Management of HIV/AIDS in Public Service: briefing

Meeting report

PUBLIC SERVICE AND ADMINISTRATION PORTFOLIO COMMITTEE
20 October 2004
MANAGEMENT OF HIV/AIDS IN PUBLIC SERVICE: BRIEFING

Acting Chairperson: Mr M Baloyi (ANC)

Documents handed out
Department Powerpoint presentation on management of HIV/AIDS in the public service
Managing HIV/AIDS in the Workplace - A Guide for Government Departments

SUMMARY
The Department of Public Service and Administration briefed the Committee on the management of HIV/AIDS in the public service. The presentation focussed on the potential impact of HIV/AIDS, how the Department had been responding, and how they could improve the response. As part of the Department's policy development strategy, it aimed to establish an HIV/AIDS Committee with representation and relevant stakeholders. In the discussion that followed, Members raised questions on voluntary counselling and testing (VCT), HIV test incentives, and stigma. The Department also clarified certain issues about NGO involvement in the public service. The Committee agreed that the Department's HIV Guidelines should be better implemented.

MINUTES
The Department delegation consisted of Professor Richard Levin, Director General; Mr Alvin Rapea, Executive Manager: Human Resources; Ms Sikeledi Tsukudu, Senior Manager: HIV/AIDS; and Ms Ndivhuro Chauke, Manager HIV/AIDS.

The Committee Members suggested Mr B Mthembu should act as Chair. The Committee accepted the suggestion.

Department briefing
Ms Tsukudu reported that the Department's focus had moved to both HIV/AIDS and health and wellness. The presentation focussed on the potential impacts of HIV/AIDS, how the Department had been responding, and how they could improve this response. The government's 2000 HIV/AIDS Strategic Plan had three phases that included impact assessment, policy and legislative review and revision, and implementation. The Department needed to promote voluntary counselling and testing (VCT) wherever possible. All staff had to treat information on any employee's HIV status as strictly confidential and not disclose it without the employee's consent. The stigma around HIV/AIDS status and the lack of integration of HIV/AIDS policies and programmes, had been problematic.

Discussion
Mr Baloyi (ANC) asked how organised labour would be involved in the process of HIV/AIDS management in the public service. Mr Rapea said organised labour had been involved in the process, but had not yet indicated whether it wanted to form part of the Capacity Audit.

Mr Walters (DA) asked whether all Government Departments had programmes. Mr Rapea said all Departments had implemented programmes.

Mr Walters asked about the rate of HIV testing in the public service. It seemed that 300 000 people had gone for counselling, but only 70% of those had actually taken the HIV test. Had the projections on the HIV infection levels in the public service changed since 2000?

Mr Rapea said the Department had not done HIV prevalence assessments. The success rate assumptions had been made based on the country's assessments.

Mr Walters referred to the Collective Agreement that HIV testing only happen at the request of the employee. He asked whether people had the opportunity to be tested?

Mr Rapea said the Department encouraged voluntary testing. The Limpopo Province served as a good example because they had staff in all regions working on this.

Mr Walters asked whether the Department had any plans for human resource management and absenteeism.

Mr Rapea said all Departments had developed human resource plans that dealt with the impact of HIV/AIDS.

Dr A Luthuli said that public service officials had been reluctant to go for voluntary testing, but offering an incentive could improve the situation. Had the Department made any plans to offer an incentive?

Ms Tsukudu said the Department had a Care and Support Programme, but separate incentive initiatives had not been offered. Some divisions had provided for incentives, while others had contracted NGOs to do the HIV testing.

Dr Luthuli said employers had been nervous about their employees' HIV status. Employers might dismiss their employees when they found out about their status. Mr Rapea responded that policies were very clear on the protection of employees.

Ms Maloney (ANC) asked whether there had been any known cases of discrimination in the public service based on a person's HIV status. Mr Rapea said no civil servant had been taken to court for dismissing an employee based on HIV status.

Ms Maloney asked what had been the extent of NGO involvement. Mr Rapea said the Department's programmes had an internal focus. They had provided communities with information through annual reports, but no specific efforts had been considered.

