Documents Handed Out: Minister's Media Briefing September 13, 2001 (See Appendix)
Questions from the media and the replies from Minister Manto Tshabalala Msimang
(Q) Where are we with the Mental Health Care Bill i.e. what is the timing on it?
It has passed Cabinet, been certified by the State's law advisors and is ready for the parliamentary committee. It will go to the committee next week and should be passed this year.
(Q) When is the National Health Bill due, and how far-reaching is it?
There were constitutional issues which needed clarification from the Minister of Provincial and Local Government. It is being heard by Minmec tomorrow. We should be seeking public comment this year.
(Q) In terms of the medical schemes legislation, are you happy with the direction the existing legislation has taken medical aids, encouraging them to become more like health insurance?
Yes, I am happy because the legislation addresses the fundamental issues, such as discrimination based on age. The amendment underscores this. However, there may still be teething problems due to medical schemes reluctance to register.
(Q) When can we expect copies of the new Mental Health Care Bill, since it is not available at the Government Printers.
I offer my apologies, it is supposed to be available now.
(Q) Can you comment on the Mail & Guardian's story this week about the expulsion of South African AIDS researchers being expelled from Tanzania? Was there contact between our government and the government of Tanzania? Was this an embarrassment for the government?
No, there was no contact with the Tanzanian government. As to the rest of your question, I don't know the validity of the story.
(Q) What is the progress on the Nursing Bill?
We struck difficulties with that Bill, so it is still in the process of being drafted. Hopefully next year, once the difficulties have been smoothed over, we can move speedily.
(Q) With regard to the program for enriching bread and maize, is it envisioned that this will be done to bread on the shelves, or will it relate solely to flour?
Yes, it relates to the loaves which are bought from shops. Sasko is already doing this.
(Q) When will these measures be introduced?
There is a difference of opinion between ourselves and the industry, I hope you can help us convince them. We had hoped that it would be by the 1st of January, 2002.
(Q) How many women are being tested in the Mother-to-Child tests for HIV, what are the costs of the tests and what are the rates of infection among the mothers?
Conclusive figures will only be available after the Minmec meeting tonight, because we need the figures from all the provinces. The numbers of women being tested are in the presentation (See Appendix)
(Q) Are they being treated with Nevirapine?
Yes.
(Q) Are there plans for money for home-based care, to take some of the pressure of hospitals.?
At this stage it is mainly religious groups and NGOs that provide home-based care. We, along with the Department of Social Development, have developed a program for the training of counsellors and we've interacted with Treasury to create some form of stipend to aid caregivers. It must be emphasised that this stipend is not the same as a salary, but merely aims to cover some of the costs, such as those associated with travelling. The stipend is already being introduced in KwaZulu Natal. The Department of Education is also involved, through its life-skills program and this is seen as part of a co-ordinated program to support caregivers.
(Q) How is the stipend organised?
We are in the process of standardising it and again I emphasise that we do not view this as a salary, since we are very wary of dampening the spirit of communitarism that we have been seeing.
(Q) Can you expand on the plan to develop nutrition - for example are food parcels envisaged as part of the response?
First of all, we are trying to ensure food security, by for example encouraging the development of backyard vegetable gardens, which will ensure a constant supply of fresh food. Second, we are investigating various immune-boosters, in association with various companies. Where there is nothing, we would like to give something, in co-ordination with poverty alleviation strategies.
(Q) Returning to the question of Mother-to-Child transmission, are 9000 women part of the ante-natal clinics?
Yes, 9000 women were counselled at the clinics. Of those, 6400 opted for testing and those who were found HIV positive were treated.
(Q) You mentioned operational difficulties - what are some of these?
It wasn't easy to develop this protocol. We found that, in line with the international experience, without support systems the program fails. These support systems were not easy to develop, since they don't develop overnight. But now they are in place, and the protocol seems quite effective.
(Q) In the teenage group, is the drop in the rate seen as permanent i.e. have we turned the tide on the infections?
Well, its not necessarily just teenagers. We have presented these graphs before. Initially, there was a very steep incline in the rate of infection, but since 1998, we have seen some levelling off, hopefully due to our education programs etc. Much of the work has been done by the ANC Youth League, which took on the issue as a priority and has been engaged very actively in awareness raising, for example. The next survey is due in October and we are hopeful.
(Q) Could you expand on the idea of support systems - what types of support are you dealing with?
When a pregnant woman comes home with the virus, you expect her to tell her family, but due to the stigma etc. this often does not occur. If no preparation work is done, there is often no support. Similarly, if the community has not been sensitised, there may be a backlash. Since it is difficult for a new mother to hide the fact that she is not breastfeeding her baby, it is often impossible for her to hide her HIV status, so we need to educate the communities.
(Q) Surely the absence of support systems could be overlooked as a counter-argument for the provision of anti-retrovirals, if there are going to be fewer babies born with the disease. And surely since the Nevirapine is a single dose, the argument for the development of resistance is not legitimate - surely resistance can't build up for a single dose.
At the conference we held in Durban, researchers from Uganda reported that they were seeing resistance to the single dose, so we are being cautious.
