The South African government’s progress towards meeting its ambitious targets to roll out antiretroviral treatment to more than 500,000 people in urgent need is slow and suffering from a number of major problems according to an independent report issued this week by an alliance of key groups involved in HIV treatment and health care in South Africa.
Shortages of health care workers, a slow uptake of HIV treatment funds at provincial level and slow accreditation of treatment sites that are ready to begin prescribing antiretrovirals are identified as the major challenges.
The Joint Civil Society Monitoring And Evaluation Forum Of The Operational Plan For Comprehensive HIV And AIDS Care, Management And Treatment For South Africa, otherwise known as the The Forum, issued its report this week after reviewing evidence gathered from South Africa’s provinces.
It found that only 8000 people are receiving antiretrovirals (ARVs) through the government roll-out programme, concurring with a recent Department of Health estimate. This compares with an operational target of 53,000 on treatment by the end of 2004.
Severe delays in getting treatment centres up and running are being caused by a severe shortage of human resources, together with delays in accrediting treatment centres.
- In Kwazulu-Natal, South Africa’s most severely affected province, patients in need of immediate treatment are being told they may have to wait until July 2005 before they can start. Only nine sites are providing drugs, despite the fact that 20 are accredited, and only 535 patients are receiving treatment, according to the Cape Argus.
- In Limpopo, South Africa’s northernmost province, only one treatment centre is accredited to prescribe ARVs, despite a target of seven accredited sites by the end of 2004 and close to 7000 on treatment. Advertised posts for HIV care in Limpopo hospitals remain unfilled too, further slowing progress.
- South Africa’s rigid accreditation system for ARV prescribing sites is slowing progress, hospitals are not being given enough information about why they fail accreditation reviews, and there have been few moves to permit the decentralized, nurse-led care that will be critical in meeting treatment targets, the Forum says.
- Despite good progress at hospital level in Western Cape and Gauteng, the most urbanised provinces in South Africa, more needs to be done to bring treatment to the primary care level facilities so that the poorest members of society have better access to treatment. Equity of access will be a major focus of the Forum’s monitoring work.
- The slowness of a government drug tendering process that should have been completed in July 2004 is frustrating several provinces in their scale-up efforts. The tender process should have delivered significant reductions in the cost of ARVs.
- A national human resources plan that addresses health care worker training, attraction, retention and attrition is still not evident, despite government claims that a national strategy exists.
The Forum recommends making better use of private sector doctors who already have training in HIV medicine. It also recommends training of HIV testing counsellors to assist in tasks currently being carried out by nurses, with a clear career path open for this group of health care workers to become accredited adherence counsellors.
Programmes are also needed to offer treatment to health care workers living with HIV/AIDS.
Finally, greater transparency on treatment plans and numbers treated is required, says the Forum, which had to carry out its own survey due to lack of information from some provincial governments. The AIDS Law Project plans to sue the government to make public its latest targets for numbers on treatment, contained in a confidential annexe to its published strategy, in the South African High Court on November 2nd.
The Forum comprises AIDS Law Project (ALP), Centre for Health Policy (CHP), Médecins Sans Frontières (MSF), Public Service Accountability Monitor (PSAM), Institute for Democracy in South Africa (IDASA), Open Democracy Advice Centre (ODAC), Anglo American, Southern African HIV Clinicians Society (SAHCS), UCT School of Public Health and Family Medicine and Treatment Action Campaign (TAC).
Full text of the report is available at the Treatment Action Campaign website.