TAC Electronic Newsletter


22 August 2005

Contents


Announcement:


COSATU Central Committee adopts TAC proposals on health-care and HIV prevention and treatment

On 18 August the letter below by TAC chairperson Zackie Achmat and deputy-chairperson Sipho Mthathi, was read out to the approximately 600 delegates of the third COSATU Central Committee (CC).

TAC welcomes the decision of the CC to adopt the contents of the letter as part of the resolutions of the CC. Amongst other things this means that the campaign for at least 200,000 people on treatment by end of March 2006, is now supported by South Africa's largest trade union federation with over 1,5 million members. TAC wishes to thank COSATU for this support and we look forward to ongoing collaboration with the implementation of this resolution.

For comment, contact Sipho Mthathi (TAC deputy-chairperson) - 021 788 3507 or 084 3007 007.

Save lives and build a People’s Health Service


Dear comrades

The Treatment Action Campaign salutes COSATU and we wish you success with the deliberations of the Central Committee. 

The leadership the Federation continues to ensure the freedom of all from poverty and disease, and is the source of the resolve that poor people and their movements have gained to defend their rights and ensure that they are counted in the new South Africa.

Thus, millions of poor South Africans depend on your resolve, including to the need to prevent and treat HIV infection. In view of this we appeal to you to take resolutions on the following issues:

The AIDS epidemic is still growing – prevent new infections


Eleven years into democracy, South Africa’s working class and the poor face many challenges. As is correctly reflected in the CC documents, joblessness, poverty, and poor service delivery continue to dim the possibility of a dignified life and enjoyment of real freedom for millions. That is why TAC considers critical, and has joined, the COSATU-led Save the Jobs Coalition.  However, HIV must be seen as a threat of equal weight, because HIV/AIDS threatens not only people's right to life, but the country’s ability to rebuild itself effectively and address the imbalances of the past.

For example:


Sadly, our country and our government is still failing to take this threat seriously. We need to alert you to the fact that the country’s existing Prevention Framework (as contained in the HIV/AIDS Strategic Plan for South Africa 2000 - 2005) expires at the end of 2005, but at present there is no consultation on a new prevention plan.

We call on this CC to call for an urgent National HIV Prevention Summit to devise a new plan to be organized by the Department of Health before end of 2005, which takes into account gender, poverty and access to information and goes beyond the simplistic Abstain, Be Faithful, Condomise (ABC) model. Such a meeting must include all stakeholders.

People with HIV are still dying – treat the people!


On treatment: The Comprehensive Plan for Care, Management and Treatment of HIV/AIDS, released by Cabinet in November 2003, stated that at least 500 000 people had AIDS and needed antiretroviral treatment. To date, only about 50 000 people are accessing antiretroviral treatment through the public health system. This means that hundreds of thousands of lives are still being lost.

The initial target contained in the Comprehensive Treatment Plan aimed to provide treatment to 53,000 people by March 2004. Eighteen months later, this target has still not been achieved. Since then TAC has urged the health department to set a new target towards which provinces and the National Department can work. A target is necessary because treatment is an urgent need for people with AIDS for whom each day’s delay decreases their chances of survival.  

TAC is calling for a national target of at least 200 000 people on ARVs by end of March 2006. We ask the COSATU CC to endorse this target and to actively promote HIV testing and treatment including antiretroviral treatment among all union members.  

A People’s Health Charter to create Jobs for a Unified Health System


Integrally linked to the ability of clinics and hospitals to speed up the provision of treatment and offer quality health services, is the presence of a Human Resources Plan for Health.
In July the Department of Health released the Charter of the Public and Private Health Sectors of the Republic of South Africa (The Charter). In August it released A Strategic Framework for the Human Resources for Health Plan (The HR Framework).  These are welcome moves, since both documents have the potential to transform our current inequitable health system into one that is affordable, equitable and unified.

It is regrettable that they have both taken too long to publish. Even more regrettable however, is that both were born without meaningful consultation with health care workers and health worker unions, civil society and other stake-holders. To add insult to injury, a very tight deadline for submissions has been set (August 15), which makes it difficult for the stake-holders to develop properly considered submissions. We appeal to you to support the call made by TAC, SAMA, the SACC, NEHAWU and others to ask for an extension of the deadline for submissions and for the process of finalizing the charter to remain open beyond 15 August.

