National HIV/AIDS Treatment Plan: briefing by NEDLAC & Government

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Health

18 March 2003
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Meeting report

HEALTH PORTFOLIO COMMITTEE
19 March 2003
NATIONAL HIV/AIDS TREATMENT PLAN: BRIEFING BY NEDLAC & GOVERNMENT

Chairperson:
Mr L. Ngculu (ANC)

Relevant document:
NEDLAC Framework Agreement on a National Prevention and Treatment Plan for Combating HIV/AIDS


SUMMARY
The Treatment Action Committee disrupted the Committee's proceedings when they stormed out on learning that NEDLAC confirmed that no agreement has been reached with the government and that negotiations are still on going. The Committee heard earlier that the government side had requested that the part of the Agreement that touched on the creation of pilot projects be bracketed since it would impair the work that was in progress. The government had also indicated that it would be unable to commit itself to the Treatment Plan given the financial and infrastructural implications - without first undertaking a thorough appraisal of such a venture.

The Committee was informed that the government's position is that where it stands it is not adequately capacitate to rollout the proposed programs but that the stumbling block in terms of discussions are not substantial given that all that the government was waiting for is the treasury report to provide the rationale for the implementation of the recommendations. The Committee called on all parties concerned to appreciate the fact that people were frustrated due to lack of progress in the negotiations. The Committee also urged all the stakeholders to be careful not to create an undesirable environment where people are always put on the defensive which scenario is a willful impediment to progress in consultations.

MINUTES
The Chair noted that NEDLAC would presentat on the on-going negotiations on the proposed National Treatment Plan with a view to up dating members where they stand and the actual status of the Agreement. He noted that much has been said about the Agreement but members were still in the dark as to the real import and purport of the Agreement hence this was a golden opportunity for members to hear from the principal players on what is going on.

Briefing by NEDLAC on Agreement for National Treatment Plan
Mr Phillip Dexter - NEDLAC Chief Executive Officer, gave a brief background to the on-going process noting that in June 2002 Cosatu had tabled a document in NEDLAC on a National Treatment Plan, which led to the establishment of a task team to consider the proposal. The task team consisted of Government, Business, Labour and the Community. It had held various meetings to discuss the document. The team had produced 10 draft documents which consisted of various amendments to the original document. The task team which brought together very senior people from government, Labour and Business had set the 16 December as the deadline to complete its work and come up with a unified position crafted in an Agreement. He revealed however that due to some outstanding issues that were yet to be thrashed out this deadline could not be met. He noted that although Business and Labour were happy with the amendments so far the Government side had sought for and were granted more time to consult with their political principals.

Briefing by Government on Agreement for National Treatment Plan
Adv Rams Ramashia, the Labour Department Director General, gave a government perspective of the genesis of events leading to the current position. He regretted that the exercise had generated unnecessary negative publicity and confusion. He pointed out that it was indeed the Labour constituency's suggestion that the Agreement be concluded by the 1 December 2002 so that the result could be announced on World Aids Day. He pointed out that due to the government obligation to consult its political principals it was unlikely that this deadline would be met but that government had reiterated its total and unequivocal commitment to the process.

Adv Ramashia noted that government had indicated that it had earlier set up a task team consisting of officials from National Treasury and the Department of Health to consider the cost implications of implementing the treatment plan and evaluate the sustainability of the existing infrastructure. He explained that the government had consulted its social partners to ensure that it arrived at an informed decision and that in the meantime government was addressing many other proposed interventions. For this reason, government had requested that the part of the Agreement that touched on the creation of pilot projects be bracketed since it would impair the work that was in progress. Government had also indicated that it would be unable to commit itself to targets given inherent financial and infrastructural implications without first undertaking a thorough re-appraisal of such a venture. He noted that Cosatu on its part had already undertaken work in this respect.

Adv Ramashia stated that on 1 December 2002 - the day the Agreement was to have been announced - an article appeared in the Sunday Independent to the effect that an Agreement had been reached between NEDLAC and government. The article said that the sum total of the Agreement is that government shall roll out the supply of anti-retrolvirals in all hospital establishments. He averred that the contents of the article were baseless since no Agreement had been reached. This article created unnecessary confusion among members of the public and those involved. He pointed out that during the period leading to the management committee meeting on 1 January 2003, Cosatu urged the government to sign "the Agreement". He submitted that this statement added fuel to the already existing confusion since there was no Agreement to be signed by government as yet.

