NGO launches countrywide monitoring of ARV rollout

A new project by the South African NGO, Health Systems Trust (HST), will enable communities across the country to provide feedback on progress in the rollout of free anti-AIDS medication. HST, based in the east-coast city of Durban, is developing a monitoring and evaluation tool to screen communities' access to free antiretroviral (ARV) drugs, and will also provide technical assistance in lobbying provincial and national government. The national treatment programme has come under fire from activists over the slow pace of delivery and problems with the procurement of ARVs. In November 2003 the government committed to providing free treatment to 53,000 patients by March 2004. This is a fraction of South Africa's HIV positive population, thought to be over five million, and the target date has also been moved forward a year to March 2005. By the end of November 2004, the Joint Civil Society Monitoring Forum estimated that only 18,500 patients were receiving the life-prolonging drugs. This prompted HST to launch HIV Gauge, an initiative that gathers responses to the national ARV rollout from communities throughout the country, to determine some of the major obstacles to the treatment plan at community level. By monitoring and assessing the programme in their own districts, community members will be empowered to lobby provincial and national government on issues around access to medication. The HIV Gauge team has launched two pilot projects that will form the basis for developing the monitoring tool. One project is situated in Umlazi, a township near Durban in KwaZulu-Natal province; the other is in the poverty-stricken rural community of Sterkspruit in the Eastern Cape province. The Umlazi project is still in the process of being set up, but research began in Sterkspruit in July 2004. Community members, including the local clinic committee, the HIV/AIDS provincial coordinator, the clinic sister and an NGO operating in the area, were interviewed regularly to discover what was hampering access to treatment. HIV Gauge found that only five people in Sterkspruit had been receiving ARVs, with 25 people currently on the waiting list. The main challenges to access were lack of human resources, an inconsistent drug supply, lack of access to information about ARVs, lack of adequate infrastructure in the clinics and poverty. "Many people simply don't have money to pay for transport to the clinic and nutrition," said Ashnie Padarath, advocacy and media officer of the HST Equity Gauge. From the information documented in the two pilot communities, the team will create a monitoring manual for use as a tool to evaluate the success of the ARV rollout in other communities. The manual will measure the key components of care outlined in the health department's treatment plan, such as: the availability and provision of voluntary counselling and testing, prevention of mother-to-child transmission, screening, provision and access to ARV treatment, routine follow-up of HIV patients, treatment of opportunistic infections, adherence monitoring and support, counselling, nutritional assistance, psychosocial support, and community and home-based care. While some of these services will not be offered directly by the local clinic, the clinic should be the central point where such information is provided, Padarath explained. Funding permitting, the manual will initially be distributed to two communities in each province by the end of 2005.