HIV/Aids care lagging in SA
2005-03-14 12:51
Johannesburg - South Africa's ambitious HIV/Aids treatment plan is lagging as the government struggles to plug a shortage of doctors and pharmacists and other professionals needed to battle the world's biggest HIV/Aids caseload.
For the second year in a row, the government has missed its target of providing free antiretroviral (ARV) drugs to 53 000 South Africans by March even though President Thabo Mbeki has described the programme as "the best in the world".
Only 33 000 people with full-blown HIV/Aids were receiving free drugs at the end of January, according to the health department's new Aids supremo, doctor Nomonde Xundu.
Two months after taking up the post of director for HIV and Aids at the national health department, Xundu says the priority is finding hundreds of doctors, pharmacists and dieticians to shore up the public health care system.
"The biggest challenge I would say is getting the human resource capacity up to the level where it needs to be," says Xundu.
'We are struggling'
"In the category of pharmacists, doctors and dieticians, we are struggling," Xundu said.
The health department set a goal of hiring 220 doctors by March this year but only 111 have been found, she said.
Out of the 271 pharmacists needed to help roll out the world's most comprehensive anti-retroviral treatment programme, only 90 were hired and 64 out of the 136 wanted dieticians were hired, she added.
"There are not that many sitting and waiting to work in the public health system," says Xundu. "The working conditions are not very attractive" with the average annual salary for doctors at some R190 000 (about $32 000).
The government recently allocated R4.3bn over the next three years to enable the rollout of free anti-retrovirals and provide comprehensive treatment.
South Africa has the world's highest HIV/Aids caseload, with 5.3 million people, or an estimated one out of five adults living with HIV and Aids, according to UN figures.
While she laments the lack of credible figures, Xundu says the health department estimates that 5.6 million people are living with HIV and Aids in South Africa, with the highest prevalence rate - at 30% - among young people between the ages of 21 and 29, especially women.
Looking for incentives
The government is looking at incentives to attract more health care professionals, offering for instance housing benefits for doctors who take up posts in rural areas where there are fewer medical facilities.
It is also trying to recruit doctors and other professionals from abroad, notably from Cuba and Iran.
"We are looking for foreign professionals but we shouldn't be bleeding the African states because they are in the same situation," says Xundu.
For HIV/Aids activists however, the missed targets are rooted in a lack of political will from a government whose leader, Mbeki, has in the past openly shown his scepticism over the need to make the fight against HIV/Aids a priority.
"The evidence is that there are plenty of people needing the programme. Instead of filling the gaps, the politicians are content to allow things to proceed at a snail's pace," says Mark Heywood, spokesperson for the Treatment Action Campaign (TAC) which two years ago won court rulings forcing the government to offer free ARVs.
TAC has launched a campaign to demand that 200 000 South Africans be put on anti-retrovirals by next year and that at least 10% of these patients be children.
A non-governmental organisation, Health Systems Trust, which has been monitoring the HIV/Aids treatment programme since its launch in 2003, also concurs that the number one problem is human resources.
"We don't have the staff, the expertise to actually run the sites", says Rob Stewart, who runs the monitoring project for the Durban-based organisation.
"But we are developing it quite rapidly," he says.
Stewart says fighting HIV/Aids in South Africa has entailed "a large restructuring of health management and personnel, right through the entire system. It's really a massive undertaking."