Health-e (Cape Town)
1 July 2009
(Page 2 of 2)
She went on to say: "let me make another obvious point - a health system is a social institution. It does not just deliver pills and babies the way a post office delivers letters. Properly managed and financed health systems that strive for universal coverage contribute to social cohesion and stability.
Hon Chairperson, the aims and objectives of NHI is to achieve exactly what the WHO Director-General has alluded to - nothing more, nothing less.
(iii) Accelerated Implementation of the HIV and AIDS Plan and increased focus on TB and other communicable diseases
Hon Speaker, let me go back to the President's State of the Nation Address: "we must work together in the implementation of the Comprehensive Plan for the Treatment, Management and Care of HIV and AIDS so as to reduce the rate of new HIV infections by 50% in the year 2011. We want to reach 80% of those in need of ARV treatment by 2011.
Hon Chairperson, here is the score-card on HIV and AIDS challenge that South Africa is facing.
This year, on the 9th of June, The Human Sciences Research Council, together with its partners the Medical Research Council, Centre for AIDS Development, Research and Evaluation and the National Institute of Communicable Diseases published a report on HIV based on interviews and testing of a random sample of the population in South Africa during 2008. The survey included people of all races, age groups, rural and urban and all provinces. The researchers concluded that
(1) The epidemic is stabilizing at 11% between 2002 and 2008;
(2) HIV prevalence at national level decreased by nearly half among children aged 2-14 years, between 2002 and 2008;
(3) HIV prevalence decreased slightly among youth aged 15-24 from 2005 to 2008;
(4) Encouragingly there was a substantial decrease in new HIV infections in 2008, in comparison to 2002 and 2005, especially for the single age groups 15, 16, 17, 18, and 19;
(5) What was most encouraging was the change in behavior among South Africans. More South Africans for all age groups protected themselves against HIV infections by using condoms. More than 95% know where to access condoms and use has increased;
(6) Furthermore, half of South Africans now know their HIV status, which means that the message on "know your status campaign" is being heeded;
(7) The researchers also reported that there has been an increase in exposure to one or more HIV/AIDS communication programmes from 2005 to 2008 with 90.2% of youth aged 15-24 years being reached, followed by adults 83.6% of 25-49 years and 62.2% of adults 50 years and older;
(8) However, despite these successes, there is still some unevenness in infections as well as behaviour change.
· HIV prevalence is still highest in KwaZulu-Natal (15.8%) and Mpumalanga (15.4%).
· It is also still highest among young women, aged 25-29 years, where a third of the women are HIV positive.
· Among all provinces, Free State continues to have high rates of multiple partnerships, perhaps due to the migratory labour patterns in that area.
We take note of the recommendations made by the researchers, especially that we need to introduce targeted interventions in some provinces with high HIV prevalence.
Secondly, that we assist young women who want to have children, to do so without risking HIV infection. We plan to support research that will generate evidence to be used in attaining this goal.
We furthermore, support that we intensify our efforts to help provinces implement interventions aimed at reducing rates of multiple sexual partners, including intergenerational sex.
We also take the recommendation that we should consider implementing provider-initiated HIV testing in all health care facilities.
Finally, we take seriously the concern that Khomanani should increase its reach and coverage to all South Africans, particularly those who are aged 50 years and older.
I would like to thank the following people for continuing to undertake research that informs policy and programme development on HIV and AIDS; these are Dr. Olive Shisana, Professor Leickness Simbayi, Professor Thomas Rehle and their staff at the HSRC as well as their colleagues from the MRC and CADRE especially Dr Warren Parker. Finally, the support of the US President's Emergency Plan for AIDS Relief in conducting this important study is very much appreciated.
Hence Hon Speaker, we will work with provinces in 2009/10 to ensure that 80% of HIV-exposed infants receive ARVs for PMTCT (based on dual therapy). This figure will increase to 95% over the two years of the MTEF 2010/11 and 2011/12. The proportion of pregnant women who are tested for HIV will be increased from 80% in 2009/10 to 95% in 2010/11 and 2011/12.
To strengthen the prevention of mother-to-child transmission of HIV, 80% of pregnant women who are eligible will be placed on ARV Prophylaxis based on dual therapy in 2009/10.
This figure will increase to 95% in the outer 2 years of the MTEF period. 30% of eligible pregnant women will be placed on HAART in 2009/10. this service will be expanded to cover 50% of pregnant women in 2010/11 and 75% in 2011/12. South Africans, and men in particular, will be encouraged to do voluntary counselling and testing (VCT). In line with the result of the research by the Human Science Research Council (HSRC) and others, we will increase distribution of male condoms from 283 million to 450 million in 2009/10, and 45 million condoms in the other years of the planning cycle. Female condom distribution will increase from 4.5 million in 2009/10 to 5 million in 2010/11 and 2011/12.
We will start 215 000 new patients on ARVs and grow the figure to 320 000 in 2011/12. This figure of patients will add to the 781 465 people already on treatment.
(iv) overhauling the healthcare system and improve its management
We will draft proposals for legal reforms to unify the public health service. We shall also develop a decentralised operational model including new governance arrangements.
Hon Speaker, we shall also finalise delegations for all managers at all levels of the public health system. We will spend attention on hospital managers or CEOs to ensure decentralisation of management. We shall also strengthen health specific management capacity for programmes and facilities, especially hospitals. In this case we shall:
· evaluate all CEOs of hospitals to ensure that they meet the minimum requirements for effective management of the set facility and institute corrective measures where indicated, including retraining and/or redeployment;
· do a feasibility study for establishment of a leadership academy of health managers.
· In further overhauling the health system, we will evaluate and strengthen the district health system and primary health care
(v) Improved human resource planning, development and management
(vi) Improving the quality of the health services
(vii) revitalisation of health infrastructure
(viii) mass mobilisation for better health for the population
(ix) review of drug policy
(x) strengthen research and development
In conclusion, Hon Speaker, I wish to appraise this House, about the issues of Occupational Specific Dispensation (OSD)
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