The war against HIV/Aids has been officially declared. General Manto Tshabalala-Msimang has issued a ground-breaking operational plan — which includes her African potato and garlic remedies, alongside the long-awaited roll-out of anti-retroviral (ARV) treatment.
At last, the strategy is on the table. Now the challenge is to gather our army (the doctors and nurses) and procure the weapons (drugs) and move the fight to the front lines.
This week, Cabinet adopted the long-awaited “operational plan” for HIV and Aids care and treatment. Insiders say Cabinet adopted it on condition that the health-care system is strengthened in the process. “More than half of the total expenditure … will go toward strengthening the national health systems,” says the government plan. Without the improvement of infrastructure, ARV roll-out will not work at all.
Over the next four and a half years, more than R750-million will be spent upgrading infrastructure in areas such as drug distribution, patient information systems and monitoring of patients’ reactions to the drugs.
The government has not yet given a specific date for the start of the ARV roll-out, but it is likely that HIV/Aids patients will have to wait until next year. A total of 53 000 people have been targeted for 2004, out of about half a million Aids patients in need of ARVs.
The announcement lifted the spirits of HIV-positive patients at the Helen Joseph Aids Clinic. “This is so fantastic,” said Sister Sue Roberts. “Only about 150 of our patients here are currently on ARV treatment.”
Patients paying R1 500 a month for ARVs will now get them free. Each patient will cost the state about R1 400 a year, thanks to pressure on drug companies and the registration of generic drugs by the Medicines Control Council.
“The government’s decision is wonderful news,” said Danie Matthee (40), on treatment for a year. “It will make the treatment accessible to everyone.”
People like Matthee will have to go to one of 53 service points around the country, to be set up by the end of next year, to get access to these drugs. By 2007, a million people will be receiving ARV treatment, said Nono Simelela, head of the HIV/Aids directorate at the health department.
Patients will be assessed for ARVs according to clinical criteria. They will also undergo counselling on ARV treatment, side-effects and adherence.
Constitutionally it is the responsibility of the provinces to implement the roll-out programme. While national government will provide the “backbone and training”, said Simelela, the provinces must identify districts for service stations, implement monitoring and evaluation systems, launch a communications strategy and ensure that provincial health systems will not be compromised by the implementation of this plan.
The question is whether our civil service has the capacity for such a mammoth task.
“We will support the provinces,” said Simelela, “but at the end of the day it is their responsibility.”
About R90-million has been allocated for ARV roll-out in the remainder of this financial year and another R1,9-billion between 2004 and 2007, according to the recent medium-term budget policy statement.
“We think there is sufficient on the table to get the programme going. Then we’ll review the figures later,” said one senior treasury official. Once ARV treatment is under way, future allocations will be linked to delivery.
This comes on top of R500-million allocated to HIV/Aids spending for 2003/04 — rising to R1,59-billion in the 2006/07 financial year — predominantly for the prevention of mother-to-child-transmission and prophylaxis for rape survivors. In addition, HIV/Aids spending features in various budget votes from education (life skills training) to social development (home-based care).
The operational plan estimates that during this financial year the roll-out programme will cost R296-million, R1590-million next year and the figure will grow to about R4,5-billion in the 2007/8 financial year.
The plan will be driven by doctors and nurses, but the lack of human resources could be a threat to successful ARV roll-out. Workshops will be conducted around the country to train doctors and nurses on ARV treatment, said Ashraf Grimwood, health practitioner and a former task team member. Universities and technikons will provide ARV training to newly qualified doctors and nurses.
“We will add to the university programmes. The time frames are tight for the class of 2003, but they have done a basic course, when they go into community service they will be trained further. We are training, training, training,” said Simelela.
itional reporting by Yolandi Groenewald and Marianne Merten