Your Worship Mayor S'thembiso Cele
KZN MEC for Health Ms Peggy Nkonyeni
Mayors, Speakers, Municipal Managers
Heads of Departments and senior government
officials
Traditional Healers and Leaders
Leaders of the Ugu Disability Forum
Women and Youth Councils
Professor Pierre Barker
NGO's and CBOs
Distinguished guests, ladies and gentlemen.
Let me begin by saluting all the volunteers. Let
me salute the doctors,nurses and other
health personnel who look after people living with HIV and AIDS.
We salute you and appreciate the work that you do in support of our national
efforts to deliver quality health care to our people. I salute also the people
living with HIV and AIDS. Your courage serves as an example to all
and it gives hope that we can indeed conquer the HIV epidemic.
It is a great honour and privilege for me to
join you today and open this important
summit on HIV and AIDS, aimed at sharing experiences and devising a
coherent strategy for the Ugu District to tackle the huge challenge posed
by the HIV and AIDS epidemic. I do this with a sense of great urgency, following the leadership provided by our President in his State of the Nation Address earlier this month when he
urged us to accelerate the implementation of the Comprehensive Plan on the
Prevention, Management and Treatment of HIV and AIDS. I do this also with
a sense of hope when I see the amount of goodwill, which our people have
shown in coming forward as volunteers, working to stop the spread of the
virus, and taking care of those who have succumbed to the disease and the
HIV orphans.
This Summit on HIV and AIDS, happening so soon
after the official opening of Council serves to illustrate the importance the leadership of this District has
attached to the fight against HIV and AIDS. In his opening address, the Ugu
Municipality Mayor, Councillor S'thembiso Cele identified the impact of HIV
and AIDS as a serious impediment in our development initiatives. He
said: The district HIV/AIDS programme has not yet achieved its objectives. We have
provided both human and financial resources. There is however, lack of a
clear direction and programme in advance of this vital course. It is now essential
that the provincial, district and local co-ordinators put together and
implement a cohesive plan. The programme must become a highly visible one. Further on he said: We are fortunate that both the National Deputy Minister and the Provincial MEC
for Health are women of our soil. I intend to ask them to give strong impetus
to this effort. This is a call on all of us to roll up our sleeves and do something to save the
lives of our people. I wish to assure you Mayor Cele that we will not fail
you. I want to congratulate the Ugu District Municipality in partnership
with the KwaZulu-Natal Department of Health and the six municipalities
for their vision and commitment in organizing this summit and thus
responding to the urgent call the Mayor and the President have made. With
40% of pregnant women in this district testing positive for HIV and with
the number of people we are burying every week, we cannot afford to waste
any more time.
According to the report on Mortality and Causes of Death in South Africa based on Stats SA's recently completed study of about 3 million death notification forms received by the department of home affairs, South Africa's adult death rate has risen by 62% in the five years between 1997 and
2002. According to the statistician general, the data provided indirect evidence
that the HIV epidemic is raising the mortality levels of prime-aged adults,
in that associated diseases are on the increase. This gives statistical
confirmation to what we know from our own experience on the ground.
It is of great concern also that many of those that are dying are the
very same people in the public service that should be providing care and delivering
on our development agenda. According to the Public Service Commission,
by 2012 up to a quarter of public servants may have died of AIDS. HIV and AIDS puts immense pressure on the public service, in times of increasing demand for services, while, its workforce is eroded through increased absenteeism and mortality. Government departments are therefore advised to consider the impact of HIV and AIDS from a strategic perspective, including incentives to encourage public servants to undertake regular voluntary counselling and testing.
The UN Report on Human Security published in 2003, says in just two decades HIV and AIDS
has become the world's fourth ranking cause of death. Life expectancy now averages 47 years in Sub-Saharan Africa. The devastation caused by HIV and AIDS is being super-imposed on other crises, such as the ongoing drought and famine in Southern Africa. The burden of HIV and AIDS is overwhelmingly
concentrated among the poorest people in the poorest regions of the world. Poverty and infectious diseases are fellow travellers - each feeding on the other. The poor are at higher risk of infectious disease, and sickness can deepen poverty.
The South African Cabinet approved the Comprehensive HIV and AIDS Care, Management
and Treatment Plan for South Africa in November 2003, which included
the development of a Monitoring and Evaluation Framework. This framework
is designed to measure progress in the implementation of the plan, including
the issue of resources invested, the activities implemented, services
delivered and to evaluate outcomes achieved and the long-term impact
made. The Plan is anchored on the principles of universal quality care and equitable
implementation, the strengthening of the national health system, reinforcing
the key government strategy on prevention and providing a comprehensive continuum of care and treatment.