We believe that both the Charter and the Human Resource Plan, if they are properly developed, are an opportunity to create thousands of new jobs in the health sector, and to improve the quality and conditions of service of existing health care workers. That is why we must oppose attempts to finalise these documents without full consultation.

We call on COSATU to urgently develop concrete proposals on numbers of health workers needed to deliver quality health services to the poor and the conditions under which health workers should be employed.

Our commitment to social justice, full-employment, decent education, public health, social security, dignified housing, equality and expanding the rights and freedoms of all people ensures full support for COSATU's struggle against unemployment, job losses and inequality.


Yours in the struggle for health, dignity and jobs!


Zackie Achmat                Sipho Mthathi
Chairperson                    Deputy Chairperson


[END OF COSATU RESOLUTION ADOPTION - BACK TO CONTENTS]

Health Department's misleading statements will not rescue a poorly drafted Health Charter

The Ministry of Health has released a statement attacking TAC, SAMA, COSATU and by implication SACC, SANGOCO, HOSPERSA, FEDUSA, NACTU, SACBC and NEHAWU because of our criticisms of the draft Health Charter. (See statement below.) The Department's statement is misleading and will not rescue the poorly drafted Health Charter.

Here are the facts:










[END OF RESPONSE TO HEALTH DEPARTMENT'S STATEMENT]

Here is the Department's statement:

Hypocrisy in the criticism of the Health Charter
16 August 2005

The Department of Health is dismayed by an undue and misleading criticism of the
process of developing the Health Sector Charter by the Congress of South African Trade
Unions (Cosatu), South African Medical Association (SAMA) and Treatment Action Campaign
(TAC).

These organisations are misleading the public by claiming ignorance about the Health
Charter drafting process as they were all invited and at least two of them participated
in this process.

The worst hypocrite is SAMA. The organisation's public statements totally contradict
the spirit of the two submissions that it has made on the Health Charter.

In addition to a joint submission as part of the Private Healthcare Forum, SAMA made a
separate submission on 15 August commending the Health Sector Charter initiative and
making additional inputs.

SAMA is one of about 15 organisations that have requested to make verbal presentation
to the Department on issues affecting medical practitioners in particular.

The Department is making arrangement for these organisations to make these
presentations.

TAC attended a stakeholder meeting where Health Minister presented the draft Health
Sector Charter and extended an invitation to all roleplayers to make an input. South
African NGO Coalition (SANGOCO), which is an umbrella body of non-governmental
organisations (NGOs) including the TAC, has submitted a written comment and is expected
to make a (verbal) presentation to the Task Team that developed the draft Charter.

The Department of Health extended written invitations to the trade union federation
Cosatu and its five affiliate-unions with interest in the health sector (Denosa,
Nehawu, NUM, SAMWU, SADNU) requesting comments on the draft Health Charter. These
organisations have not responded.

The fact that these organisations (Cosatu, SAMA and TAC) have not raised their concerns
until the Charter drafting process reached this advanced stage suggests there might be
an intention to derail this initiative, which is critical in the transformation of the
health system.

The Department is satisfied with active participation and massive response that the
draft Charter has received from health stakeholders. More than 50 written submissions
representing the views of more than 100 organisations have been received from a variety
of groups including various sections of private health sector, labour and civil society
organisations.

We appeal to Cosatu, SAMA and TAC to stop misleading the public and join the rest of
the health sector in engaging constructively with the process of developing the
Charter. As SAMA puts it in its submission: "the health care system needs to be
transformed at various levels to be more patient centred and medical professionals have
a pivotal role to play in this regard."

The Department of Health is committed to ensure the process of drafting the Health
Charter produces a document that enjoys collective ownership by all health
stakeholders.

