Submission on the HIV and AIDS, STIs National Strategic Plan for South Africa 2007 – 2011
We welcome the opportunity to comment on the draft NSP 5-year plan. Although we are aware that the Chief Director: HIV/AIDS and STDs has requested only short inputs (“not essays”) the complexity of the plan, and its importance to South Africa, has required the detailed response below. In addition, whilst working on this submission a further draft (dated 14 November 2006) has been made available. However, most of the points we deal with below remain relevant.
The following are the key areas that we believe need to be addressed:
- The document is the first South African country plan that combines prevention, treatment, nutrition, care and support in a single plan. We welcome the fact that in its preparation thus far, consensus has been achieved on its broad framework through a process of consultation. However the document has reached a stage where it requires careful attention to the detailed programmes and targets it requires, and this in particular needs further expert input.
- Given the complexity of the Plan, and its importance, we feel that delaying the release of the final document (by no more than three months) would allow wider consultation, more scientific input and strengthen it considerably.
- However, we believe that SANAC can achieve consensus on the NSP’s key messages, broad programmatic areas, interventions and targets in time for World AIDS day on December 1st 2006.
- At present the draft is not user friendly, neither does it communicate the most urgent and important priorities for our response. In this regard we believe the NSP must set out several key challenges, including:
- Scaling up voluntary HIV testing dramatically and sustaining consistent visible messages that recommend knowing your status (Attached to this proposal is a suggested new approach to HIV testing);
- Protecting and promoting the sexual rights of girls and women and ending violence;
- Encouraging voluntary disclosure and linking this to non-discrimination, treatment literacy and respect for human rights;
- Encouraging people to seek treatment for HIV and TB and devising a plan to ensure that the treatment need is met by South Africa’s private and public health sectors.
- One area where the draft needs extensive discussion relates to target setting. We strongly feel national and provincial targets must be aggregated from district-level targets on key aspects of the plan, that are rapidly calculated, and that district managers are held accountable for these targets. All targets, where possible, should be district-specific, but in particular, PMTCT and ARV access targets for adults and children must be set at district level.
- The very low projected treatment numbers in the care and treatment section is of huge concern – not least because they contradict the targets in the Operational plan. They suggest that only 20% of people eligible for antiretrovirals will be treated annually.
- Many of the interventions mentioned are often very difficult to measure. We have suggested hard outcomes for the Priorities section that are more practical. There needs to be attention to practical monitoring and evaluation at a local level that acknowledges the problems experienced in the last two years in data collection.
- There are a number of key omissions in the draft including:
- A critical evaluation of spending on the programme, with strong reference to outputs.
- Management of HIV in our prison population
- Management of HIV in the military.
- the role that the private health sector can play in terms of access to treatment and care, (this is despite reference to the fact that this document should guide all South African sectors).
- There is needless duplication of other state structures’ targets. It would be better to explicitly situate this plan as a part of other priority national strategies around poverty reduction, the Millenium Development Goals etc.
- Within the epidemiology section, the description of the epidemic is at times needlessly dramatic, at other points over-optimistic, and at times contradicts the cited data.
- There should be an explicit acknowledgement of the need for local research in the programme, and a plan for regular government-researcher-stakeholder forums to discuss research priorities and results of ongoing projects.
- The document needs significant editing for consistency, accuracy and language. We feel that as this will be a reference document for five years, it should be as polished and professional as possible.