A New Treatment Action Campaign (TAC) leadership team was elected at the organisation's 7th National Congress recently held in Benoni in Gauteng. The congress was attended by 174 delegates representing 174 TAC branches from across eight of South Africa's nine provinces.
Founded in 1998, the organisation is best known for its struggle against AIDS denialism in the early 2000s and its successful advocacy for access to HIV treatment for all who need it. Less well known outside of health circles is the TAC's treatment literacy programme which brought knowledge of the basic science of HIV and related rights into many of South Africa's working-class communities and rural areas. (See the note at the end of the article regarding the relationship between TAC and Spotlight.)
Today, South Africa has the world's largest HIV treatment programme and HIV treatment is widely available in both the public and private sectors. What then is TAC's role today, given that the problems it was originally founded to address have largely been solved? Below we've tried to capture the views of some of TAC's new leaders.
Evolving role
Dr Fareed Abdullah, chairperson of the TAC board, says that the TAC's work has evolved over the years in line with the main challenges in the health sector. Apart from its political structures, the TAC also has a board that oversees the financial and organisational side of its operations.
"The first two to three years (circa 2000), were about getting treatment for pregnant women, and very quickly after that, it became clear that you're saving the babies but you need to save the mothers as well. And so adult treatment quickly followed in, and TAC shifted its focus to scale up of antiretroviral treatment," says Abdullah.
"And whilst the denialism stunted the rollout of PMTCT and treatment for adults in South Africa, there was this bigger, looming issue of prices. The leadership of the TAC at that time had the wisdom to understand that there was an interdependence between those two issues. So, asking for treatment and fighting denialism went together with access to medicines and lowering the prices," he says.
According to Abdullah, that was a good decade of work, "and it's quite unbelievable that the price of ARVs today is 1% of what it was in the time of denialism".
Abdullah remembers 2006 as a key moment when the TAC and government finally got together and wrote the country's first shared HIV plan, the National Strategic Plan (NSP) for HIV, TB, and STIs 2007 - 2011. This, he says, was the only true effective NSP and the only true coming together of civil society and government.
Shift to 'fixing the health system'
In 2010, says Abdullah, TAC started to see the weaknesses in the health system and started shifting its focus to addressing these challenges.
In practice, this meant using TAC's network of 250 branches to monitor healthcare services at local facilities and to advocate for solutions when things go wrong.
"In South Africa, we've got about 3 500 primary healthcare facilities and currently, through the branches of TAC, I can proudly say we are monitoring about 300," says Anele Yawa, the organisation's newly re-elected General Secretary.
Sibongile Tshabalala, the organisation's newly re-elected chairperson, is upbeat about the independence and impact of TAC's branches. "Some members are also part of the community structures," she says, "You find them leading in ward committees, clinic committees, and hospital boards that shows that there's still activism on the ground and they still do what they're supposed to do."
"Instead of talking outside from the fence, we are now inside," he says. "Not everything needs to be taken to the streets."
Monitoring on steroids
But arguably the most important shift in TAC in recent years came in 2019 when the organisation teamed up with Positive Women's Network, SANERELA+, Positive Action Campaign, and the National Association of People Living with HIV/AIDS (NAPWA)to form the Ritshidze Project.
Through Ritshidze, TAC and its allies conduct structured community monitoring at 400 public sector clinics across the country. Through these monitoring reports, Ritshidze has created a new source of trusted data on what is happening in the healthcare system and what users of the system are experiencing. Spotlight previously covered several of Ritshidze's provincial reports and a landmark national report on key populations.
Yawa says that TAC has changed the way they do things.
"Instead of talking outside from the fence, we are now inside," he says. "Not everything needs to be taken to the streets." Instead, armed with data collected through Ritshidze, TAC engages directly with provincial health departments and facility managers in an attempt to find solutions.
Patrick Mdletshe, the organisation's new deputy general secretary, is in favour of more collaborations such as those behind Ritshidze. "We need more new partners," he says, "people with different skills, people that can articulate issues differently, people within the legal fraternity, and doctors that understand the healthcare system, meaning we need to build a very wide reach and range of partners with different skills than ours."
Minister of Health Dr Joe Phaahla was similarly positive about collaboration, telling the congress that the Department of Health is ready to continue with a healthy relationship with TAC. "We believe TAC and other civil society organisations have a big role to play as part of holding the department to account, especially at district and facility level [and] to collaborate with the department to educate our people and create awareness and demand for TB services, the development and implementation of TB stigma mitigation plans, [and] the support of local TB screening and testing campaigns," he said.
Challenges ahead
According to the TAC leaders we spoke to, many familiar challenges remain. More than two decades after the organisation's "HIV POSITIVE" T-shirts first became iconic of the struggle for HIV treatment, Mdletshe says stigma remains a barrier to HIV testing and to people disclosing their status. He also mentions budget cuts and the persistent problem of staff shortages - this latter problem being abundantly clear from the reports produced by Ridshidze.
And then there is corruption.
"We are in a country where corruption has become commonplace," says Tshabalala, specifically mentioning the Digital Vibes scandal and the widespread corruption relating to personal protective equipment (PPE) needed to prevent SARS-CoV-2 transmission. She says that the reality is that those who pay the ultimate price are poor people. The congress was held in Gauteng, the province where whistle-blower Babita Deokaran was assassinated almost exactly a year ago after raising the alarm about suspicious payments at Tembisa Hospital.
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
Abdullah expresses similar concerns.
"There are a lot of good people, a lot of good stories. But overall, the health system is in serious decline," he says. He says that the COVID-19 pandemic exposed the whole healthcare system. "It made it so clear that corruption had set root in a way that we never imagined it could get so bad like the PPE scandals were just a sign of how low we've gotten in this country." He says the thieves and the crooks have shown that they have no sort of rules - all they can do is steal under any circumstances.
"So that puts a bigger task on the shoulders of an organisation like the Treatment Action Campaign," says Abdullah, "because it's one thing to fix the health system but if corruption plays a role in breaking up the system, then that means TAC has a bigger problem to tackle."
Whether the newly elected TAC leadership is ready to build the coalitions and engage in the strategic activism required to shift the needle on this "bigger problem", only time will tell. For now at least, they seem to harbour no illusions about the size of the task ahead.
NOTE: This article is about the TAC. Spotlight is published by SECTION27 and the TAC, but is editorially independent - an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.