Enquiries:
Sibani Mngadi
Cell: 0827720161

Issued by: Ministry of Health
16 August 2005

[END OF HEALTH DEPARTMENT STATEMENT - BACK TO CONTENTS]

Joint letter by civil society organisations to Minister of Health on draft Health Charter


12 August 2005

Dr ME Tshabalala-Msimang
Minister of Health
Private Bag X399
PRETORIA
0001

URGENT

Per fax: (012) 325-5526

RE: The Charter of the Public and Private Health Sectors of the Republic of South Africa (The Charter) and A Strategic Framework for the Human Resources for Health Plan (The HR Framework)

We are writing to you in respect of the Charter and the HR Framework. We believe that both have the potential to transform the current inequitable health system into one that is affordable, equitable and unified.

We fully support the principle and rationale of both the Charter and the HR Framework. However, we note that both have taken a very long time to be drafted, developed and released in the public domain for comment.

In addition, the deadlines imposed for making written submissions are particularly short. In our view, both the Charter and the HR Framework have been developed without the necessary participation of many civil society organisations and/or their constituencies. In particular, the concerns of health-care workers and users of the health system have not been sufficiently addressed. 

We are therefore concerned that given the above, as well as the very short deadlines imposed for making submissions on both the Charter and HR Framework (15 August 2005 and 15 September 2005 respectively), that proper negotiation and discussion with organisations representing health care workers as well as users of the health system (public sector in particular) is unlikely. This is because so far, public participation has been severely curtailed, and where permitted, rushed and largely superficial. It also appears that there has been very little parliamentary oversight over both processes. The latter is crucial given that the Department plans to finalise both the Charter and the HR Framework shortly.

In addition, inexplicably, the Department has chosen to have parallel processes on issues that should be deliberated upon jointly. It makes no sense to separate the issue of HR from the broader transformation issues affecting the health sector. 

We therefore appeal to you to ensure that all stakeholders are given a reasonable opportunity to engage with the Department and other parties, on these issues. For us, written submissions are a good starting point but definitely not the penultimate step in finalising the Charter and the HR Framework.
 
Therefore, while a number of organisations, are trying to meet the deadlines for making written submissions, we believe that the real process of negotiation and discussion is yet to commence.

For this reason, we would like to request a meeting with you and/or the relevant task team/s with a view to having open and proper negotiations. In the interests of participatory democracy, transparency and bona fide negotiation, we hope that this meeting will take place as a matter of urgency. This is especially important given the time frames imposed for finalising the Charter and the HR Framework.

Finally, in our view:

Kindly note that a copy of this letter including the signatures of all the organisational representatives listed below will be sent to your offices shortly. In the meantime and for the sake of convenience, please direct all correspondence to Mark Heywood (Tel (011) 717 8632, fax (011) 403 2341).

We therefore look forward to hearing from you as a matter of urgency.

Yours faithfully

South African Medical Association (SAMA)
Kgosi Letlapa – Chairperson
Tel 012 481 2000
Fax 012 481 2118

National Education Health and Allied Workers Union (NEHAWU)
Fikile Majola – General Secretary
Tel 011 833 2902
Fax 011 833 0757

HOSPERSA
Johan Steyn – General Secretary
Tel 012 365 2021
Fax 012 365 2043 

FEDUSA
Chez Milani –General Secretary
Tel 011 279 1800
Fax 011 279 1821

South African Council of Churches (SACC)
Dr Molefe Tsele - General Secretary 
Tel 011 241 7818
Fax 011 492 1449

Catholic Health Care (CATHCA)
Mr Tim Smith – Director
Tel 011 880 4022
Fax 011 880 4084

Treatment Action Campaign (TAC)
Sipho Mthati - Deputy Chairperson
Tel 021 788 3507
Fax 021 788 3726

AIDS Law Project
Mark Heywood – Head
Tel 011 717 8600
Fax 011 403 2341

CC:
Honourable James Ngculu MP 
Parliamentary Portfolio Committee on Health
Per fax: (021) 403 2072 and (021) 403 2808

Ms NC Madlala-Routledge
Deputy Minister of Health
Per fax: (012) 325-5526
 
Mr TD Mseleku
Director-General, Health
Per fax: (012) 323-0093

MEC’s for Health
Mr Monwabisi Bevan Goqwana
Fax: (040) 635 0115
Mr Sakhiwo Belot
Fax: (051) 405 4608
Dr Gwen Ramokgopa
Fax: (011) 838 4143
Ms. Peggy Nkonyeni
Fax: (033) 395 2258
Mr Charley Sekoati
Fax: (015) 293 6150
Mr Pogisho Pasha
Fax: (013) 766 3475
Ms Eunice Shiwe Selao
Tel: (053) 830 2000
Fax: (053) 833 1925
Mr Mandlenkosi Elliot Mayisela
Fax: (018) 387 5726
Mr Pierre Uys
Fax: (021) 483 4143

