The government’s comprehensive HIV/Aids treatment programme was launched 18 months ago and a proper system for monitoring and evaluating the roll-out is still not in place.
Delays in installing the system account for a large chunk of the R39-million underspend by the Department of Health’s HIV/Aids cluster this year, revealed by the mini-budget.
Analysts pointed out that this was a serious deficiency in one of the world’s largest Aids treatment programmes. Currently about 70 000 people take anti-retrovirals through public-sector health facilities, while another 60 000 are being treated in the private sector or through workplace programmes. Brazil has the second-largest treatment programme, with an estimated 120 000 patients.
Failure to get proper feedback from a developing programme of this size means that successes are not replicated, while failures are not corrected. Drug supplies need to be monitored to prevent the stock-outs that have already threatened to take or have taken place, reduce “leakage” into the black market and stem corruption.
François Venter of Wits University’s reproductive health and HIV research unit pointed to the safety issues. Without a pharmaceutical “vigilance” system, the government and doctors could not gather enough information about the side effects of powerful anti-retrovirals — even though the government has repeatedly stressed their toxicity.
A senior official said there were concerns about the speed at which assessment tools were being developed and used. “How does the country know if the programme is working? There is not enough information in this programme, we don’t know what is being evaluated, or the indicators of success or failure.”
The Department of Health has also failed to brief Parliament’s health committee on the treatment plan. Presentations to the committee have repeatedly been cancelled, while it is rumoured that a presentation to Cabinet on the plan was rejected.
Nhlanhla Ndlovu, head of the Institute for Democracy in South Africa’s (Idasa) Aids budget unit, said reporting back has not been adequately prioritised. “Some provinces have failed to provide information. It doesn’t surprise us to see that some monitoring and evaluation funds were not spent.”
The Joint Civil Society Monitoring Forum, a group of about 20 NGOs, is trying to monitor the rollout. Although health officials had asked to attend its last meeting, no-one turned up — despite invitations and telephonic confirmation.
At the last meeting, the forum summarised the last known treatment numbers: these suggest that, by mid-August, KwaZulu-Natal had 19 000 patients on anti-retrovirals, with figures for Gauteng and Limpopo standing at 20 000 and 5 000 respectively at the end of July. In mid-September, the North West had 7 578 patients, the Free State had 2 500 and the Western Cape had more than 11 147.
Recent figures for Mpumalanga — historically the worst-performing province — were not available. In January it had 936 patients on anti-retrovirals.