National Strategic Plan for HIV, STI & TB & National Health Insurance, Minister & Department of Health briefings

Meeting report

Chairperson’s Opening remarks
The Chairperson welcomed the Minister and Department of Health, and encouraged Members to continue the hard work and energy they had displayed in the previous year, as well as taking good care of their own health.

National Strategic Plan for HIV, STIs and TB, 2012 to 2016 presentation
Dr Aaron Motsoaledi, Minister of Health, gave a short introduction to the National Strategic Plan for HIV, Sexually Transmitted Infections (STIs) and Tuberculosis (TB) for 2012 to 2016. He reminded Members that a previous similar plan had operated from 2007 to 2011, and had been successful, and the Department would outline the major differences between the two. He highlighted that in South Africa, as distinct from other countries, HIV and TB were treated as two very separate diseases, despite the fact that the number of South African people infected with both HIV and TB was the highest in the world. 22 countries in the world carried 80% of the TB of the world, and South Africa ranked as the first, with 60%, of people infected with TB. This, however, had dropped from its previous incidence of 73% infection. Countries like China and India were sitting with 5% and 1%. In the new NSP plan, TB was included as part of the responsibilities of the South African National AIDS Council (SANAC).  

The Minister said that some people had advocated that the name (SANAC) be changed to “The Council for HIV/TB”, but there had also been opposition to this, on the basis that it could cause confusion about the role HIV played in TB. 80% of South Africans who were HIV positive died from TB. The new National Strategic Plan (NSP) would try to link the two diseases more closely.

The second major difference between the previous and present NSP was that it was proposed that every person living in South Africa should be tested, at least once a year, for HIV. The HIV Counselling and Testing Campaign (HCT) had not been taken seriously enough, including by Parliament. 15 million people were targeted, but there were 50 million in the country.

Ms Precious Matsoso, Director General, Department of Health, noted that the provinces were involved in the review of the previous 2007-2011 NSP, and a review report had focused on what had been achieved by that NSP, including a review of the sector performance, which found that some had not performed as expected. From now on, every province would have an input into the NSP. The input had been done through the former SANAC secretariat, at national, provincial and sectorial levels.  on the development of the new NSP.

The new NSP for 2012-2016 processes were launched on World AIDS Day 2011. All provinces were provided with technical support for consultation on the NSP. The programme implementation committee would meet to review the implementation plan on 8 March 2012, and a plenary session would sign off the implementation plan on 15 March 2012. The plan would be officially launched on 24 March 2012, World TB Day.

She emphasised that the new NSP identified some areas that had not been given enough attention in the previous plan. These included the contribution of gender-based violence to AIDS. Women and children were separately profiled. The President had confirmed South Africa’s commitment to the cause of HIV, when he approved the new world targets for its reduction. The new NSP was to capture some of these targets for the fight against HIV. She reiterated that there was a co-mobility between the epidemiological profile of HIV and TB. This was a developmental issue. If there were insufficient interventions on HIV, this would have an impact on a number of other sectors, including agriculture and transport.

It was recognised that several institutional arrangements and provincial structures had to be strengthened to enable South Africa to win on the new NSP strategy. A strong devolution and evaluation system would be set up, and there would be constant research conducted to enable the making of informed decisions on the most workable and successful interventions.

The cost of the new NSP was not likely to be much higher than the 125 billion that was spent on HIV in the previous year. Moreover, much had been learnt from the previous NSP plan, so many of the interventions that had been found to work for HIV would now be put into practice, along new interventions, to redirect resources and allow for more useful interventions.

The proposed long term vision for the country, which was aligned to with UNAID and World Health Organisation targets, was a “four zero” approach with respect to both HIV and TB. This meant that there should be zero new infections from HIV and TB, zero preventable deaths associated with HIV and AIDS and TB, zero discrimination associated with diseases, and zero infections related to mother to child transmission. This last “zero target” was an initiative of South Africa itself, which did not appear in other international targets, but South Africa had already proven that it could reduce mother to child (MTC) transmission. The MTC transmission had already been reduced to 3.5%, and she said that a target of moving to zero was achievable.

