Capacity shortfalls undermine roll-out

A lack of capacity in South Africa's healthcare system is a serious challenge to the government's plan to roll-out a free treatment programme for its HIV-positive citizens, a European Union (EU) official told PlusNews.

According to Ian Ralph, health advisor to the European Commission in South Africa, the slow pace of providing free antiretroviral (ARV) drugs was in some instances due to "very good reasons", as health systems remained under-resourced, causing a "major operational problem".

Having drafted a "sound and sustainable" strategy to treat people living with the virus, the government is having to "radically restructure" its health system to successfully implement the programme, he added.

While he "applauded" the government's efforts to bring health care services to the people, Ralph noted that the roll-out of ARVs relied heavily on doctors and was largely hospital-based, making it difficult for many rural and disadvantaged people to have access to the drugs.

Nevertheless, the government's treatment plan could be a much-needed catalyst to improve the country's ailing national public health system.

Over half of the total health budget will be spent over the next five years in implementing the programme, and will also go towards upgrading health infrastructure and the recruitment and training of health professionals.

But activists are becoming increasingly frustrated by the government's failures to meet its targets.

In a memorandum handed over to government earlier this month, protestors from the Treatment Action Campaign (TAC) pointed out that many health facilities remained short of health-care workers, despite the promise of the treatment plan to hire an additional 22,000 health-workers by 2008.

"The public sector is understaffed because of uncompetitive salaries, poor working conditions, death and illness due to HIV/AIDS, low morale caused by death and illness among their patients due to HIV/AIDS and a lack of career development opportunities," TAC said in the statement.

TAC called for government to publish a human resource plan for the public health system, which should "cater for improved conditions of service, including higher salaries and real career growth opportunities, as well as the recruitment of thousands more workers to the public health-system immediately."

The official target was to have 53,000 people on ARV therapy by March 2005 - only 30,000 people are currently accessing medication.