South Africa’s guide to addressing HIV and TB for the next five years does not have the support of key activists, who are also critical about how the plan was drawn up.
The Treatment Action Campaign (TAC) and Section27 do not endorse the new National Strategic Plan (NSP) – the roadmap for South Africa’s fight against HIV and tuberculosis (TB) for the next five years.
The NSP, which was launched the day after the Cabinet reshuffle, is usually negotiated in multi-sectoral consultations in the SA National AIDS Council (SANAC) and enjoys broad support.
But activists have called out the leadership of SANAC for its “opaque” consultation processes, claiming that some critical groups and people have been left out.
The TAC and Section27 says the NSP fails in four main areas:
- Lack of accountability: “A critical flaw in the NSP is that it shifts all the responsibility for implementation of the NSP to provinces” but provides very little guidance to provinces on how to develop implementation plans or any mechanisms by which provinces or districts can be held accountable for implementation.
- Human resource shortage: Many of the interventions proposed in the NSP will require substantial increases in human resources, such as contact tracing for TB. Substantial human resource requirements are needed but these are not spelt out.
- No proper costing and funding: The NSP hardly at all engages with what the various interventions may cost and if we have the money secured.
- The NSP is weak on a number of serious issues: While the NSP does contain some language on the decriminalisation of sex work and on the provision of condoms as part of a programme in schools, it fails to plot a concrete way forward.
Hallmark of latest NSP
The “hallmark” of this NSP (2017-2022) is to “intensify efforts” in geographic areas with high HIV and TB rates. It also focuses on delivering “high impact interventions” to “key populations” – those at a higher risk for HIV and TB, including sex workers, men who have sex with men, drug-users and prisoners.
It outlines eight goals with the ultimate target, set by The Joint United Nations Programme on HIV/AIDS (UNAIDS), to effectively end AIDS as a global public health threat by 2030.
These goals include accelerating HIV prevention, reducing new infections and deaths as well as focusing on “key populations”. They also include goals like addressing the social drivers of disease and grounding the fight in human rights principles, calling for leadership and accountability.
But Russel Rensburg from the Rural Health Advocacy Project (RHAP) says that there “are complaints from different sectors as to the integrity of the consultation process”.
Concerns about consultation process
“There are allegations that the input of critical stakeholders, most especially community groups, have not been taken sufficiently into account. It would strengthen the plan’s standing if it could make fully transparent the consultation process and how key concerns have been addressed; or if not, why not,” wrote Rensburg last week in the public health magazine, Spotlight.
SANAC came under fire earlier this year for suddenly deciding not to re-appoint its chief executive officer (CEO) Dr Fareed Abdullah. Instead of extending his contract, the SANAC board appointed Dr Connie Kganakga as acting CEO.
Similarly to the consultation process for drafting the NSP, the CEO appointment process has been opaque. A month after Abdullah’s departure, a permanent appointment has still not been made.
Said Rensburg: “What is required is a strong SANAC that has the support of all stakeholders. A strong SANAC that can lead, direct and accelerate the response. We fear SANAC in its current state does not meet this muster.” – Health-e News.
NSP 2017 – 2022 Goals
- Accelerate prevention in order to reduce new HIV and TB infections and new STIs – Breaking the cycle of transmission
- Reduce illness and death by providing treatment, care and adherence support for all – 90-90-90 in every district
- Reach all key and vulnerable populations with comprehensive, customised and targeted interventions – Nobody left behind
- Address social and structural drivers of HIV and TB infection and STIs – a multi-department, multi-sector approach
- Ground the response to HIV, TB and STIs in human rights principals and approaches – Equal treatment and social justice
- Promote leadership at all levels and shared accountability for a sustainable response to HIV, TB and STIs – Mutual accountability
- Mobilise resources to support the achievement of NSP goals and ensure a sustainable response – Spend now, save later
- Strengthen strategic information to drive progress towards achievement of NSP goals – Data-driven action
An edited version of this story was published by The Huffington Post