The NSP had several baselines. Social and cultural barriers that fed the HIV rate were addressed. Methods that promoted prevention, care and treatment were introduced. Health and wellness would be pursued. The NSP sought to promote rights of those who were infected, and there would be an increase of access to justice for the marginalised groups, like women and children.  

The NSP aimed to reduce the HIV rate by at least 50% with combination of preventative approaches. In terms of treatment 80% of the patients would be initiated on Antiretroviral treatment (ART), and it was targeted that 70% would still be alive and on treatment five years after treatment was initiated. The numbers of new TB infections should be reduced, as well as the number of TB deaths, by 50%.

The NSP planned to reduce the rate of vulnerability of young children who were infected, by bringing down infection rates overall. Greater awareness to children in school would help bring down the infection rate too. There were aims to reduce the self-reported stigma and discrimination around HIV. Community systems would be strengthened. Efforts aimed at poverty alleviation and enhanced food security programmes would be supported.

The NSP also planned to increase the opportunities to testing to ensure that everyone in South Africa underwent voluntary testing for HIV, and was screened for TB. Where necessary, people would be enrolled in relevant wellness and treatment, or care and support programmes/

The NSP also aimed to provide greater access to different sexual and reproductive health (SRV) services. Once again, Ms Matsoso mentioned the efforts to reduce the MCT of HIV, aiming initially for a reduction to below 2%, and eventually to 0%.

Community education was very important. Those who had been sexually abused would be counselled, and services provided for survivors of sexual abuse.

Other disabilities, such as blindness, from HIV related diseases, also required attention. This would entail not only access to services, but also community engagement to ensure that more people were responsive to those with disabilities. In relation to human rights and access to justice, she noted that South Africa’s strong Constitution already focused attention on the vulnerable groups, so a legal framework of the NSP that respected, promoted, and fulfilled rights of vulnerable groups was in place. SANAC would work with all institutions that dealt with human rights and with any form of discrimination with respect to HIV and TB.

Another new initiative was that South Africa should seek to manufacture and produce its own ARVs, along with putting more people on treatment.

Ms Matsoso noted that the NSP that would be distributed to provinces would be translated into all the local language, where the previous NSP had used only two languages.

Finally, she tabled statistics for the strategic objectives, costs and finances, NSP launch, communication strategy, NSP products and preparing for implementation (see attached document: “Core Impact Indicators”).

Minister Motsoaledi stated, in conclusion, that the focus of the new NSP would lie not only with its launch, but, more importantly, with its implementation, and it would be monitored periodically, instead of only at the end of the five-year term.

Discussion
Mr W Faber (DA, Northern Province) asked how children would be tested, from a legal point of view.

Dr Motsoaledi stated that there could be legislative provisions around the testing of all South Africans. To date, the testing had been voluntary and it was found that when the HCT campaign was launched, a number of children wanted to have themselves tested. Within three months, most of those being tested in KwaZulu Natal were children. He pointed out that many children were born HIV-positive, without their own actions contributing to this status, and for this reason it was beneficial that everyone should be tested to ascertain their status. A task team had been formed, and it had agreed that children should be tested in school, so the new NSP spoke to establishing testing facilities in schools.

Mr Faber asked if drug usage was likely to be a prime contributor to HIV.

Dr Motsoaledi conceded that drug users were amongst the four high-risk profile groups for becoming infected with HIV, particularly if they were intravenous drug users who shared syringes. This was why it had been suggested, at the World AIDS Conference in Vienna, that drug users be given free syringes.  Other high-risk groups were sex workers, men who engaged in sex with other men, and long-distance truck drivers.

Mr M De Villiers (DA, Western Cape) asked what the connection was between HIV and TB.

Dr Motsoaledi answered that someone who was infected with TB would not necessarily also have HIV. However, a person who had HIV was far more susceptible to being infected with TB. A drug had been produced for those who were infected with HIV, to reduce the likelihood that they would also be infected with TB. So far 100 000 HIV positive people have been targeted for administration of that TB-preventative drug. It was for this reason that the two categories of diseases were seen as needing to be treated together.

Mr De Villiers asked what the capacity was in SANAC.

Mr De Villiers enquired about recently reported problems in the provinces.

