The matter was raised by the Treatment Care and Support Technical Task Team (TTT) which tabled a document with recommendations for our consideration. These recommendations for action and the recommendations from the subsequent PIC discussions were noted by the director-general (DG) for health.

The DG undertook to take this as strong advice from the PIC and to produce an action plan to urgently address this matter for discussion with the deadline of Monday, 9 February. The DG noted that he would discuss this matter with the minister of health prior to presentation of this plan.

Following a number of discussions between role players over the weekend, an action plan was agreed to during a conference call on 9 February. The following people took part in the call: Thami Mseleku (chair of PIC), Helen Rees (co-chair of PIC), Mark Heywood, (SANAC deputy chair), Yogan Pillay (DDG, Department of Health), Ashraf Coovadia (Treatment, Care and Support TTT Chair) and David Kalombo (Department of Health HAST directorate).

On the call the following was noted and agreed to:

1. The Department of Health will continue its ongoing discussions to urgently source ARV drugs from the pharmaceutical companies. In addition to these efforts the DG is having discussions with other provinces to see if supplies can be sourced from elsewhere to speed up this process. The aim is to get ARV supplies to the Free State within a couple of weeks or sooner if possible.

2. The Department of Health will identify a source of funding to cover the shortfall in expenditure for ARVs currently being experienced by the Free State.

3. Discussions are ongoing to address the projected shortfall in budgets for the ARV programme that will be experienced by all provinces in 2009-2010. This includes discussions with bilateral donors. The minister of health has personally involved herself in these discussions. It was noted that with the increase in the number of accredited sites, and the possibility of down referral and nurse treatment being expanded, the shortfall is likely to get larger.

4. Noting that there are about 15 000 patients now waiting to be initiated on ARVs in the Free State, the document produced by Dr François Venter on the "Expedited referral of patients for ARVs", will be distributed to the Free State, and Dr Coovadia and Prof Rees will offer support to the province to implement these recommendations. The aim is to identify the sickest patients for urgent treatment.

5. A communication plan to let medical staff, patients and the communities know what is happening will be implemented by the Free State.

6. A follow up call between the same role players will be held at 4pm on Friday, 13 February to monitor progress.

The spirit of the discussions between all the role players was good, with everyone committing to finding solutions. We will continue to send you feedback on progress.

Issued on behalf of:
Thami Mseleku,
SANAC PIC chair and director-general for health, Department of Health, Pretoria

Prof Helen Rees
SANAC PIC co-chair and executive director of the Reproductive Health and HIV Research Unit, University of the Witwatersrand

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