It is also anchored on sustainability, the
promotion of health lifestyles, the
promotion of individual choice of treatments, integration with the government
nutrition strategy, ensuring the safe use of medicines, the prevention
of drug resistance, and local and regional integration. The
Plan rests on two important pillars, prevention and treatment. Firstly prevention,
to ensure that the great majority of South Africans who are currently
not infected with HIV remain uninfected, and secondly treatment, to
enhance efforts in the prophylaxis and treatment of opportunistic infections,
to provide anti-retroviral therapy (ART) in patients presenting with
low CD4 counts, to improve functional health status and prolong life, to
integrate traditional and complementary medicine and to provide a comprehensive
continuum of care, support and treatment.
I am concerned that our people should not fall
prey to those who make unproven claims of
cures for AIDS. There is as yet no cure. We therefore appeal to all our people
to assist in ensuring that those who make such claims
are dealt with appropriately. We have procedures for scientifically testing
and registering all medicines through the Medical Research Council (MRC)
and the Medical Control Council (MCC).
As HIV/AIDS affects the lives of millions of
people in South Africa, a growing sense of urgency has developed about the need to respond to the epidemic, by increasing all efforts to scale up the HIV and AIDS prevention, care
and support programmes, including the provision of anti-retroviral treatment. This builds on the National Strategy on HIV and AIDS, which was adopted in 2000. The efforts to expand the response to the epidemic are bringing together government, business, non-governmental and community based organizations.
In seeking to improve our capacity to deliver
care and treatment, we must consider how we
are going to enhance our response to those who come forward asking
to be counseled tested and treated. We must not disappoint them. The mayors
have reported that our medical service is not responding well to these
people, many of whom have pinned their hopes on getting the drugs, which
our government has promised. Some of these people have to travel long distances
to get to our HIV ARV rollout sites and have to spend a lot of money
on taxi fares. This cannot be right. We must find a way to reach out to
them and to take the service closer to where they are. As
part of this effort to scale up our delivery of ART, and as part of
the Comprehensive Plan and to improve our systems, I have invited Professor Pierre Barker from the Institute for Health Care Improvement (IHI) to share their experience.
IHI has been working in South Africa since July 2004. The aim
of IHI is to work with local care providers to introduce sound disease management
and efficient practices to the health systems, including the systems
that deal with the AIDS epidemic, and to make the transition from palliative
care to chronic care in the era of ART.
We are privileged that Professor
Barker is here with us this morning to share the valuable experience
from IHI. As we gather to share experiences
and information, it is crucial that we assess
whether we are doing enough to ensure the success of the Plan to fight
HIV and AIDS. We must assess whether we have an adequate strategy for ensuring
equity in the implementation of the Plan. As former President Mandela
said at the 46664 Concert in Cape Town to raise funds for fighting the
epidemic, AIDS is no longer a health issue, it is a human rights issue.
It is a human rights issue if people who need treatment cannot get it
because they cannot afford the taxi fare to get to the treatment site. It is a human rights issue if babies are born with HIV
when it could have been prevented or are not
properly followed up and treated. It is a human rights issue
when people die because they are poor. It is a human rights issue when women
and children get infected with HIV as a result of rape and gender based
violence. As we consider these issues and we
look at our plans to combat HIV and AIDS, we
must speak candidly about the challenges we face in the implementation of the Plan. Our strategy will be enriched and strengthened if we agree that we need one
another, if we agree to forge strong alliances that cross all sectors
of our society. We need to hear the voices of those who are living with
the virus.
We need to hear the voices of those who are at
the forefront of the implementation of our
comprehensive plan. We need to hear the voices of
business people and the public sector that are losing skilled personnel. We
need to hear the voices of those who are straining under the burden of care.
As the struggle to defeat apartheid taught us, it
is best when the people we seek to free are
supported to be their own liberators. Murphy Morobe, the DDG
for Communications in the Presidency, has said, on accepting a petition at
parliament, it is right that the people living with HIV and AIDS should lobby government, be our conscience and help us
identify our blind spots. His Worship
Mayor Cele has said this Summit must come up with a coherent plan.
I want to now address some key implementation challenges.
In preparation for this talk, I visited some of
the sites in this District that are
implementing the Comprehensive Plan on HIV and AIDS. What I found was that
although there is a steady increase in the number of patients that are
coming to the sites for voluntary counseling and testing, the numbers of those
on anti-retroviral treatment are falling far short of the number of people that
need the treatment. There are challenges
posed by the strict criteria and guidelines used to determine
who qualifies to be on treatment. These include issues of disclosure,
adherence to treatment and the ability to foot the bill of travel
to the sites. I have been informed during my visits to the ARV rollout
sites that this has the negative effect of excluding many people whoneed the
treatment, most of whom are the poorest of the poor who for no reason
of their own making, live far from the sites. Linked to this is the challenge
of stigma, which hinders many from disclosing their HIV status. Another challenge is posed by the minimum criteria for the effective delivery of the
Comprehensive Plan, according to which adequate numbers of appropriately
trained doctors, pharmacists, nutritionists/dieticians, professional
nurses and counselors are required at the service points. This hinders
the speed at which the Plan is being implemented. We must find a way around
this problem, while ensuring that the requisite minimum standards of care
are maintained and we must accelerate the training of health personnel and
the volunteers.
