South African National Aids Council: Department briefing

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Health

20 August 2007
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Meeting report

HEALTH PORTFOLIO COMMITTEE
21 August 2007
SOUTH AFRICAN NATIONAL AIDS COUNCIL: DEPARTMENT BRIEFING


Chairperson: Mr L Ngculu (ANC)

Documents handed out:
Progress report: SANAC and NSP Implementation: PowerPoint Presentation

Audio recording of meeting

SUMMARY
The Director General of the Department of Health briefed the Committee on the progress of the South African National Aids Council (SANAC) and the National Strategy Plan implementation. SANAC had been formed in 2000, but a new SANAC was launched in April 2007, with a new three-tier structure to improve its efficiency. Membership was split between various listed Departments and broadly based non government organisations and groups. Its first meeting was due on 10 September 2007, and would consider implementation plans for all sectors, coordination of donor support and the monitoring and evaluation framework. The Programme Implementation committee would meet on 27 August to confirm terms of reference and constitute the technical task teams. The SANAC Trust Board would meet in October to approve the activities of sectors to be funded through the Trust. The post of Head of the SANAC Secretariat was currently under advertisement. The National Strategic Plan was endorsed by all sectors in April 2007 and would guide all sectors in their response to HIV and Aids. Communication activities had been set in motion and key messages had been developed. The Khomanani campaign would continue. A multi-sectoral team of experts in monitoring and evaluation was working on a framework to be presented for endorsement at the September meeting. A detailed costing exercise was under way. Civil societies were at various stages in the development of their implementation plans and technical assistance was being offered to them. Challenges included delays in preparation and implementation of plans by civil society and the need to build capacity to implement, monitor and evaluate.

Members raised concerns on the funding, and sought clarity on what SANAC had been implementing since March, an outline of the community services that were planned, and the role and function of the Global Fund in relation to SANAC. A number of questions were asked around funding of sectors, whether government would be able to contribute if funding was not raised, and the role of the SANAC Trust. Questions were also raised on donor approval and procedures, the reasons why World Bank offers for funding of Antiretroviral treatment had been turned down, the impact of the sacking of the Deputy Minister on the National Strategic Plan, and the position of the trustees. The composition of the NGO sector representatives, the identity of donors, whether there would be full representation at the September meeting, and the challenges in monitoring and evaluation were questioned. The continuity of programmes was also discussed.

MINUTES
South African National Aids Council (SANAC) Progress Report: Briefing by Department of Health (DOH)
Mr Thami Mseleku, Director General (DG), Department of Health, gave a general overview of the progress of the South African National Aids Council (SANAC) since its launch. He indicated that SANAC had been formed in 2000, replacing the Inter-Ministerial Committee on AIDS (IMC), which was at the time the highest level political body that provided any form of guidance and political oversight on HIV and AIDS. The new SANAC was launched in April 2007 with a new three-tier structure so as to improve its efficiency. At the date of launch not all civil society sectors were represented, but the government had supported some sectors to elect representatives, and the membership now included the Ministries of Education, Health, Social Development, Correctional Services, Minerals and Energy, Public Service and Administration, and Transport. Non government sectors were broadly based, and were fully listed.

SANAC was due to hold two meetings a year, with the first meeting being due on 10 September 2007, when it would consider implementation plans for all sectors, coordination of donor support and the monitoring and evaluation framework. The Programme Implementation committee would meet four times a year, with its first meeting on 27 August to confirm terms of reference and constitute the technical task teams. The SANAC Trust would secure funding and promote and facilitate the execution of functions. SANAC had decided in May 2006 to conduct a review of its operations and the Board's support had awaited the conclusion of that review. The Board would meet in October to approve the activities of sectors to be funded through the Trust.

The SANAC secretariat, in order to efficiently support the Council, needed to have the necessary human and financial resources. The Head of Secretariat would be at Chief Director level, and the post was currently under advertisement.

Mr Mseleku noted that the National Strategic Plan (NSP) for 2007-11 was endorsed by all sectors in April 2007, and would guide all sectors in their response to HIV and Aids. It maintained the four key areas of the 2000 - 2005 strategic plan;  Prevention, Treatment Care and Support, Research Monitoring and Surveillance, and Human Rights and Access to Justice. Government was well organized to discharge the responsibilities in the NSP, and departments had engaged with this plan and understood what needed to be done. The situation was on track. Communication activities had been set in motion and key messages had been developed. The Khomanani campaign would also popularize the details of the NSP, and there would be activities at community level.

The Department of Health had convened a multi-sectoral team of experts in monitoring and evaluation to develop a framework, which would be discussed at a stakeholder consultation workshop in September. The final draft would be presented for endorsement by SANAC on 10 September. A detailed costing exercise was under way. Civil societies were at various stages in the development of their implementation plans and technical assistance was being offered to them.

Mr Mseleku concluded that there were still two challenges faced through delays in preparation and implementation of plans by civil society and the need to build the capacity to implement, monitor and evaluate.

Discussion
Ms M Madumise (ANC) asked for explanation of the acronym UNGASS.

The Chairperson replied that UNGASS stood for the United Nations General Assembly Special Session.

