By: Rizèl Delano, Leadership in HIV/Aids
Fri, 19 Jun 2009
In the early days of the epidemic it was assumed that if the public had the necessary information about the transmission of HIV, they would take the necessary steps to protect themselves from infection and the epidemic would be contained. This did not happen.

While Aids education and awareness strategies deployed in South Africa did alert people, they were insufficient to promote or sustain behaviour change and today South Africa’s healthcare system is still far from making a difference as HIV infection rates climb higher and higher. Unfortunately, people will only change behaviour or attitudes when they feel they have a vested interest in change, believing that their lives will improve through the process.

Successful interventions show that a community peer educator approach is most appropriate to achieve this.

The community-based response has a number of benefits: it is more cost effective and sustainable if properly resourced and supported; caregivers are in close proximity to their patients; and caregivers can mobilise support from within the community. However, lack of financial support continues to derail the progress made thus far.

Fighting Aids with hands tied
Late last year the United Kingdom promised to give South Africa’s former Health Minister Barbara Hogan £15-million to help combat Aids in the country.

Hogan was appointed minister of health in September 2008 to help shake up the health service in crisis and on World Aids Day she announced a return to the National Aids Plan dropped under the rule of former president Thabo Mbeki.

UK International Development minister, Ivan Lewis said it was vital that Ms Hogan succeed in overturning myths about HIV/Aids.

He said: “For too long, South Africa has been fighting Aids with its hands tied behind its back. Those ties have now been removed and the country has a fantastic opportunity to fight against this epidemic. Barbara Hogan has set a bold and exciting vision on HIV and that is why the UK is fully committed to work with her.”

Professor Diana Gibb is one of the world’s leading authorities on HIV and its transmission from mother to child in developing countries. Dr Gibb played a key role in a trial carried out jointly by a UK and South African team, which found dramatic reductions in mortality in infected babies if they are treated early, rather than waiting until the children show clinical symptoms. The results, published in the New England Journal of Medicine, were so compelling that they have changed international guidelines on how best to treat HIV-infected babies.

How to make use of these findings?
But how to make best use of those findings is a challenge that epitomises the difficulties ahead for South Africa and Hogan.

In practice, dealing with all the HIV/Aids demands, it’s difficult for a health service whose skilled staff are leaving the country and struggling after years of inadequate funding and support. Hogan said that accountability, human and financial resource constraints remain the challenges faced by her office.

“Firstly, we have to look at costs of drugs. We do have locally manufactured antiretroviral (ARV) drugs, but available at high costs, and we should rather think about importing.”

Costs are not only related to the individual price of each tablet, it also relates to the procurement procedures and managing of stocks. Concerns are, however, not related to the costs of ARVs, but also about better improved drugs with less side effects.

Hogan further said: “South Africa simply doesn’t have the resources to roll out a proper healthcare delivery system on the scale needed.”

The country depends heavily on donors to provide much of the healthcare services and support.

To assist South Africa, PEPFAR was able to identify a new source of supply, received approval to procure, and enabled the health department to roll out ARVs, particularly to the Free State depots that have been neglected terribly due to non-availability of ARVs. Health-e investigated the effects in the Free State and what measures the provincial health department made to remedy the situation.

A shortage of drugs
“Right now we still have many people who are experiencing shortage of drugs and who cannot access them,” said the provincial TAC spokesperson, Sello Mokhaliphi.

“We are talking about people who have been on the waiting list from last year and who still have not received ARVs today.”

But the national debate at hand is: What do parliaments do to assist with the treatment of HIV and Aids?

National Parliament is not in isolation of the provincial legislatures — health is a concurrent function. With the recent voting campaigns, many promises were made, all to improve the current situation as health issues feature prominently in all political manifestos, an indication that South Africa’s public health system is a great concern to voters.

The most extensive solution was offered by the African National Congress (ANC), which proposed a national health insurance (NHI) system. This is essentially a compulsory single medical aid scheme for all working people, which will be used to directly fund free healthcare for all.

The scheme, planned along the lines of the Canadian health system, will be publicly funded and administered and aims to improve the quality of healthcare.

What about the risks?
While the NHI has been discussed by the ANC for a long time, the party now promises to implement it within five years. While details of the scheme are not yet public, the ANC manifesto states there will be engagement with the private sector in general, including private doctors working in group practices and hospitals.

The risks associated with the NHI are huge. The scheme will be enormously expensive to implement and even the then Finance Minister Trevor Manuel expressed doubt about whether it will be possible to phase it in over the next five years because of the state of the global economy.

Currently, the government spends about R60-billion a year on health services, yet it is unable to keep up with the demand for treatment.

The ANC endorses the targets set in the new national strategic plan for HIV/Aids by committing itself to reducing the rate of new HIV infections by 50 percent and providing care and support to 80 percent of those who need it.

Despite the recent refusal of Congress of the People (Cope) President Mosiuoa Lekota to admit that HIV causes Aids, Cope’s manifesto promises that the party will ensure the implementation of a comprehensive HIV and Aids strategy encompassing prevention, treatment, care and support for those affected and infected.

The Democratic Alliance is also keen on bringing the private sector into state hospitals, and offers some practical solutions. One proposal is that the provision of quality primary healthcare offered by clinics will be boosted by the delegation of some services to private doctors and community organisations.

Interestingly, the DA proposes that traditional healers could also deliver certain public healthcare services such as vaccinations — provided they acquire the necessary training.

Another solution proposed by the DA is the use of technology to enable public sector patients to collect their prescriptions from any accredited pharmacy.

One of the greatest bottlenecks for patients in clinics and hospitals is the wait for their prescription drugs, mainly because there is a dire shortage of pharmacists.

While expecting parties’ election promises to come true is naïve, it seems certain that South Africa’s health system will face a shake-up in the form of an NHI scheme, but the exact nature of this scheme is still the subject of debate and likely to take some time to emerge.
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