Mr Ramashia said that the management committee reported on the work of the task team at its meeting on 1 January 2002 noting that although substantial progress had been made, no Agreement had been reached as yet and hence negotiations would continue. He pointed out that the Business community announced that it had compiled a document, which it planned to table before the task team at a later stage. This in itself, he averred, goes a long way to demonstrate that no deal had been sealed at this point. At the said meeting, he expressed his concern that certain deliberate perceptions had been created within Labour and TAC to suggest that there was an Agreement when the contrary was the truth. He protested that this state of misinformation was putting government representatives in a very difficult position and that unnecessary time and energy was being expended on self defence rather than consulting for positive results.

Mr Ramashia noted that the Labour constituency then indicated to the task team that it was organizing a march. The management committee noted that although this was within their democratic right - it however had the unintended consequences of deflecting the process. The management team noted that since substantial progress had been made, representatives should report back to their respective constituencies. He had appealed to other constituencies to desist from making statements that suggest that an Agreement had been reached when this was not the case.

Mr Ramashia pointed out that on 29 September 2002, NEDLAC placed a full page advert in the Business Day to the effect that an Agreement had been reached and that all that was awaited was for the parties to append their respective signatures to the dotted line. The government had moved to deny the truthfulness of what appeared in the advert and challenged anyone with proof to the contrary to table it. Further the President confirmed in an SABC interview that there was no such Agreement. He observed that on 18 February 2003 an article appeared in the Cape Times to the effect that President Mbeki had repudiated the NEDLAC Agreement and in the same article Cosatu alleged that the President had willfully negated what had been agreed upon. In order to set the record straight, government had called a media briefing where it stated categorically that although the process of negotiation was still on-going, no Agreement had been reached yet. The government hastened to reiterate its commitment to the collaborative process with NEDLAC.

Mr Ramashia pointed out that subsequently the Cosatu Secretary General had held a meeting with the Minister of Health after which he issued a statement to clarify that the NEDLAC - Government engagement had indeed covered substantial ground but that there were still some outstanding issues. He pointed out that until these issues have been ironed out, no Agreement could be spoken about. He regretted all the attendant misunderstandings that had dogged the process.

Briefing by Department of Health
Dr Ayanda Ntsaluba, Health Department Director General, assured the Committee that the government is committed and was prepared to give the process the best possible attention but that there has been fragmentation caused by a failure on the part of all players to ensure a collective effort. It was of critical important for the government to be seen to act responsibly and not in a haphazard manner. He hoped that at this stage clarity has been brought to the matter, noting that Cosatu's statement has gone a long way to clear the air. He lamented the fact that some sections of civil society report one lie after the other thereby lacking a modicum of respectability and the dignity to admit mistakes.

Dr Ntsaluba pointed out that discussions have so far been fruitful and that government representatives have regularly consulted their political principals on areas of concern. He remonstrated that the process has been held under siege due to the needless time and effort that has been expended in explaining the fact that no Agreement had been reached as yet. He added that a team that is working on the government response would come up with a document to state the government's position. He noted that it was important that the political principals have unequivocally expressed government commitment to this engagement.

Dr Ntsaluba concluded that it was important for all concerned to note that there is already a lot that is ongoing and continues to be done by various sectors to prevent and treat the HIV/AIDS pandemic. He noted that people should disabuse themselves of the wrong notion that the mere fact that government is engaging NEDLAC in ongoing negotiations, nothing else is being done to address the debilitating effects of the HIV/AIDS pandemic.

Discussion
The Chair expressed satisfaction that clarity has finally been brought to bear on this raging controversy and that a clear picture has emerged on where things stand at present. He castigated those who have been perpetuating one lie after another about there being an Agreement where - indeed - parties had reached none. He urged parties to pursue the process of engagement and in that spirit resist any temptation to be derailed by those who put their bona fides under doubt. It was quite clear that all parties are committed to the ultimate success of the process.

Ms Dudley (DP) asked if the specifics of the amendments could be provided and the expectations of each party.

Dr Ntsaluba noted that it was fair to divide the document into three broad parts:

- one large area where substantially all the proposed programs are consistent with the policies and activities the government is currently pursuing.
- a second part is essentially a call for greater co-ordination and that there is a broad consensus on this question.
- the third category is where there is ongoing policy considerations to determine if there are sufficient resources to finance the implementation of the plan. This is where parties have not reached consensus. The government position is that where it stands it is not adequately capacitated to rollout the proposed programs. The stumbling block in discussions is not substantial and all that government was waiting for is the Treasury report to provide the rationale for the implementation of the recommendations.

