Delays in the drug procurement process and lack of training for doctors are postponing the rollout of antiretroviral therapy (ART) in South Africa, the country’s government admitted last week.
Except for the Western Cape Province (which has set aside its own funds to buy antiretroviral drugs), the celebrated South African HIV care and treatment programme has yet to treat a single patient. Activists are beginning to question the government’s resolve to put the operational plan into action, citing statements made over the last week by Health Minister Manto Tshabalala-Msimang and President Thabo Mbeki.
Three months ago (November 19, 2003), the South African Government signed off on the rollout and committed itself to implementing the operational plan (OP) that was to direct the gradual delivery of comprehensive HIV care and treatment. This includes the rollout of antiretroviral therapy (ART) provision in the public sector, via sites in each of the country’s 77 health districts, within a year (to around 50,000 people), and in every municipality within 5 years.
To achieve such an ambitious project, the OP recommended very aggressive measures to upgrade the country’s healthcare infrastructure in order to provide HIV care. But already it appears that a number of tasks essential for the program to work, such as the upgrading and accreditation of sites and training programmes for healthcare workers to deliver antiretroviral treatment, are falling increasingly behind schedule.
The drug procurement process is a case in point. To find the best prices, the OP recommends that the government invite tenders from the various pharmaceutical companies who could manufacture the programme’s antiretroviral drugs.
The government has now (last Frtiday, February 13th)invited tenders from the potential suppliers, almost three months after the plan was approved. This is only the beginning of the procurement process. Orders can only be placed once all the tenders are received and reviewed and the best offers are selected. This means that the orders may not be filled for several months - many doctors are telling their patients not to expect drugs until June at the earliest.
Criticism of the government’s lack of haste in implementing the plan is mounting. Fed up with the government’s slow response to the epidemic, South Africa's Catholic church has announced that it will start providing anti-AIDS drugs this week. The Roman Catholic church is South Africa's largest provider of home-based care.
Meanwhile, the Treatment Action Group (TAC) has announced that it will now monitor the rollout of the programme, and will publish a report on March 21, just in time for South African elections in April.
But it is unclear how much the South African administration cares what its critics say. In his State of the Union speech on February 6, 2004, President Mbeki mentioned AIDS only once, as merely one of many of the health issues confronting the nation. He said nothing of the operational plan or the HIV treatment programme. In an interview with the South African Broadcasting Corporation, Mbeki questioned why there was so much emphasis on AIDS: "There are many, many things that impact on the health of our people. Why is it that nobody wants the president to speak about that? It puzzles me why people don't want to think.
"I don't think there is any country in the world which can hold the candle to South Africa as far as spending on HIV and Aids goes," he said.
TAC quickly challenged this assertion in a press release claiming that a number of developing countries in fact do much better than South Africa when it comes to HIV prevention and treatment, often with far fewer resources.
For example, Brazil's government treats over 100,000 people and has less than a quarter of South Africa's HIV infections. Its prevention and treatment programmes are far more advanced than South Africa's. Within Africa, both Botswana and Cameroon have more advanced treatment programmes.
Now a sliding start date?
Meanwhile, the Health Minister told the South African Parliament that she has never committed to a start date for the rollout of antiretroviral therapy. She said that the Department of Health was very busy laying the groundwork for the programme. “When we have put everything in place, we will announce the day we are ready, and kick off. From that day, within a year, 54 districts will be operational,” she said on Monday. However, the operational plan calls for a site in each of South Africa’s 77 health districts.
The Health Minister noted one key problem delaying readiness — there aren’t enough doctors trained to provide antiretroviral therapy. "We found that out of 20,000 doctors, only 2,000 can be relied on to adequately manage the provision of antiretrovirals. So we have a huge capacity problem. We have started training, but it's much more complex than that.”
How long South Africans will have to wait for treatment is anyone’s guess, but more and more die as each day passes.
TAC spokesperson Nathan Geffen blames the delays on the Minister of Health.
“Under the current Minister of Health, the whole ministry has regressed. It goes way beyond AIDS.”