(Q) Could you give us an idea of how far off a comprehensive picture of the HIV/AIDS situation in this country is?
I thought I explained this. At the moment, we use prevalence rates, and we are would like to have the incidence rates. We are working with the CDC in Atlanta and we have a team in the department working on surveillance. We are very concerned because there are lots of figures thrown around, for example that there are 1500 new cases every day. This has been the figure most often quoted for the last four years, so surely it cannot be accurate. This is also linked to the mortality statistics I mentioned. During the deliberations of the Presidential AIDS Panel, many figures were thrown around without confirmation. As a result, a task team was put together to investigate the statistics, which included members of the Medical Research Council (MRC), among others. We need to use roundabout methods to attain the statistics, because doctors do not write out a prescription for 'AIDS'. Hopefully, the task team will be finished by December. There has been a preliminary report from the MRC to the social sector, but this is somewhat worrying to us, because we would prefer a report from the team as a whole. We look forward to this briefing.
(Q) Dr Resnick has been writing many letters to the press, and signs them as a member of the Presidential AIDS Panel. Since the panel never reached consensus, in some ways he is using this to lend his views excess credibility. If he is signing letters as a member of the Presidential AIDS Panel - he was a member of the panel. People include everything on their CVs which they think will make them look good. There's nothing we can really do about that.
(Q) Do you agree with what he has been saying?
What has he been saying?
(Q) That HIV does not cause AIDS for example.
We have set up a task team that is examining some of the disputes among the panel members, such as the questions over the tests. I stand by the findings of the task team.
(Q) Can you give us an indication of the government's response to the Treatment Action Campaign’s (TAC's) court case?
Yesterday was the deadline for the government's response. We have indicated our intention to oppose the action, along with the eight provinces. Predictably, the Western Cape has chosen to follow its own route, and its own defence.
(Q) We hear stories of long queues, clinics without drugs etc. what measures are in place to address this.
Yes there are such reports and its fair to say that some of the queues are the result of staff attitudes, which we are taking steps to address. With regard to the medicines, a 1996 survey found that we had 86 per cent of the essential drugs on the essential drugs list, which I feel is quite good. However, sometimes when a particular brand is prescribed, and that is out of stock, the staff say there is nothing instead of finding a suitable alternative. This is one of the problems we have found. The Patient's Rights Charter was launched in 1999. In November, we are having a prayer meeting at the request of hospital staff, and we are again declaring November Patient's Rights Charter month. It must be emphasised that these are isolated cases and the majority of staff are doing a sterling job. But we are looking at introducing incentives for rural staff.
(Q) With the study being commissioned on the state of hospitals and the added burden placed on them by HIV/AIDS, are you convinced things are as they should be in the hospitals. There has been criticism from the unions that social spending, in hospitals for example, has been curbed.
Yes, hospitals are at full capacity, and I think with HIV at times they are operating at more than full capacity. The audit in 1998 revealed that we needed R8 billion to address the backlog. Treasury made some resources available, but not enough. A number of programmes were launched aiming at refurbishing hospitals, and we are constructing three new hospitals - in Durban, Pretoria and Umtata. We are engaged in the revitalisation of the hospitals, not just the buildings, but the teaching staff management and human rights skills.
(Q) In the past you've said that South Africa cannot afford generic anti-retrovirals. In Nigeria, they're giving them to fifteen thousand people. Why can South Africa not afford them?
There are many differences between South Africa and Nigeria. In South Africa, we cannot afford these medicines. The budget for medicines is R2 billion. We face a number of diseases in this country, and if we bought anti-retrovirals, we couldn't afford to treat any of the others. At the meeting with the pharmaceutical companies in June, we all agreed that the medications we're very expensive. You also need to keep a supply of twelve different cocktails, because resistance builds up so quickly. For HIV, resistance builds up after two years, for malaria, it takes fifteen. This also does not mean that we are not offering any treatment, for example we have the National guidelines for the Treatment of Opportunistic Infections, and we've found that when you treat these, people improve. There is also the area of immune-boosters and nutrition. Not giving anti-retrovirals is not the same as not providing treatment. We are also engaged in studies on the hidden operating costs, because it is all very well to say that a drug costs a certain amount, but this is not the only cost associated with providing these drugs.
(Q) What about Botswana's AIDS program?
They must have sat down and calculated the cost, and decided they can afford it. I am telling you that I have calculated the cost for this country, and for me its not affordable.
(Q) As a follow-up, is there any cost that the pharmaceutical companies could offer the anti-retrovirals at, which the government could afford?
There are additional costs associated with the close monitoring of patients which is needed. For example the cost of blood tests, 4 visits to clinics per year to be treated by a specialist, counselling patients, establishing specialised clinics for the administering of the more than twenty drugs, establishing laboratories for the additional testing required. The indiscriminate use of anti-retrovirals i.e. in the absence of these other facilities can have serious implications. I would like to repeat that not offering anti-retrovirals is not the same as not offering treatment. We will do everything in our power, for example in the treatment of TB.
(Q) Would it be fair to say that South Africa should move away from the debate over anti-retrovirals?