Mr Ramashia said that it was not possible to speculate how soon the process would be concluded due to various outstanding issues. These are:
- there is a document that has been tabled by the Business community which is yet to be considered by the task team.
- the ongoing work that is being undertaken by a government task team has yet to yield results. This report is crucial since it considers the critical question of costs and infrastructure. - thirdly, notwithstanding what is tabled at NEDLAC the position of the political principals would help inject a fresh impetus to the process.
In view of all these variables, it was not possible for one to speculate on when all issues would be ironed out to give way to a solid Agreement.

Mr Dexter admitted that the question of adequacy of resources was indeed a genuine concern and more work was needed in that regard. The issue of generics is both a matter of law and raised issues of constitutionality. It was necessary to address the legal framework to pave the way for the roll-out of free treatment as envisioned. He pointed out that consultations in NEDLAC were rough and emotive but that parties appreciated that people were frustrated due to lack of progress in the negotiations. He called on all stakeholders to be careful not to create an undesirable environment where people are always put on the defensive which scenario is a willful impediment to progress in consultations.

Ms Mnumzana (ANC) urged all parties involved to extradite themselves from a certain frame of mind which tends to suggest that some people are heartless and do not care about the plight of the suffering masses. What has emerged is a difference in detail and that the way the process is managed is very crucial. She lamented that due to these interruptions it is difficult for the government to focus on what it had already started in terms of pilot sites.

Ms Baloyi (ANC) observed that members were starved of information regarding this process and the meeting had offered members the opportunity to understand the underpinnings of the process. She urged the two Directors General to expedite the conclusion of the process to alleviate the stress those infected and affected. She added that it is important for parties to set a clear framework for the conclusion of the process and not to drag on ad infinitum.

Ms Malumise (ANC) called on the government negotiators to put in place mechanisms to forestall a situation of confusion that has dogged the process this far.

Dr Mbulawa (ANC) said that she would want to echo concerns expressed by members on the stress the delay of the process is causing to affected people. She called on NEDLAC to form the habit of accurately reporting back to its constituencies so as to avoid the current confusion.

At this juncture, a section of the public observing the meeting got up and left the meeting, ignoring the Chair's call for them to file out in an orderly manner and not to disrupt the proceedings. On stepping out of the auditorium, they broke into song and shouted slogans.

The Chair expressed disappointment that the very same people the Committee hopes to work with are now creating an unfortunate situation of confrontation and called upon the Treatment Action Campaign to reconsider their current tactics which he said are unnecessarily belligerent. He emphasized that all parties are committed to a better health system and that it was unhelpful to demoralize certain sections of the community.

Mr Ramashia assured the Committee that all parties are seized by the seriousness of the burning issues at hand and that there is a clear commitment and desire across the board in NEDLAC that the process should move forward. He noted that there was a need for greater co-ordination to align programmes with the ongoing work on the ground since some sectors have already rolled out various interventions. He regretted that some people have the need to generate heat for reasons unrelated to the task at hand and fully endorsed the Chair's views in this regard. He said that concerns expressed by members have been noted and every effort would be made to ensure the process moves forward speedily.

The Chair wanted to know what mechanisms, if any, have been put in plans to forestall a recurrence of the current confusion.

Mr Ramashia pointed out that he hoped all the stakeholders have picked up the message on accurate reporting to respective constituencies. He assured members that from the government side the details of the process are a closely guarded affair since the consequences of leakages are all too familiar. He noted that some stakeholders choose to release the details to serve their own personal agenda. He singled out the disruption caused by TAC members and blamed it on skewed reporting. He cautioned stakeholders against an attempt to raise expectations of the populace based on unfounded information. He called for responsibility on the part of all parties involved.

Dr Jassat (ANC) suggested that in the light of these proceedings, it was appropriate for the Committee to issue a press statement to set the record straight.

The Chair rejected this suggestion noting that members of the press were around for that purpose and that the Committee should focus on its work.

Ms Malumise said that a member of the media had requested her to ask a question on his behalf.

The Chair wondered whether Ms. Malumise had become an agent of the media and cautioned that such a maneuver has its own inherent dangers. He however allowed the member to pose the question.

Ms. Malumise said that in view of the Chair's cautionary remark she has decided to withdraw the question.

Ms. Jacobus (ANC) called on members to try and engage all stakeholders in order to understand and challenge them on their viewpoints.

The Chair noted that it was distressing to deal with certain constituency representatives who came with ideas cast in stone and were unmoved even when confronted by glaring facts to the contrary. He expressed the frustration of the Committee in that whenever an issue has been discussed such groups go to the press and say something completely the opposite.

The Chair thanked the presenters for the way they had handled issues in a frank and focused manner and not become mired in emotional outburst, as is often the case when such sensitive issues are discussed. The meeting was then called to a close.

 

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