicants must not only supply information on its
population size, but also "the disease patterns and health status of the
population". Further, the "names and addresses of other similar
existing services in the catchment area of the proposed new service"
must also be supplied, including those of pharmacies, hospitals and clinics.
Such information is clearly necessary if the licensing process is to be
fair and accountable. But should the collation of such data not be the
work of government rather than health care practitioners? Are we not
requiring applicants for licences to jump through too many hoops?
As currently drafted, the application form is cause for concern. Some
health practitioners believe they are being asked to do the impossible.
What if the relevant data is not accessible or affordable? Upon which
data must the information be based? The department's application form
guidelines are not particularly helpful in answering these questions.
What is needed is a bit of give and take on all sides. The right of
access to health care services must come first.
The government needs to concede that the regulatory framework requires
fine-tuning. Until its District Health Information System can provide
the requisite data for accurate assessment, it must be less prescriptive
and more lenient. A good start would be a new application form that
requires applicants simply to make out a case why their services are
For their part, dispensing practitioners need to accept the system in
good faith. If licences are unreasonably denied they can and should
seek appropriate legal redress.
[END OF MEDICINES ACT DISPUTE]
[END OF NEWSLETTER]