Professor Levin said the issue of measurement had been complex and challenging. There had been real methodological challenges given the issue of confidentiality and how to measure beyond extrapolation. The impact of the programme had been one of the key issues of measurement. The Public Service Commission had undertaken to do this, and the Department was still waiting for the outcome of this evaluation. The issue of measurement had not been irrelevant, only methodologically challenging, and the Department had not felt confident in undertaking it themselves.

Ms Tsukudu said the programme had focussed on the protection of employees and promoting testing. The different government departments had been using different approaches. Some Departments had not been successful in testing employees at work. More departments had experienced successes in working with NGOs where employees could go for testing in their own time. The Department had been focussing on providing employees with information. The Department had aimed to empower the employees and their families.

Mr Walters asked about the HIV/AIDS infection rate in the public service. Ms Tsukudu said the rates had not been requested from the Department.

Mr Walters asked whether the Minister of Health or other top officials would be prepared to go for a HIV/AIDS test to lead by example?

A Member said leaders should be treated as a separate entity. People should make health decisions based on their own will. It would be ethically unacceptable to ask the Minister to go for an HIV test. There had not been any evidence to prove that employees and the public would line up to test as a result of the Minister's test.

Mr Baloyi said Members should engage in a positive discussion with the Department and debates should be kept out of briefings. If the DA wanted to engage in such a debate, a specific meeting could be arranged, but Party politics should be kept out of the meeting. The Chair said it had been improper for Mr Walters to ask a response from the Department officials on behalf of the Minister of Health.

Dr Luthuli asked whether the Department had done a cost analysis in terms of sick leave, deaths and a workplace policy. What had been the direct and indirect costs of HIV/AIDS? To what extent had HIV policies been implemented?

Ms Rapea said NGOs had been doing HIV testing, but the statistics had not been requested from the Department. The Department had not done a cost analysis, but a 'pile-up project' was underway. When finished, the project would indicate such costs.

Mr Walters referred to post-exposure prophylaxis as part of the Department's policy development strategy. He asked which Departments did not have access to post-exposure prophylaxis. Ms Tsukudu said post-exposure prophylaxis would be available to all Departments.

Ms P Mashangoane (ANC) asked about the powers of the HIV/AIDS Committee and what relationship it would have with the Department.

Ms Tsukudu said that different units and staff from all levels would form the Committee. The Committee would not have legal powers, but it would develop a policy for the Department and implement programmes.

Mr M Baloyi (ANC) asked about the problem of medical cover. Professor Levin said medical restructuring would be discussed in November this year. The Department had extended medical cover to 330 000 public service employees. The medical restructuring would have a significant impact and proposals had been very comprehensive. Extensions of medical cover would be offered. The scheme proposed five benefit plans and would be available to employees according to income and current medical cover. The scheme would be phased in over two to three years, and would increase State costs. Employees' contribution to medical aids would reduce if proposals were accepted.

Mr Baloyi said the stigma around HIV still existed and should be managed by the Department. Ms Tsukudu commented that an environment of openness should be created. The Department had adopted guidelines devised by the University of Pretoria to manage stigma. These guidelines would be made available to the Committee.

Mr Baloyi asked how NGOs had been involved in HIV testing. Had there been any criteria to involve some NGOs and exclude others? Ms Tsukudu said the Departments had made the decisions on which NGOs they would use, but others had been decided through tenders.

Mr Gcwabaza (ANC) asked whether there were any policies that allowed employers to seek information from doctors about the HIV status of an employee. Mr Rapea said any such practice would be unethical and was not allowed. The Department had introduced disability leave so that supervisors would not be tempted to obtain such information.

Ms Maloney (ANC) referred to the guideline development by the Department, and asked whether provision had been made for traditional healers.

Ms Tsukudu said the guidelines had not mentioned traditional healer. Different departments made their own partnership decisions. Mpumalanga's guidelines had explicitly included traditional healers in their programmes.

Ms Luthuli asked whether the number of HIV infected people was expected to be halved by 2040. Professor Levin said such benchmarks fell within the domain of the Department of Health. The Department had recognised the need for assessment, but the aim had been to promote guidelines and policies.

The Chair said everybody had the responsibility to ensure that the Department's guidelines were implemented.

The meeting was adjourned.