Long way from treatment target

South Africa is not on track to meet its target of reaching 80 percent of people in need of antiretroviral (ARV) treatment by 2011, Health Minister Aaron Motsoaledi told reporters on 15 September.



A five-year National Strategic Plan (NSP), adopted in 2007, set ambitious targets for the HIV/AIDS programme and was viewed as the beginning of a new era of greater government commitment after a decade of official foot-dragging and denial about the extent of the epidemic.



But Motsoaledi, who took office in May 2009, said a R1-billion (US$123 million) funding shortfall, combined with a shortage of skilled healthcare workers and an ailing and overburdened public health sector, was hampering efforts to roll out ARV treatment, and the programme was still only covering 700,000 people - about 50 percent of the target set in the NSP.



Mark Heywood, director of the AIDS Law Project and deputy chair of South Africa's National AIDS Council (SANAC), said 700,000 was likely an overestimate, as it reflected the number of people who had started taking ARVs since the programme began in 2004, rather than the number currently on treatment. "It's generally accepted you can lop 20 percent off that figure," he told IRIN/PlusNews.



Heywood welcomed the health minister's honesty, but cautioned against giving up on the NSP targets. "It's easy enough to just say we're not going to meet the targets, but it means we're effectively writing off quite a number of people's lives," he said.

It's easy enough to just say we're not going to meet the targets, but it means we're effectively writing off quite a number of people's lives

"The challenge for him is to convene stakeholders and try to develop a plan that includes finance, ensuring the medicines are there, and ensuring the health systems are in place."



National health department spokesperson Fidel Hadebe said Motsoaledi was in discussion with provincial health departments and had instructed his deputy minister to meet with the health minister of Free State Province, where the delivery of ARV treatment has been particularly erratic.



Runaway overspending by the Free State health department in 2008 led to a four-month moratorium on new patients starting ARV treatment, and another crisis is looming - HIV/AIDS activists are warning that understaffed clinics and long waiting lists are preventing many patients from accessing ARVs.



"We need to jack up our implementation," said Hadebe. "If you keep having other Free States then that is going to limit your prospect of reaching the target."



Civil society groups have been talking about the R1-billion (US$123 million) shortfall in the ARV programme for several months, but Motsoaledi's comments were the first official confirmation of the situation.



The health department has requested additional money from the Treasury, but has also appealed to international donors for assistance. Hadebe declined to name the possible donors but said sustainability of the treatment programme would also depend on finding government funding sources.



Francois Venter, director of the Southern African HIV Clinicians Society, pointed out that the health sector had been underfunded for many years. "It will require massive resources to get back confidence in the [public] health system, and the people who are hurt the most are the poor who can't move to the private [health] sector," he told IRIN/PlusNews.



"Motsoaledi is a man of integrity and I think he's being realistic, but the previous cabinet must hang their heads in shame for allowing [former President Thabo] Mbeki and [former Health Minister Manto] Tshabalala-Msimang to continue their mismanagement of the health system for the last 10 years."



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See also: SOUTH AFRICA: No simple formula for universal access