Dr Motsoaledi said that there had recently been a crisis in KwaZulu Natal and Gauteng, in relation to the National Health Laboratory Services (NHLS). When the NHLS was established, KwaZulu Natal initially opposed using it, but then paid only on a capitation amount. When the issue devolved into a dispute, a retired judge was called in to arbitrate and his ruling was expected by the end of February. Gauteng was the largest province in terms of numbers of tests done. If the NHLS did not operate in Gauteng and KZN, this was likely to account for most of the deaths in the country

Mr De Villiers asked about the patent implications if South African pharmaceutical companies were to produce ARVs.

Ms Matsoso responded that South Africa constituted 25% of the global ARV market, hence 25% of the products used were already subject to patents.

Mr S Plaatjie (COPE, North West) asked whether the department and government had sufficient resources to implement the new NSP.

Dr Motsoaledi said that South Africa could not ignore the reality that if it did not afford sufficient funding to address HIV and to reduce new infections, there would be severe effects on the economy.  All possible resources would be put into the fight against HIV.

Mr Plaatjie asked if there was any scientifically proven link between HIV and poverty.

Ms W Magkate (ANC, North West) noted that more black people than white people had HIV, and asked whether the conditions in which so many of these people lived influenced their disease-risk.

Dr Motsoaledi explained that every disease was linked to socio-economic circumstances. Infections were higher in areas where hygiene was poor. There was, therefore, a connection between poverty and TB. However, it was the conditions in which people lived, and not their racial grouping, that would affect their susceptibility.

Ms Makgate was happy to hear the plans for public education.

The Chairperson thought that more facilities should be provided to schools with higher numbers of children who had been orphaned because of HIV.

The Minister responded that the issue of orphaned children was to be taken care of, under the school health programme.

The Chairperson asked how the Department would manage the researchers who came into the country to do research on HIV, and who would not give feedback to the public on the research results.  

The Chairperson asked if those who were to be licensed to produce ARVs were likely to include traditional healers, who were consulted by many people.

The Director General responded that in the past, efforts by the United Nations had included input from traditional healers. However, before anyone would be licensed to produce the ARVs they would need to meet a series of requirements. Firstly, the chemical substances in the allegedly effective drugs would need to be obtained and subjected to laboratory testing. The way in which the producer or traditional healer worked would be interrogated, and permission would be granted against a set of conditions.

Ms M Moshodi (ANC, Free State) asked whether the Department of Health would reach out to the rural people, especially people on the farms.

Dr Motsoaledi responded that the new NSP would include and assist farm dwellers.

The Committee’s Content Adviser commended the Department of Health on the new NSP, commenting that it would help to address the social and structural barriers that affected HIV/AIDS. She asked whether the Department would have a coordinating structure for the activities of the various provinces.

Ms Matsoso responded that systematic and mathematic methods were used to compile data in different provinces.

Proposals for National Health Insurance (NHI): Minister’s introductory briefing
Dr Motsoaledi gave a very brief outline of some of the reasons behind the proposed National Health Insurance scheme. Some of the significant medical issues that South Africa faced were caused by excess body weight and obesity, lifestyle, including alcohol consumption, and crime. He emphasised that many hospitals were benefiting unduly from the services, many of them completely unnecessary, which were being offered. He cited one example, where a dentist had insisted that it was necessary to do a root-canal treatment on a boy of 10 years old, and had charged his parents R200 000 for this work. The primary reason behind this treatment was the money, and not the welfare of the child. This was but one instance of money that was being spent on medical care that was really not necessary. South Africa was increasingly faced with uncontrolled commercialisation of health care. He said that the National Health Insurance (NHI) was intended to bring about reform in the health services that would improve the provision of service. It would bring down the exorbitant costs, and would promote equity and efficiency so as to ensure all South Africans had access to affordable, quality healthcare services regardless of their socio– economic status.

More details on the estimated figures and more details on the NHI were printed in the Government Gazette of 12 August, No 34523.

The Chairperson said that a separate meeting to pursue discussions on the NHI would be arranged, and a hard copy of the Minister’s presentation would be circulated to allow for further discussion.

The meeting was adjourned.