TAC Statement on Announcement by the Minister of Health of National Task Team to Develop Operational Plan for Antiretroviral Program

August 20, 2003

"The magnitude of the HIV/AIDS challenge facing the country calls for a concerted, co-ordinated and co-operative national effort in which government in each of its three spheres and the panoply of resources and skills of civil society are marshalled, inspired and led. This can be achieved only if there is proper communication, especially by government. ... We consider it important that all sectors of the community, in particular civil society, should co-operate in the steps taken to achieve this goal." (TAC and others v Minister of Health and Others 05 July 2002)
The TAC welcomes the swift announcement by the Minister of Health of the task team to develop an operational plan for an antiretroviral program rollout in the public health sector. We also welcome the clarification of the terms of reference of the Task team, and note that the Task Team has as its primary objective the development of an implementation plan and schedule.

The Task Team will be headed by experienced and respected researcher Dr. Anthony Mbewu of the Medical Research Council. It includes senior departmental officials such as Dr. Lindiwe Makubalo and her husband Dr. Phillip Onyebujoh, as well as Ms. Precious Matsoso, the respected registrar of medicines. Dr. Ashraf Grimwood is also a well-known HIV clinician.

The TAC restates that we will work with the team the minister selects. However, we have serious reservations about its composition. Criteria for membership is not clear, but on the surface (with the exception of Dr. Grimwood) it seems that members have been selected who have not been critical publicly of government's past omissions, and who have not been at the forefront of advocacy for antiretroviral treatment and a national treatment plan.

We note that the Task Team:

We wish the Task Team to succeed. It's responsibility is daunting and many lives depend on the quality of its work. That is why we consider it crucial that the team contains people with experience in the areas vital to the success of antiretroviral therapy in the public sector. There are many doctors and nurses in South Africa who meet these criteria. After all, successful antiretroviral treatment is taking place in public facilities such as clinics in Khayelitsha and Gugulethu and hospitals such as Chris Hani Baragwanath, Helen Joseph, King Edward, Somerset and others.

The Task Team has insufficient representation from civil society, especially people with HIV/AIDS. More than any health intervention in history successful implementation will require massive community mobilisation to de-stigmatise HIV, promote accurate information about treatment and prevention, and support adherence to medicines. Neither of the South African National AIDS Council PWA (People with HIV/AIDS) representatives are on the task team. We do not suggest that TAC had an automatic right to assist in the task team, but we do think that we could bring to the team essential experience in community-related HIV issues, especially around removal of stigma, patient support and treatment literacy.

The Minister of Health and TAC have had serious and painful disagreements. The differences will not disappear overnight. The same can be said for the relationship between the minister and most of the doctors and nurses at the forefront of providing care in the public sector. But success in saving as many lives as possible demands that we co-operate in developing the best plan. The Minister has a Constitutional obligation to work with all people with a real interest in this matter. Co-operation does not require full agreement or even pretending to be best friends. Therefore TAC conveys its deepest disappointment to the minister at her selection, because we believe the team lacks additional critical personnel.

To rectify this, we urge the minister to allow at least two representatives selected by the Southern African HIV/AIDS Clinicians Society, two public sector nurses with experience in antiretroviral therapy chosen by the nursing unions, a SANAC PWA representative and a person selected by TAC. We also urge the minister to invite Medecins Sans Frontieres to submit a representative, since their experience in setting up the antiretroviral programme in Khayelitsha has been invaluable not only to South Africa but to poor communities globally.

Further we call for an urgent meeting of SANAC, to discuss the decision of Cabinet and to begin to mobilise society for enhanced and more effective prevention and treatment strategies.

By accepting these very reasonable requests the minister can demonstrate her commitment to ensuring that the task team has the experience and representation necessary to produce and implement a high-quality operational plan. She will also demonstrate that she has the strength of character to put aside personal issues in favour of the more important issue of saving the lives of hundreds of thousands of people with HIV/AIDS.


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