[END OF LETTER TO MINISTER OF HEALTH - BACK TO CONTENTS]


How my child lives with HIV

By TM as told to Vathiswa Kamkam

[THE NOTES ON CALCULATING THE DOSAGE FOR CHILDREN ARE BY TM AS TOLD TO VATHISWA KAMKAM. WE HAVE NOT VERIFIED OR EDITED THAT CALCULATION. - EDITOR]


My name is TM. I live in Town Two, Khayelitsha. I was born on 1 January 1971. On 25 June 1997 I gave birth to a baby girl at Karl Bremmer Hospital. During that time I also heard that I was HIV-positive. My little girl passed away after five days. At that time I became sick and I was told I had double-pneumonia. I also tested positive for Tuberculosis (TB) for the second time. I started taking my treatment for eight months.

In 2003 I fell pregnant, I didn’t get AZT and I only got Nevirapine during labour pains because I delivered at six months of pregnancy. AZT is one of the ARVs that are given to pregnant HIV-positive women at 34 weeks to prevent her baby from infection in the Western Cape.

On the 23 March 2004, I gave birth to a baby boy, SM, who weighed 1,5 kilograms. He became sick and lost weight.

I was worried about SM and I had no hope that he would survive. I stayed with him in hospital from April until June 2004. After three and a half months, he was tested for HIV with the Polymarase Chain Reaction (PCR) and he was HIV-positive. He started taking antiretroviral treatment. His daily combination is 9ml stavudine (d4t) ,  4ml lamivudine (3tc) and 1,2ml of lopinavir/ritonavir syrups. The dosage for a child is calculated according to the child`s weight and age and the CD4% which is determined by weight x height / 3600 (uqikelelo lwamajoni omzimba omntana) and the square root of the answer. This is called the body surface area.

SM used to cry and kick the bottles when I gave him the medication but now he grabs me when I have the bottles and he doesn’t cry at all. I think he is used to the medication. He had been on the medicines for one year on 10 June 2005. His weight now is 9,4 kilograms.

It is not difficult even for me to take my antiretrovirals as I started them on 10 April 2005 because we took them at the same time (eight o’clock). I would like to say to other mothers: Don’t be afraid when your child needs to start ARVs. They help. I saw this from my child. I lost hope but now I have gained my hope back.

[END OF HOW MY CHILD LIVES WITH HIV - BACK TO CONTENTS]

Brief discussion on truck driver story from previous newsletter


The story of a HIV-positive truck driver, FS (as told to Sibongile Mashele), who continued to have sex with his wife and impregnated her raised some controversy. One reader wrote:

"I found the interview with FS a little problematic. I just wondered about several aspects in the article. For example, after being diagnosed with HIV, he apparently does not disclose this to his wife, has unprotected sex with her, she falls pregnant, loses the first child and then falls pregnant again and now they have an apparently healthy 11-year-old. His wife fortunately tested negative on two occasions. She is thus very fortunate indeed! He continues to have sex with many partners and does not disclose his status to them but insists on using a condom – this is good! He emphasizes the importance of always using a condom if you are HIV+ (except with his wife, at least on the occasions she wanted to fall pregnant …) – this is good. I just wondered about the message that this interview is putting out. I wondered if a brief commentary on such an interview might not be in order – esp. related to the risk to his wife and/or child when having unprotected sex with her."

Editor's response: We agree that the story raised some controversial issues. TAC certainly does not condone FS having unprotected sex with his wife without informing her of his status in order to have a child. Nevertheless, we think it was an interesting story about a transport worker, a class of people at high risk of HIV who seldom have a voice. But the reader's point is taken that this should have been accompanied by commentary.

[END OF TRUCK DRIVER DISCUSSION - BACK TO CONTENTS]

[END OF NEWSLETTER]