HIV struggle undermined by medicine stockouts and mismanagement
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:
- 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.
- Crumbling health systems
In many provinces the public health system is plagued by corruption and 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 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.
- 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.
- 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.
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.
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