19 November 2003
Presented by Minister of Health, Dr Manto Tshabalala-Msimang
Cabinet today in principle approved the Operational Plan for Comprehensive Treatment and Care for HIV and AIDS, which it had, on 8 August this year, requested the Department of Health to prepare. Amongst other things, the Plan provides for Anti-retroviral Treatment in the public health sector, as part of the government's comprehensive strategy to combat HIV and AIDS.
The meeting instructed the Department of Health to proceed with implementation of the Plan.
It is envisaged in the Plan that, within a year, there will be at least one service point in every health district across the country and, within five years, one service point in every local municipality. Some areas will be able to start sooner than others, and the Department of Health will keep the public informed of the progress of the rollout.
These service points will give citizens access to a continuum of care and treatment, integrated with the prevention and awareness campaign which remains the cornerstone of the strategy to defeat HIV and AIDS.
Concretely this far-reaching decision of government will mean:
- tepping up the prevention campaign so that the 40 million South Africans not infected stay that way
- A sustained education and community mobilisation programme to strengthen partnership in the fight against the epidemic
- Expanding programmes aimed at boosting the immune system and slowing down the effects of HIV infection, including the option of traditional health treatments for those who use these services
- Improved efforts in treating opportunistic infections for those who are infected but have not reached the stage at which they require antiretrovirals
- Intensified support for families affected by HIV and AIDS
- Introduction of antiretroviral treatment for those who need it, as certified by doctors
To deliver this kind of care across the country, with equitable access to all, will require a major effort to upgrade our national healthcare system. This includes the recruitment of thousands of health professionals and a very large training programme to ensure that nurses, doctors, laboratory technicians, counsellors and other health workers have the knowledge and the skills to ensure safe, ethical and effective use of medicines.
Built into the implementation of this programme will be a massive public education campaign so that patients will know what is expected of them. This will include the provision of all the necessary information about benefits as well as dangers of usage of ARVs, to allow patients to make an informed choice.
Over half of the total budget that will be spent over the next five years in implementing this programme will go to upgrading health infrastructure, emphasising prevention and promoting healthy lifestyles. As such, the implementation of this plan will benefit the health system as a whole.
Cabinet agreed that the funds allocated for this programme should be "new money". The programme will and must therefore not detract from other programmes of health care and provision of social services.
South Africa has reached this point at which qualitative enhancement of our response to HIV and AIDS, within the framework of our five-year strategic plan, is possible due to a number of factors. These include
- A fall in the prices of drugs over the past two years without which this programme would have been impossible, including new opportunities to manufacture some of these drugs in South Africa, as well as successful negotiations with pharmaceutical companies
- New medicines and international and local experience in managing the utilisation of ARV's and other interventions
- Growing appreciation of the role of nutrition in enhancing people's health and efficacy of medicines
- The building of a critical mass in our country of health workers and scientists with skills and understanding of the management of HIV and AIDS
- The availability of fiscal resources to expand social expenditure in general, as a consequence of the prudent macro-economic policies pursued by government.
Centrality of prevention
Government wishes to reiterate that there is no known cure for AIDS. We cannot therefore afford, as a nation, to lower our guard. Prevention therefore remains the cornerstone of our campaign.
The eradication from the body of the HIVirus remains beyond reach. The mechanisms of HIV infections remain difficult to fathom, and the downhill plunge of the infected, to severe immune deficiency over the next 2-14 years is ill-understood. The co-factors that are thought to mitigate immune destruction of healthy CD4+ cells by the minority of infected CD4+ are still uncharacterised. In the South African context the immune systems is assaulted by a host of factors related to poverty and deprivation.
The Operational Plan places a high premium on strengthening prevention efforts and it underlines the critically important messages of prevention and of changing lifestyles and behaviour. These elements of our Comprehensive Strategy remain the starting point in managing the epidemic.
At the same time, it should be noted that not everyone who is HIV positive requires Anti-retroviral Treatment. As such, the plan also provides for enhanced care for those who are infected but have not as yet progressed to an advanced stage of AIDS.
At the same time, the challenges of home-based care, the campaign to combat discrimination against those who are infected and affected remain critical. So is the task of intensifying efforts to deal broadly with poverty and poor nutrition.
Progress in implementing the Plan adopted by government today will depend, to a significant degree, on intensified mobilisation across society. Besides the legion of non-governmental and community-based organisations who are involved in constructive work in this regard, the media is an important partner, as it has the potential to communicate messages of awareness and hope, and to keep the nation accurately informed about the campaign against HIV and AIDS.
A cooperative relationship among all sectors of society, particularly in the implementation of this element of the comprehensive strategy, the spirit of letsema and vuk'uzenzele, a message of hope and responsibility as well as constructive engagement in the realm of practical work will ensure that South Africa advances even more decisively in this endeavour.
The Comprehensive Plan for Treatment and Care carves out a future for those infected with HIV, and for those suffering from immune deficiency; whilst assisting the vast majority of South Africans who are HIV negative to remain that way. The peculiarly South African nature of the problem demands South African solutions; solutions contained within this complex and detailed Comprehensive Plan for Treatment and Care.
Such an ambitious goal - targeting the immense complexity of the human immune system operating within the environmental milieu of Africa - predicates a multifaceted, integrated and intersectoral response in prevention, treatment and care. The Plan is the final piece completing the jigsaw puzzle of the National Strategic Plan for HIV and AIDS 2000 - 2005 whose four key areas of intervention were: prevention, treatment, care and support; research, monitoring and surveillance; as well as legal and human rights.
Cabinet wishes to express its appreciation of the work done by members of the Task Team - including in particular experts and specialists from inside and outside the country - whose contribution has helped shape this Plan. We are confident that, as with our national prevention efforts, this Plan will rank among the most comprehensive in the world.
Government is once more strengthening the hand of the nation in the fight against HIV and AIDS, in keeping with its mandate to build a better life for all. If correctly implemented this Operation Plan provides an excellent opportunity to complete the treatment sector of the National Strategic Plan for HIV and AIDS whilst also strengthening prevention. The challenge is immense but not impossible.
We are confident that, together, bound by a people's contract for a better life, we shall all continue to make progress in building South Africa into a land our dreams.
There is hope!
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Issued by: Government Communications (GCIS)