There is an urgent need to simplify the process
of data capturing and the keeping of statistics. Much of the time of the management at health centres is
taken up by the present patient information system. Mechanisms are needed to improve data collection and flow mechanisms to ensure quality, validity and accuracy, while ensuring that we do not put a heavier burden on the already stretched hospital and clinic staff. Laboratory Services are an important element in the implementation of the plan. Monitoring quality assurance and efficient performance of the laboratory services have been incorporated into the M&E Framework. A key challenge
is to ensure that laboratories can deliver an efficient and fast service at all the sites. If a clinic has to wait a whole week to get blood test results, that makes their efforts to help the people more difficult. we are looking at improving the provision of
health technology at our primary health care sites, so that they can give a comprehensive service and attend to all chronic illnesses, including looking after patients who are on ARV
treatment. We want to encourage a situation where the management of HIV and AIDS will become
like that of any other chronic illness, like diabetes and hypertension. This will improve issues of access, equity and stigma. The stigma attached to HIV and AIDS has led to a situation where many do not want
to come forward and test for the virus, a situation where those who have
tested do not feel supported to declare their status. We need to encourage
people to know their HIV status. This will help in both the prevention
of the spread of the virus and in the treatment of AIDS. The stigma
can only be addressed through openness and involving all sectors of society.
We need more people to talk openly about the
disease, especially people living with AIDS.
For people to come forward for voluntary counseling and testing
and to volunteer for treatment, it is important that an environment of
openness and support is encouraged. To fight
the stigma we need strong, unequivocal leadership from the political, religious and community leaders, nurses and doctors as well as from the organizations working with and representing people living with HIV and
AIDS. If we say people who need help must be able to make informed choices,
we must not impose our own fears and doubts. There is much hopelessness
and resignation in many of our communities. We need to turn this
around and give the people the tools to be their own liberators. We must
show empathy and communicate a message of hope, by ensuring that they know
about the availability of treatment and by accelerating its rollout.
Women need special attention. A report released
by the UN at the international AIDS conference in Bangkok last year, acknowledged the intersection between gender inequality, poverty and HIV and AIDS. According
to the report women make up 57% of those living with HIV. Young
African women aged between 15-24 years are three times more likely to be
infected than their male counterparts. The report suggests promoting concrete
actions that address the reality of women's lives and help decrease their
vulnerability to HIV as the only way forward. The
report also stresses the importance of reducing violence against women, ensuring
greater access to HIV prevention and treatment services and protecting
their property rights. We have heard of cases of customary law widows
being thrown out of their homes and their property taken over by their
in-laws. The protection of the rights of women married under customary law
requires our urgent attention. Our Constitution recognizes customary marriages
and gives them equal status with those based on the modern western legal
system. Women married under custom have the same rights to inherit and own
property, as those married under western law.
As we gather here in this summit, we must look
at the issue of how we are going to be organized
in this district in order to succeed in stemming the tide
of the HIV epidemic. By coming together from so many walks of life, we recognize
the importance of working together. We need
the support of the people. It is encouraging
to see the amount of goodwill that exists among our people to
forge alliances in the fight against the HIV virus. The World Bank, South African
Business Coalition on HIV and AIDS and Standard Bank have joined hands
to launch guidelines for building business coalitions against HIV and AIDS
throughout sub-Saharan Africa. The success
in the implementation will be facilitated by a well-defined social
mobilization and mass communication strategy. This crucial strategy includes
external information, education and communication programmes. The specific
aim of this strategy is to ensure that all relevant government programmes,
health care providers, people living with HIV and AIDS their families,
care givers and stakeholders are fully knowledgeable about all the key
provisions and requirements of the plan as well as their respective roles
and responsibilities. It is the objective of this component to create a supportive and safe environment for people living with HIV and AIDS provided largely through educational programmes that address stigma and discrimination.
Community based groups members of churches and NGOs are needed to be trained as counsellors and caregivers so that they are able to provide comprehensive care and support. In order for the Plan to succeed, we need to establish a broad-based consultative forum at district level (the District AIDS Council), which will be
led by the Mayor. Further down, we could also from Municipal AIDS Council,
led by the Municipal Mayors. Building these councils from below will
help strengthen and give direction to the provincial and national AIDS Councils,
by providing valuable input from the ground, at the implementation level.
These councils will meet regularly to listen, get progress reports, identify
gaps in the implementation of the Plan and advice the District Council
on a new course of action where it is indicated. The Forum will feed into
related structures at provincial and national levels.In closing I wish to remind
this Summit of the need for urgency. I want to plead for openness. We have much to learn from one another. We should not seek to re-invent the wheel. We should be open to learning from the experiences and successes of others. Let Ugu District and KwaZulu-Natal lead the
fight against the HIV/AIDS epidemic.
We are becoming champions to save lives. Let us
turn the tide against this epidemic. The future depends on the actions we take now. I thank you and wish this groundbreaking initiative success.
Issued by: Ministry of Health
(Source: South African Governemnt Information, February
22, 2005)
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