The Treatment Action Campaign (TAC) this week expressed deep concern about the inaction by provinces in implementing programmes to prevent mother-to-child transmission of HIV/Aids.
In July the TAC won a Constitutional Court case that ordered the state to make nevirapine available to all HIV-positive pregnant women. Three months earlier, the Pretoria High Court had ordered state facilities in all provinces to supply the anti-retroviral drug.
The TAC’s lawyers have sent letters to all provinces asking for updates on their nevirapine plans, but they have received satisfactory responses only from Gauteng and KwaZulu-Natal.
”Provinces with no roll-out plans risk contempt of court actions,” warned the TAC’s Nonkosi Khumalo.
She said the TAC was setting up meetings with all health MECs to ensure they understood the requirements. ”We want to help provinces with logistics and training. We have spoken to the national health director general, Ayanda Ntsaluba, and he has made a concerted effort to work with us.”
A partial survey by the Mail & Guardian indicated a patchy national picture, with the Western Cape having the best record.
Faried Abdullah, a senior provincial health official, estimated that up to 90% of the Western Cape’s population had access to formal mother-to-child programmes. He promised full coverage by March 2003. The programme was initiated under the previous Democratic Alliance administration.
The Northern Cape will only implement phase one of its programme by December 1. ”It is envisaged that we will commence the service at Kimberley, Upington and De Aar hospitals,” said Thabo Lekhu, the provincial spokesperson.
The North West did not respond this week, but MEC for Health Molefi Sefularo announced in July that his department was ready to begin supplying nevirapine. He said the roll-out would be completed by year end.
The Free State said it had started its roll-out programme in all districts and planned to overspend its yearly budget by about R95-million to comply with the court order.
Districts are, however, at different stages of readiness for full implementation,” said spokesperson Elke Grobler.
In Mpumalanga there appears to have been no progress on any aspect of anti-retroviral provision. The province’s MEC for Health, Sibongile Manana, is a well-known Aids dissident. Limpopo also appears to be at a standstill.
A Cabinet statement in April, committing the government to a universal roll-out of nevirapine and rape prophylaxis treatment, was widely hailed as a crucial policy turnaround. Now suspicions are growing that the statement was a tactical retreat in advance of the G8 meeting in Canada, at which the New Partnership for Africa’s Development was due to be discussed.
In particular, the Cabinet statement only refers to a nevirapine roll-out after the end of this year and makes no commitment to anti-retroviral therapy for people already infected with HIV.
Dr Des Martin, president of the 2500-member Southern African HIV Clinicians Society, remarked: ”One has not seen any follow-up on the April 17 Cabinet statement in terms of an anti-retroviral treatment programme taking place sooner rather than later. All the signs are that we have a huge problem; action is needed.”
Martin said he had ”great admiration” for Ntsaluba and the head of the Department of Health’s Aids programme, Nono Simelela. ”They know what should be done, and they’re very committed to something happening — but they’re working against political odds.”
The Department of Health failed to respond to questions on the status of the universal roll-out plan in all the provinces as well as its research into implementing anti-retroviral therapy and reducing costs.