MINISTRY OF HEALTH
18 September 2000
MEDIA BRIEFING

Documents handed out:
Briefing document: Minister of Health (Ms Manto Tshabalala-Msimang) [appended]

Minister Tshabalala-Msimang stated from the outset of the briefing that there was a misunderstanding regarding the purpose of the meeting. The Minister stated that the focus of her briefing was to elaborate on the progress that has been made on the programmes that were highlighted by President Mbeki during the State of the Nation Address in February earlier this year. She emphasised that the aim of government is the elimination of poverty directing much of their activities to an integrated rural development strategy. The Minister explained that the role of the Department of Health is to take part in a number of interdepartmental activities aimed at advancing these initiatives.

Ms Tshabalala–Msimang proceeded to give a run-down of the activities that they are currently engaged in as well as highlighting the objectives of such efforts (see briefing document). Amongst the issues that drew the most interest was the relationship between the HIV virus and AIDs. Much of the discussion revolved around this issue but additionally concerns were raised on the impact of condoms on the spread of AIDS, as well as the link between AIDS and TB (Tuberculosis). The media also asked when the discussions with the pharmaceutical giants were going to come to fruition.

Discussion
(Q) You state that condom usage in addition to the syndromic management of STDs (Sexually Transmitted Diseases) has caused syphilis to decrease from 12% in 1995 to 6% in 1999. From what part of the population were these figures obtained?

(A) Minister: The figures relate to pregnant women specifically.

(Q) On the meetings that you are going to have with the pharmaceutical companies, where will you meet? With whom will you meet? Do you have any idea of what the prices might be?

(A) Minister: Five pharmaceutical companies said that they want to meet with us in Geneva on 29 September. NGOs (Non Governmental Organisations) and countries like Mali, Congo, Uganda and South Africa who will be representing SADC (Southern African Development Community) would be present. It was agreed to divide Africa into blocks (east, west, central and SADC) and to set principles that would govern negotiations with these companies. Amongst our concerns is the sustainability of the price decreases. We wish to inform these companies that we lack the infrastructure to implement complex programmes. For example anti retroviral drugs require constant monitoring, so we cannot use them.

(Q) Does HIV cause AIDS?

(A) Minister: How many times must I answer this question? What has triggered this question? I have not said that it does not cause it. We need to look at other factors that can spread the virus. We need to have a comprehensive programme to address the problem of AIDS. I want the media to understand that it is not the virus alone that fuels the epidemic, we must look at various factors. People want to put words in my mouth. I am not a child, do not try to get a ‘yes’ or ‘no’ from me. I refuse to answer the question.

(Q) You talk about care, support and treatment for AIDS. What sort treatment are you talking about? Is anti retroviral a possibility?

(A) Minister: I definitely do not mean anti retroviral. I have commissioned AIDS activists in Uganda to come up with a report on the best route to take. Consequently we have completed guidelines for managing opportunistic infections.

(Q) In his interview with Time magazine, President Mbeki let on that HIV might or might not be the virus that causes AIDS. How will this affect the utilisation of your resources?

(A) Minister: AIDS is a very emotive topic. The President was misunderstood in what he said. He uses short sentences which are easy to understand. In his statement he said that HIV is not the only cause of AIDS. Please go back and check it.

(Q) You have not answered the question. Does HIV cause AIDS?

(A) Minister: It does, I have not denied this.

(Q) Does the government know of cases where a person who does not have HIV has died of AIDS?

(A) Minister: We need to look at the manner in which this disease has been introduced. Does a medical certificate state that an AIDS patient has died of HIV. Confidentiality is a sensitive issue, which you are well aware of. All that we can do is to ensure that we have adequate support systems.

(Q) You have not answered the question on the utilisation of your resources. Your government has been in power for the last six years and each year AIDS has increased. How does this guide your use of resources?

(A) Minister: Firstly it is not my government but our government. Where is your sense of patriotism?

(Q) Do not dodge the question.

(A) Minister: The ANC had a strategy for AIDS in place before they even came to power. The President had asked us to review this strategy as AIDS was on the increase. We have therefore identified some other factors that have contributed to the increase, poverty, nutrition etc. At present we have allocated more funds to battle the onslaught of AIDS.

(Q) Has agreement been reached on issues that you discussed with the pharmaceutical companies?

(A) Minister: We have made requests and they have made offers but nothing has been agreed upon as yet.

(Q) If you have TB, will you test positive for AIDS? Is the virus you refer to the HIV virus? Additionally do you think that condoms are playing a positive part in combatting AIDS?

(A) Minister: We are doing studies to see the interaction between AIDS and TB. We have sites all over South Africa to monitor it. If you are HIV positive and you have TB, the TB is still curable. I have dealt with the HIV issue, I wish to look at other issues as well. On the question of condoms, yes, I do feel that they are playing a positive role, as we are unable to keep up with the demand for them. People must be using them.

