In November 2003, the National Department of Healths Operational
Plan for Comprehensive HIV and AIDS Care Management and Treatment for South
Afric was released publicly. The Operational Plan details a multi-sector
response to the pandemic. It specifically recognises the critical role of
antiretroviral drugs (ARVs) in the treatment of people with HIV/AIDS and aims to
ensure free, universal access to ART through the public sector. The Plan aimed
to establish at least one service point in each of the countrys 53 health
districts by the end of the first year of implementation. Implementation is
largely the responsibility of the nine provincial Departments of Health with
support in key areas from the National Department of Health.
It is estimated that in 2004 about 500 000 South Africans had
AIDS defining illness and were in need of life-saving antiretroviral therapy
(ART). It is envisaged that within five years, all South Africans and permanent
residents who require care and treatment for HIV and AIDS would have equitable
access to this treatment.
As part of this research project, telephonic interviews were
done with representatives of HAART sites across the country. The largely
quantitative data from these interviews was supplemented by meetings with
representatives within national, provincial and local government, and clinicians
and researchers across South Africa. This information has been collated in a
database and provides a picture of progress made towards achieving the
objectives of the Operational Plan.
Covering 75 facilities which provide HAART to 10 181 patients in
the public sector, information collected in this database demonstrates a clear
trend towards rapid scaling up of treatment availability. Individual patient
benefits, along with a marked impact on staff morale and a renewed positive
approach to health care delivery were also observed. It is encouraging to note
that in the majority of cases the introduction of ART services has not weakened,
but has strengthened the drug supply and management system.
Support services, specifically those from laboratories, are
generally functioning well, although the sheer quantity of testing and
diagnostics and monitoring requirements will severely test their capacity in the
near future. Data collection to inform both patient and programme monitoring
remains fragmented and weak. Significant resources must be dedicated to
strengthening approaches to Monitoring and Evaluation.
There is a clear trend towards greater availability of treatment
for urban-based adults compared to adults in rural areas, while children are
under-represented and pushed to the back of the queue.
While positive progress is evident, the sheer magnitude of the
HIV epidemic results in demand for treatment continuing to outstrip supply.
Successful integration of ART services with other essential programmes such as
TB and PMTCT remains limited, resulting in resource inefficiencies and lost
opportunities to improve treatment outcomes. Options for further integration
with other primary health care services need to be established to facilitate a
continuum of care.
The continuing absolute shortage of key professional staff
compounded by too few support staff requires that greater attention is given to
improving staff management and supervision systems, training of staff, and a
review of the existing scope of work for each staff cadre. It is essential that
existing staff are utilised most effectively, while every effort to improve job
satisfaction and the working environment must be made. Options of developing new
cadres that are less attractive to poaching countries, but relevant to
South Africas needs should also be investigated. The long awaited strategic
human resource plan may address some of these issues, but it remains unclear
when and how this is to be developed.
Community level partnerships remain limited and greater effort
is required to build relations between government departments, medical
facilities and civil society. An improved understanding of current and potential
roles of community based structures is needed. Patient support, through
community outreach and support programmes was acknowledged as crucial by a
number of respondents. Such programmes are at risk unless significant resources
are committed.
Extensive partnerships with national and international
organisations as funding agents and as providers of technical support have
flourished. These require constant monitoring to ensure that the benefits of
such partnerships are exploited, while avoiding possible pitfalls. The
opportunity to design and implement a strategic research agenda at national and
provincial levels remains to be capitalised on, while a national prevention plan
and alternative testing policies need to be evaluated to keep pace with the
changing needs of the population and health services.
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