Mr Mseleku added that this was a special session called by the United Assembly. At its most recent sitting it had issued a declaration calling for targeted programmes, and had discussed matters in which SANAC was currently involved.

Ms Madumise asked why SANAC had not yet implemented anything since its new inception.

Mr Mseleku replied that what he had described in the report was what had been implemented since March 2007. SANAC had decided to work on its structures first, from the top high-level structure down. It had also decided that from March to September 2007 it would establish the various other structures agreed upon, and ensure that those structures developed business plans for the NSP,  so that when the high level structure convened in September it would be able to adopt the plans. He stressed that there had been day to day progress on implementation, and it was quite an involved process that would require more time to discuss in depth. He emphasized that the work of NSP was ongoing.

Ms Madumise asked for an outline of the community services that were planned by SANAC.

Mr Mseleku replied that Khomanani at community level was an extensive subject. The previous Khomanani campaign had embarked on activities such as teaching, prevention and care and it also had youth groups working in youth-friendly clinics. These community services and additional new services would be continued by the new Khomanani programme.

Mr M Waters (DA) asked who funded the sectors that had contributed representatives, and what was the cost of the funding.

Mr Mseleku replied that the sectoral activities were government funded. Since the Trust which was meant to fund SANAC was still waiting for SANAC's decisions on 10 September, it was not presently funding any activities. Therefore at the moment the burden fell upon government to restructure SANAC and fund its interim activities. He was not able to name a figure presently for that cost.

Mr Waters asked for the number of people that served on the Global Fund, and who appointed them. He noted that the Chairperson of the Fund was the Minister.

Mr Mseleku replied that he thought there might be some misconceptions that he would like to clear up. Firstly, the Minister neither chaired nor was a member of the Global Fund. SANAC’s previous responsibility had lain in being the Country Co-coordinating Mechanism (CCM) of the Global Fund, since that Fund had insisted that any proposals to it should come from a CCM. The CCM was effectively a partnership between government and the civil society. Because SANAC had been represented as a CCM, the Deputy President had chaired the meetings, and discussed budgets and proposals from the provinces and the various sectors. This had been a rather ineffective structure, and it was then decided to create the National Resource Mobilization Committee,  which was chaired by the Minister of Health, and which consisted of SANAC members, which of course would include both government and civil society. This Committee had met once to discuss the global fund.

Mr Waters asked whether it was the Minister or a separate committee that would deal with donation approval. He also asked for the elaboration of the process when acquiring donations. 

Mr Mseleku replied that with regard to fundraising the meeting on 10 September would be looking at the rules that should govern this approach, and how SANAC should seek donations. This would include discussion on the potential donors to be approached, the rules around acceptance, and the reasons and rationale behind any of the rules to be made on donor funding. The role of the Committee would be to implement the SANAC decisions. The approval of donations would rest squarely in the hands of SANAC and not the Minister.

Mr Waters asked whether the sacking of the Deputy Minister had had any impact upon the National Strategic Plan.

Mr Mseleku replied that it had had no effect at all on the NSP.

Mr Waters asked if Dr Xundu, Chief Director of the HIV and Aids programme at the Department of Health, would remain in her post.

The Chairperson remarked that he did not understand the relevance of the question, but Dr Xundu was present at this meeting.

Mr Mseleku replied that Dr Xundu, like any other civil servant, had the right to decide if and when she might choose to leave her post. At the moment she retained her position. She should not be subjected to any pressure one way or the other.

Mr B Mashile (ANC) asked if SANAC had enough capital to be able to start functioning as from 10 September, and whether it was intended that the Department of Health would be able to support SANAC until it had acquired donor funding.

Mr Mseleku replied that the initially the Trust was created by a donation from the government. These were the funds referred to by the Auditor General, who had commented that they were accumulating interest instead of being used to implement programmes. SANAC would be using these funds, which amounted to R34 million, to finance all its activities after 10 September. However, the funds were not sufficient to enable implementation of plans of the various sectors. As a result the was need for the Resource Mobilisation Committee must supplement those funds.

Mr Mashile asked if the SANAC trustees were still in place, relevant and available.

Mr Mseleku replied that the trustees were still available and very much relevant in the caretaker position. The aim was that no political members should be trustees, but at the moment the composition of the Trust could not be changed, until the higher level restructuring was completed. There were proposals on how to restructure the trustee positions so that they became fully representative of SANAC. Furthermore it was aimed to move away from the current situation where the Deputy President had to answer to the Director General in relation to SANAC activities.

Ms M Matsemela (ANC) reiterating her hope in the new SANAC structure, She asked whether there was any progress in provincial, district and municipal areas.

Mr Mseleku replied that this was a matter still to be dealt with. It was agreed that the restructuring would first take place at national level first and then there would be discussion on how to deal with the provinces. Certain provinces had regulating legislation whilst others did not, and it would be necessary to decide whether to adopt an umbrella approach, or whether to deal with each province separately. 

Ms Matsemela asked whether the global fund had assisted in any way in the issues of HIV and AIDS, considering the fact that the Board of Trustees was not currently functioning and was not currently funding SANAC.