(Q) Ms Francis Ngubane, a worker at Baragwanath Hospital, asked over the radio why should they test for HIV if the President believes that HIV does not cause AIDS?

(A) Minister: I reiterate what I previously said. The President did not make such a statement. We need to look at testing and the issues that contribute to the AIDS epidemic. The results of these tests will be available in November or December. These are false rumours. Once again I ask you to read the President’s speech correctly.

(Q) Could a person die of AIDS if he is not HIV positive?

(A) Minister: HIV is a whole syndrome, for example, diarrhoea, meningitis. Only if a person is HIV positive could you say that they died of AIDS.

(Q) Are you telling teenagers who have AIDS to have sex with condoms?

(A) Minister: We encourage teenagers to use condoms to prevent the spread of AIDS. We did not say that teenagers must not use condoms.

18 September 2000

PRESS BRIEFING BY THE MINISTER OF HEALTH IN CAPE TOWN

1. Ladies and Gentlemen:
It is important to first clear the misunderstanding that has been created around the purpose of this media briefing.

2. The focus of this briefing is to elaborate on the progress that has been made on the programmes that were highlighted by our President during the State of the Nation Address in February this year.

3. A central task facing government is the elimination of poverty. A key strategic intervention to meet this challenge is the integrated rural development strategy. The department of health takes part in a number of interdepartmental activities aimed at advancing these initiatives.

· We continue to consolidate the provision of a comprehensive package of PHC services for all the citizens free of charge through the public health system targeting particularly the rural poor. The introduction of community services for doctors continues to assist improve our services at the periphery. We have now extended this programme with the introduction of community service for dentists which began in July 2000. There are minor teething problems with this programme but these are being addressed. We are now also busy with the placement of pharmacists who shall be starting in January 2001. We remain convinced that the universal provision and easy access to basic PHC of good quality is the single important contribution the health sector can make in the fight against poverty.

· We have initiated a process for Vitamin A supplementation because of high levels of deficiency in some of our communities. This programme targets children under 5 years as well as lactating women 4 weeks postpartum.

· We also are at an advanced stage in our programme to introduce fortification of our major staple foods. This aims at eliminating the high levels of micronutrient deficiencies which are closely associated with disease and suboptimal development of children.

· We continue to improve the efficiency in the implementation of the PSNP. An audit of the existing programme has been completed. Results will be available in November. We believe that this will further enhance our our controls and overall efficiency of this programme. We also are working with other sectors in government in devising ways of ensuring that the PSNP grant and the other grants aimed at poverty alleviation are better aligned and targeted.

· We are working with the three provinces targeted by the integrated rural development strategy to finalise business plans aimed at accessing 25 million dollars worth of aid from the Japanese government.

4. Needless to say, HIV and Aids continue to pose a significant challenge for us. We remain firmly of the view that our success will lie in our efforts to deal simultaneously with the many facets that fuel this epidemic. Obviously more emphasis will be placed on different elements at different times. For example , we are now placing more effort on care and support whilst continuing to deepen social mobilization and our intersectoral response. Some highlights are · The establishment of SANAC and its task teams. Its adoption of the 5 year national strategy and the key actions that will flow from its recently concluded strategy session on 8 and 9 September. Provincial Aids Councils have now also been established.

· We are encouraged by some evidence that seems to suggest that there is some delay in sexual debut amongst the youth. We are bulding on this by intensifying the life skills programme in schools. Our integrated strategy with Education aims at rolling out this initiative to all schools within 3 years.

· We are encouraged by the increase in the demand for condoms. 200 million condoms were purchased and distributed last year by the public health system. We are encouraged by the clear evidence of increasing demand. We are improving our logistic system to be better able to track uptake in the 140 condom distribution points that we are using countrywide. We are in discussion with the state tender board to include stiffer penalties for those suppliers that are not delivering on time. We are worried by the high batch failures with some of the condoms. At the same time this vindicates our decision to insist on the need for the SABS to batch test to ensure quality. We cannot compromise on the quality of the condoms we distribute. We are however discussing with the SABS for them to improve on the speed with which good quality condoms are released to the public. We are also encouraged by the clear evidence of a decline in the incidence of syphilis in the country which seems linked to the introduction of syndromic management of STDs (from 12% in 1995 to 6 % in 1999). We have now finalized a strategy for the establishment of a countrywide STD surveillance system so that we can aggressively deal with the contribution that STDs make in fuelling the HIV epidemic. Simultaneously, we have approached the Health Professions Council to incorporate a module on STD treatment as a compulsory module in the Continuing Medical Education programme. We are also encouraged by the evidence that continues to come from the targeted intervention sites in Welkom and Carletonville. The challenge for us now is to systematically scale up these experiences. We see the two areas of STD treatment and condom supply as important areas where we can establish genuine partnerships between the private and public sectors

· In March this year, we released our guidelines for the treatment of opportunistic infections. Training is now taking place in the provinces.

