In May last year the South African National Aids Council (Sanac) mandated the department of health to begin drafting a new five-year National Strategic Plan for HIV/Aids, following the end of the term of the previous five-year plan. What began as a fairly low-key process in the bureaucratic realm, however, was rapidly catapulted into the limelight when the deputy president and the deputy minister of health started meeting with civil society and the trade union movement to forge a new era in the political management of HIV/Aids.
One of the key meetings, the Civil Society HIV Prevention and Treatment Congress in October last year, came to the conclusion that ‘a new strategic plan that is clear, bold, has targets and programmes is what the country needs most of allâ€.
This set in motion widespread involvement and interest in the development of the plan, generating numerous written submissions, sectoral conferences, the appointment of a task team in January this year, and the holding of a national two-day summit in mid-March, where there were intense discussions on the content of the plan.
The energy around this plan has been extraordinary. Whereas the previous strategic plan was released at the Durban 2000 Aids Conference, more as a defensive statement against growing accusations of government denial and inaction than anything else, this plan is the symbol of new national unity. In each of the processes leading up to and at the national summit, there was a level of engagement and commonness of purpose that for a moment evoked the optimism and collective will of the immediate post-1994 era.
The most remarkable aspect of the process so far has been how politicians, especially Phumzile Mlambo-Ngcuka, finally found a language to speak meaningfully about Aids. In her two speeches to the summit the deputy president managed, without drawing on clichés, to communicate simultaneously messages about personal responsibility and shared solidarity, social causes and individual agency, seriousness and hope.
Women were not the only ones leading the charge: Acting Health Minister Jeff Radebe and President of the Medical Association Kgosi Letlape stood out in their contributions at the summit.
The plan is a fairly sizeable document and covers a lot of ground: it includes sections on the spread and causes of HIV; implementation processes and responses to date; and has tables of goals, objectives and measurable indicators of performance for prevention, treatment and mitigation. The tone of the plan has been influenced by the orientations of two key players in the drafting process: a desire to avoid an over-biomedicalised view of Aids on the part of Nomonde Xundu, the Aids programme manager in the department of health; and an emphasis on social and economic rights from Mark Heywood, of the Aids Law Project and Treatment Action Campaign.
The plan has a distinctly social feel to it, even if it battles with the problem that phenomena such as gender equality are hard to pin down in targets and budgets.
Strategic plans are not just about programming and targets but also about creating an object to rally around; about directing and creating a vision of possibility. In the process of its finalisation, the plan has shown a lot of promise in all these areas. It will soon be formally handed over to Sanac, but the danger is that momentum may be lost and the plan might become an end in itself, rather than a means to an end.
The next few months will be crucial in demonstrating, firstly, whether the plan has the muscle to mobilise bureaucratic will to overcome what has been an uncertain and uneven response through the various spheres of government; secondly, whether the openness to it and involvement in it by the wide range of players will continue beyond the drafting of the plan; and thirdly, whether the new political energy and profile can be maintained.
As one member of the task team asked pointedly: why is the deputy president not on television more often? Having got beyond some of the key tensions of recent times between government and civil society, it is important that Aids does not get drawn into other political fault-lines such as the succession battles within the ANC. If these conditions are met, we may finally begin to experience the response to Aids in South Africa as a genuine national one.
Helen Schneider is an associate professor in the Centre for Health Policy, School of Public Health, Wits University. She was a member of the Task Team involved in drafting the Strategic Plan