Dear Mr President,
As we enter day six of the national lockdown, the rapidly spreading Covid-19 coronavirus has now crossed the 630 000 threshold of confirmed cases and more than 42 000 deaths across the globe, since first being identified in Wuhan, China. Immunocompromised people have been identified as being at increased risk. Over the past few weeks, we have had more evidence of what we already know – health mirrors inequities in South Africa, where the burden of chronic diseases is borne by those with inadequate access to water, sanitation, nutrition, safe transport, adequate housing and ventilation.
Given the relatively high prevalence of HIV and tuberculosis in South Africa, your decision to enforce a nationwide lockdown to strengthen the containment of the virus and to flatten the infection curve should be commended.
As you recall, your lockdown announcement was accompanied by a number of measures that look to support key sectors in the economy, particularly the financial sector and burgeoning small business sector. The creation of a social solidarity fund has been a welcome innovation and presents an opportunity for all South Africans to contribute towards greater social cohesion.
We recognise that the decisions of the past few weeks have not been taken lightly. Reports are emerging of extensive consultation with organised labour and intense collaboration with corporate South Africa. A number of working groups have since been established, including a project management office managed by PwC. As we understand, work streams were organised by sector, with health being led by Aspen Pharmacare, labour led by Bowmans, economy led by the Rothschild group, and communications led by Business Unity SA.
The extent to which groups interacted with other sector groups is unclear, but the heavy emphasis on the economy and the relative weakness of the social mitigation measures suggest that organised business played a leading role in the shaping the response. Further, while much of the response is guided by the Disaster Management Act, legislation is not clear on how these groups’ relationship with the presidency or the national command council is governed.
We praise the involvement of business and organised labour, but we worry that it may have taken place without sufficient scope for counter-narratives and diverse voices. The role of Big Pharma without patients’ voices, for example, is a big issue for us as it may result in disaster capitalism.
Mr President, you have also mentioned multiple times that your consultations included civil society leaders, however, it is unclear which groups in civil society were consulted within the health sector, beyond health practitioners.
While some SA National Aids Council leaders have been consulted, we worry that they do not represent the majority of health civil society organisations. Furthermore, we are unaware of engagement with other groups, such as shack dweller groups, sex worker-led formations, migrants’ rights groups and many of the groups living in precarity. Engaging these groups is essential in order to get community participation.
The need for a people-driven response
While the stabilisation of the economy, particularly continuity in the availability of services, is essential, there is a human dimension to the response and a deeper people-driven response is required.
South Africa is not new to this, as we faced a similar crisis in the country’s response to HIV/Aids. We have learnt many lessons on the importance of a human rights-based approach to public health and the power of health system users to educate and organise themselves to ensure a better health system, including access to treatment for all.
Today, South Africa runs the largest domestic antiretroviral therapy (ART) programme in the world, with more than 4 million people on treatment. Much of the success of the ART programme can be attributed to the commitment of activists from the PLHIV (people living with HIV) sector in ensuring that people know their status, overcome stigma and are treatment literate. A purely technical response from government could not have achieved this.
We acknowledge the need to mobilise in different ways during this trying time, and community organisations have largely responded to the call to do so. But we also know that much more needs to be done by every single one of us and that we need a people-driven approach to beat Covid-19. We will be engaging in community literacy campaigns, in line with yours, to ensure that communities are kept well informed about the virus.
Mr President, given our shared history and the increased risk that community transmission presents to people living with HIV, it is disappointing that none of the country’s five largest membership-based PLHIV organisations have been included in supporting the country’s containment efforts thus far. The Treatment Action Campaign (TAC) has significant capacity in community responses to disease prevention, and its cadres can support initiatives at national, provincial and community level. TAC has a strong network of partners within the social justice space and is well placed to act as a conduit for greater community participation in the containment of Covid-19.
TAC has been mandated by the National Association of People Living with HIV and AIDS (Napwa), the Positive Action Campaign, the Positive Women’s Network, the SA Network of Religious Leaders Living with or Personally Affected by HIV and AIDS (Sanerela+), as well as civil society organisations including Section 27, the Rural Health Advocacy Project (RHAP), the People’s Health Movement and Health Enabled to request that TAC join the national command council to ensure that the voices of PLHIV and public healthcare users are reflected in considerations.
We reiterate that we are fully behind the efforts to flatten the curve. This is not the time to play politics. In whichever way we can, we want to contribute to fighting the pandemic. The new screening, testing, tracing and medical management programme offers us a chance to all get involved in ways that are deemed necessary, and we welcome it. Let us participate in a way that is proven to improve health outcomes and health systems in our country.
People’s Health Movement
Positive Women’s Network