· We have commissioned work which in the next two months will begin to give us a clearer picture of the impact of the HIV/AIDS epidemic on the public health system. This is particularly necessary for the completion of our strategy on homebased care. Following our initial discussions between the health and welfare Minmec's, the different provinces are piloting on different models of homebased care.

· We reported previously on TB/HIV pilot sites which we had established to be better able to learn on the HIV /TB interaction and the challenges it poses. We are now extending these sites to have at least one site per province by the end of this year.

· We successfully hosted the 13th international Aids conference - the first time this conference was held in a developing country. Clearly from the deliberations of this conference, our strategy particularly the focus on primary prevention and robust treatment of opportunistic infections is correct. It was also clear during this conference that the problems of equitable access to treatment are now firmly on the international agenda. Of course we are aware also that the conference also highlighted areas of controversy both in our country and abroad such as mother to child transmission. These are difficult and emotive issues. Government is committed to approaching this matter with great sensitivity and is open to have discussions to try and find sustainable solutions in the shortest possible time. As previously stated, we regard the conference as having been a success. We look forward to receiving the recommendations of the technical discussions that WHO will hold in October on the evidence available on Niverapine for use in MTCT. We particularly look forward to their advice on the twin challenges of resistance and breastfeeding. I wish to stress that it is very important for us to grasp some of these international concerns so that we do not in our passion and determination to act , start conveying messages that are inaccurate. For example , as we accuse government of inaction, it is important also to recognize that the Niverapine we talk about is not registered for purposes of use in MTCT. That is why we have decided that in the meantime a correct response by us would be to extend our research sites to each province with a view particularly of focusing on the operational challenges .

5. We continue to improve implementation of DOTS. An area that has been of concern to us for quite some time now has been the coordination between our DOTS driven strategy and the inpatient care given largely through SANTA and Lifecare. We are currently doing a detailed audit and review of the services provided by these two institutions. This work will be completed by the end of this year and will contribute to enhancing our ability to provide a continuum of care for our TB patients.

6. We continue to confront the problem of drug resistance in Malaria together with our neighbours. A new therapeutic drug has been registered which can be used in some of the high drug resistance areas e.g KZN. We have secured the support of SADC and WHO AFRO for the continued use of DDT for vector control in a limited way to deal with the pyrethroid resistant vector in KZN and Mpumalanga. Let us stress that the extent and the limited nature of the use of DDT envisaged will have insignificant environmental effects.

7. We continue to register success with our immunization campaigns. The campaigns which we conducted in June and July against measles and polio were a success. Epidemiological surveys done on children at 18 months shows very encouraging impacts of the Hepatitis B vaccination programme that was introduced in 1995. In the prevaccination era , 8 to 12 % of children at 18 months were carriers of the hep B virus in rural Eastern Cape. New infections now are very rare. We continue now also to monitor the impact of the HIB vaccine which we introduced last July.

8. Maternal mortality and morbidity reduction remain one of our challenges. Based on the report on maternal death notification which was released last year, we have now finalized the guidelines on the care of the woman in labour. We shall be launching this later in the year. We hope that this will correct some of the defects identified in that report. Later this year we shall also review the analysis of the deaths that happened in 1999.
We continue with the training of staff to ensure safe implemantation of the Choice to the termination of pregnancy Act. We are particularly expanding services in the more rural areas - responding to the limitations that were highlighted during the parliamentary hearings on this matter. I wish to repeat the appeal I made during my budget speech to our health workers to respect the rights of women to reproductive choice.

9. Human resource development is important to underpin our health sector reform. We have reviewed the first phase of our HR plan which I commissioned late last year. Flowing from this, preliminary discussions have been held by a team of the DG and the provincial HODs with our statutory councils as well as the deans of medical schools. Followup meetings with other key stakeholders are envisaged. It is the intention that these consultations address some of the key weaknesses identified. Important amongst these are

· More intake of those from disadvantaged backgrounds at all levels

· Curriculum reform in line with our PHC strategy, our human rights approach and the health challenges of a developing economy and a society in transition.

· Better definition of the scopes of practice of the different groups within the framework of a multidisciplinary approach to healthcare delivery.

· Strategies to correct distortions caused by overproduction and underproduction of some categories

10. An important area in our overall national effort is that of the restoration of the dignity of all South Africans. Some specific interventions we are undertaking in this regard are

· Continuing with the implementation of the patients rights charter

· We have tabled before cabinet an amendment to our mental health Act. This will signal a significant change in the care of those with mental illnesses to give expression to the spirit of our constitution. This bill is now being finalized by the state law advisors.

· We are revitalizing our hospital sector to make it more responsive to the needs of the users. This involves both the physical rehabilitation as well as improvement in the management.

Issued by GCIS on behalf of the Department of Health