Mr Mseleku replied that the Trust had its own funds. The global fund issue related to the fact that if the global fund approved any proposal, then the money was to be transferred through the country processes. Funds could come from the global fund and go through National Treasury to the respective organisations that would have had their proposals approved. SANAC reported on the processes and the implementation of the business plans of the global fund but National Treasury would account for the money received from the global fund for transmission to the identified recipients. The two were not linked and would not be linked.

Ms S Kalyan (DA) asked if any opposition parties were included in SANAC, and if not, what was the reason for the exclusion.

Mr Mseleku replied that SANAC did not represent membership by any political party, either ruling or opposition parties. Parliament, which comprised representatives of all political parties, performed oversight on all structures, including SANAC. If there were to be parties represented specifically in SANAC, then Parliament would be both player and referee. The separation of powers was ensured by having members of civil society and government accountable to parliament.

Ms Kalyan asked why the Department of Health had refused funding aid from the World Bank for the rolling out of anti retroviral treatment (ARV).

Mr Mseleku replied that the National Treasury, in responding to this issue, had articulated the reasons why this funding was rejected. The main reason was that the Ministry of Health was not in the job of fundraising or funding. The lending and borrowing of money was a prerogative led by the National Treasury and it must retain its ability to choose whom they should be able to approach for funds. Further clarity on this matter could be obtained from National Treasury. SANAC would not be able to deal with the issue if they had nothing to do with the funding coming from the World Bank.

Ms Kalyan asked if there was any continuation of any programmes from the old SANAC. She commented that she did not know why the new SANAC was only confirming its terms of reference so late, as this should have been done at the launch of the new SANAC.

Mr Mseleku replied that there was continuation of the work with the global fund, as well as continued implementation of programmes on the ground. Issues of prevention and awareness were continuing. If members wanted specific details on the continuity aspects he suggested that there could be a separate meeting to deal with this.

Ms Kalyan asked for composition of the non-government sectors. The presentation had referred to men and women only, but had not given a detailed explanation as to whether these represented people living with HIV or AIDS, nor whether the Treatment Action Campaign was included.

Ms Kalyan asked for the names list of some of the donors.

Mr Mseleku replied that currently there were no donors for the new SANAC, so it was currently impossible to produce a list. The only coordination at resource level was that of the global fund, which was currently the only source of funding for the new SANAC

Ms N Mathibela (ANC) asked if all the sectors were going to be represented at the meeting on 10 September. She was concerned that although technical assistance was provided to various sectors, only two had managed to submit anything.

Mr Mseleku replied that the technical assistance had indeed been provided, some to organizations that were still trying to start up, and some to assist with credibility problems. This technical assistance also included assistance on processes, and a challenge was to ensure that the right people attended the right meetings to elect the right representatives, to avoid any claims that certain groups had been excluded. SANAC only helped to facilitate issues but it did not choose the representatives to be invited. Only two sectors had confirmed that they would be ready for 10 September. This did not mean that the other sectors would not be present, nor that they would not be ready. This would be checked during the meeting of 27 August.

Ms N Nkabinde (UDM) asked if there was any training given to empower the people that became members of SANAC.

Ms M Manana asked for clarity on the Departments that formed part of SANAC. Although the presenter had mentioned two departments, he had then named only one as Public Works.

Mr Mseleku apologised that he had mentioned two, for he was only aware of Public Works. He was trying to make the point that the principle of co-option was available.

Ms Manana asked if there were any programmes that were addressing the challenges mentioned, particularly on monitoring and evaluation.

Mr Mseleku replied that SANAC was already working on these issues identified as challenges. The delays from sectors in implementing programmes according to agreed time frames had been dealt with. Challenges in capacity, monitoring, evaluation and implementation were general problems that plagued South Africa generally. Both NGOs and government had problems in staffing. The government was presently implementing a programme to deal with capacity issues at all levels. This sought to put in place the numbers required to facilitate the implementation of the programmes, and there were training programmes for educators and the health sector. Government was also funding NGOs to build capacity. This was an ongoing challenge that had to be continuously addressed.

Mr Mseleku added that monitoring and evaluation were new issues. An M & E framework had been included now for the first time in the NSP and SANAC, and it would be necessary to find capacity to carry out the work so as to produce concrete and tangible information for planning and implementation. The challenge was compounded by shortage of skills in drawing and analyzing data, although there were programmes to address this at government and NGO level. SANAC would have to adopt its own programme for capacity building for the particular sectors as needed.

Mr Mashile asked what would happen if the relevant sectors failed to raise funds in time, and whether government could provide interim funding.

Mr Mseleku replied that most of the sectors had their own funding but there were exceptions, such as the youth sector that needed help in mobilising resources to reach its goals. This sector obviously needed more assistance than the business sector that was generally able to generate its own funding.

The Chairperson asked for clarity whether the President and senior members would be at the high level structure meeting.

Mr Mseleku replied in the affirmative, but added that some members were yet to be confirmed. The Chairperson, who was the Deputy President, was the only designated person. A proposal that the Chairperson could be a civil society representative would be discussed.

The meeting was adjourned.


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