| Government and business forge new social compact on HIV/Aids responses |
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Senior executives from the private sector and government leaders met to discuss the way forward in tackling the HIV/AIDS epidemic, at a South African National Aids Council (SANAC) plenary meeting.
Present at the meeting was Deputy President Kgalema Motlanthe; Minister of Health Dr Aaron Motsoaledi; Deputy Minister of Basic Education Enver Surty; and the chief executive of SANAC, Dr Nono Simelela; among others. SABCOHA's chief executive, Brad Mears, called the meeting a "watershed event". It was held on held on 25 November in Johannesburg. Motlanthe said that there was still much work to be done in relation to HIV/AIDS and the objective was to ensure a more dynamic interaction. He pointed out that incidence levels remained very high, while understanding or knowledge of the epidemic was virtually zero. Messages conveyed created deep confusion with regards to behaviour, conduct and what kind of intervention was effective. "The Minister of Health is focused on getting the health system better able to respond to this challenge," he said. Motsoaledi said there was a plethora of statistics, some of which were very disturbing - KwaZulu-Natal, Mpumalanga and Free State always had the highest incidence rate, while Western Cape was always the lowest. HIV among pregnant women was greater than 40%. Incidence in Eastern Cape appeared relatively low, but there could be other reasons for that. The recorded funeral deaths graph comparing South Africa to Brazil since 1994 was particularly alarming, showing the increase in mortality in just seven years. The minister quoted statistics from Lancet, an internationally renowned medical publication. The magazine reported that South Africa was going through four pandemics: it carried 5% of the global TB burden, 17% of the global HIV burden and 1,3% of the injury and violence burden. The HIV and TB co-infection rate was 73%, equal to 1% of the South African population, while TB treatment capacity in KwaZulu-Natal and Mpumalanga was 40%. In the rest of the country it was 60%; the international target was 85%. 34,6% of absenteeism at work was because of HIV and TB. According to both public and private hospital files, there were 75 000 deaths under five years of age, 57% of those because of HIV. The Independent Electoral Commission's comparison of the Department of Home Affairs with the voter's roll recorded 396 336 deaths between 1 September 2008 and 31 August 2009. Controversy still surrounded the Department of Home Affairs death register, which reflected 756 062 deaths for 2008. There was a likelihood that 2007 figures could have been underreported. He said that regardless of the figures, this called for "the dawn of a new era, one of responsibility and accountability and action. Increased VCT and massive behaviour change is required and this is where business comes in." Motsaledi explained that a ten-point plan was being drawn up to:
Mears said that what business would like to get out of the meeting was not only to support the government's World AIDS Day initiative, but ongoing dialogue over and above the business-as-usual engagements. "Additionally, there is a need to create AIDS competent communities. There are pockets of excellence and the private sector is willing to share and/or learn from the government. We should identify short-, medium- and long-term outcomes. There are businesses that are willing to support the uptake of VCT/HCT. "SABCOHA developed the Private Sector Policy in early 2007 based on the four zeros. Our objectives can only be met with profound leadership, if the private sector wants to treat, then it must also report. How can companies contribute towards strengthening the health system in South Africa? How do we scale up funding? With US$108-million having been unlocked from the Global Fund, the percentage of funding benefiting the private sector is miniscule. "Round 10 Global Fund applications should include increased corporate participation. Sharing of human skill, capacity and competence should be considered, for example secondments and local level to SANAC. Doors and opportunities need to be opened up at provincial level," Mears said. Regarding sector responses, Mears said financial services and motor manufacturers had come a long way, whereas the construction and transport sectors needed to do more. The private health care sector comprising medical aids, hospital groups, disease management services and general practitioners had capacity and willingness to support the government. Disease management services should be called upon to report on what they were doing and what general practitioners treated. "At the same time, the private sector is not uniformly well resourced. Certain sectors are vulnerable and need support from the government, not only from the Department of Health but also from the Department of Trade and Industry, as an example. The private sector has trained more than 6 000 micro enterprise owners. Small and medium enterprises are strategically well positioned to extend the government's condom distribution initiative. Existing initiatives would lend themselves for scaling up," Mears said. "The sectoral response within business has done reasonably well. There are pockets of excellence which need to be expanded and extended. Certain sectors still need to scale up and the objective is to create sectoral leads. With the 2010 FIFA World CupTM around the corner, the tourism and hospitality sectors in particular need to be adequately prepared. Current blockages affect quality, efficiency and M&E. "SETAs are unfriendly towards capacity building with regards to HIV. Health insurance funding requires dialogue. There is a great need to change behaviour in this country. HIV and TB present the biggest burden. If the infection rate is not curbed, the situation becomes unsustainable. "Conflicting policies need to be avoided, for example the Department of Health, Department of Social Development and Department of Labour have counterproductive and contradictory policies. NEDLAC is regretfully dysfunctional, but would be an ideal structure for dialogue if it translates into tangible results at provincial and district level, where business finds meaning. This has been demonstrated with SABCOHA's Northern Cape Provincial Strategy, which is implemented at provincial and district level. "Creation of a new social compact needs to come from the government, as it has to create the space for business to buy into. Leadership needs to be demonstrated and partnerships need to be enabled," he added. Recommendations for the way forward were:
In conclusion, Mears said: "We have the preconditions for an explosion of the epidemic in addition to high levels of unemployment that need to be addressed." The deputy president thanked the presenters for their inspiring presentations. Questions raised at the meeting included:
The Minister of Health acknowledged that sustainability did place extra strain on resources and that it was tricky not to treat because of sustainability as people were dying in large numbers. Early treatment created savings elsewhere and, according to the World Bank, it did make economic sense to treat. He said the government planned a massive prevention drive and that SANAC had put together a team including representatives from business to determine the "how to" of a massive testing campaign. This was targeted at all ages between 15 and 80, about 28 million people. All were vulnerable and at R15 each, it would cost at least R400-million to test everyone. "This cannot be achieved with health personnel only and all sectors on SANAC will be engaged somehow. It will have to be done with military precision and an audit is currently in progress to determine requirements. AIDS fatigue should be mitigated by the government's new energy and vigour and should help the VCT campaigns," Motsoaledi said. Dr Simelela reiterated that HIV was not a health issue. A paradigm shift was required to address the broader issues and there needed to be ownership of the response. The private sector was called upon to undertake internal interrogations and exhibit willingness to provide without expectations of a direct return. Business was an extension of the country's leadership and the provinces claimed that there was an inability to access the private sector. Dialogue was required to agree on deliverables. Business sectors also needed to call on one another to do more. Developments at SANAC called for senior skilled staff to be seconded as soon as possible. The Department of Health and business were to nominate small groups of people to work on concrete issues in a defined timeframe for report back to SANAC, she said. In summing up, agreement was reached on strategic leadership and a new social compact. All sectors will have to participate, and not only the deputy president can convey the message. Everybody has a role to play, even if it means that business has to go to remote villages to test. Business welcomed the suggestion for a small number of business representatives to engage and nominated Mears as the primary contact. The government will decide who will be operationally involved. The private sector needs to know what skills are required to keep the momentum going. Motlanthe thanked everyone for their contributions, agreed to co-ordinate the various stakeholders and stated that it would not be the last of such engagements. He would like to understand how the various business sectors developed their own programmes and how they could be integrated with the provincial, local and district AIDS councils to affect this epidemic. - By Les Tilley Presentations:
Click here to view Brad Mears presentation:
Click here to view the Minister of Health's presentation: Related articles: World Aids Day - 1 December 2009 Finally, a World Aids Day to remember US gives R900m for ARV treatment Deputy President announces $108m grant for HIV prevention projects |
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