I did not say that, but for the foreseeable future, yes. Unless you can convince the pharmaceutical companies to aid in the provision of infrastructure etc.
Appendix: Appendix:
PARLIAMENTARY MEDIA BRIEFING: SEPTEMBER 13 2001: MINISTER ME TSHABALALA-MSIMANG, MP.
Developments in the health sector
Introduction In order to cover a range of topics effectively during the 90 minutes we have at our disposal, I propose to break the session into two parts. In the first part I'll deal with important legislation - and then take questions on this subject. And in the second part we can discuss some of the more newsworthy programme developments.
SECTION 1: FORTHCOMING LEGISLATION
The Mental Health Care Bill
Perhaps the most interesting piece of health-related legislation to be tabled this session is the Mental Health Care Bill. This is the first new law on mental health care in 28 years and it coincides with the World Health Organisation's focus for the year 2001.
The Bill takes a fresh look at mental health care and moves away from a model that depended heavily on institutionalising individuals almost indefinitely to an approach that is much more consistent with our Bill of Rights.
Among other things: * The draft Bill replaces the old system of "committal" of patients to psychiatric hospitals, with the concepts of "assisted" and "involuntary" care. Involuntary care may apply to persons receiving treatment either in the community -- as outpatients -- or in psychiatric hospitals. * The draft legislation provides for more regular reviews of patients in "involuntary" care to assess their suitability for discharge and sets up Review Boards to do this job. * It defines how basic human rights are to be interpreted in relation to individuals who are unable to exercise independent judgment. * The Bill also provides that individuals subject to involuntary institutional care are entitled to legal representation and stipulates that they should be eligible for legal aid if they cannot afford a lawyer. * Another aspect in which it upholds human rights is in terms of access to information. The blanket of secrecy that the old Mental Health Act threw over psychiatric hospitals by virtually banning media access has been lifted in the new law.
The draft law has been widely consulted with organizations involved in mental health care, but the Bill will naturally be subject to the usual processes of public comment.
In April this year, on World Health Day, we committed ourselves to supporting the international WHO campaign for the rights of all people affected by mental illness. We pledged to break the chains of prejudice and fear that still exist. And I truly believe that this legislation is in the spirit of the undertaking we made.
The Medical Schemes Amendment Bill
When the Medical Schemes Act was passed several years ago it certainly broke new ground and provoked a lot of predictions of doom and gloom. Clearly, the new law has not destroyed the medical schemes industry and we are beginning to see the impact of renewed regulation.
The experience of the Council for Medical Schemes in administering the Act has given us a good sense of how useful the legislation is and it has also shown up some shortcomings. The Amendment Act is intended to deal with these shortcomings. Some of the intended changes are minor amendments to the phrasing of the Act and others are more substantial. They relate to improving protection for members, strengthening the hand of the regulator and removing requirements that are unnecessarily burdensome for the schemes. The Bill was published for comment in June and the version tabled in Parliament incorporates some changes made in response to submissions received.
I'd like to highlight a few of the provisions in the Bill.
Firstly, we have moved to reign in the practice of reinsurance because we have clear evidence of widespread abuse of this practice since 1996 - abuse that has resulted in significant losses to medical schemes. The Bill requires that proposed reinsurance contracts must be independently evaluated and then approved by the Registrar of Medical Schemes before they are finalized. The Bill prescribes the factors that the Registrar shall consider in this approval process; it does not give the Registrar unlimited powers.
Secondly, the Bill requires more frequent financial reporting by schemes to the Registrar (that is, on a quarterly basis). It provides for additional rapid reporting on request and addresses the question of inspections for purposes of monitoring. The rationale for these provisions is to ensure early detection of problems with a view to rectifying them in time. As a first option, the Council takes an interactive approach to resolving problems and malpractices precisely because members of medical schemes usually stand to gain more from this than from a simple punitive approach.
Thirdly, the Bill pays attention to regulating the operations of brokers in the medical schemes field and empowers the Minister to make regulations on the conduct of brokers and conditions in which they may operate. The same clause empowers the Minister to impose penalties on medical schemes or administrators for the late payment of claims.
Another feature of the Bill is its reinforcement of the principle of non-discrimination. There is a provision specifically prohibiting exclusion of members on the grounds of age and one allowing the Minister to regulate the conditions under which waiting periods may be applied. The original Act, as you will no doubt recall, does allow for higher premiums to be charged to older members who have not carried medical scheme cover for an extended period - and this provision is retained to protect the financial viability of schemes.
The Medicines Control Amendment Act regulations
The comment period on the draft regulations relating to the Medicines Control Amendment Act (Act 90 of 97) ended about two weeks ago. This is the Act that got the pharmaceutical companies to challenge us in court and, not surprisingly, we received submissions from a whole range of stakeholders. Redrafting of aspects of the published regulations will be finalized in the next few weeks and we expect to have the regulations in place before the end of the year.
We have actively engaged with various groupings within the pharmaceutical industry on these regulations. We also met with the South African Medical Association and other representatives of dispensing doctors to discuss their concerns.
The regulations are quite wide-ranging, but those sections that have provoked the greatest interest are:
* The provision that will enable us to buy pharmaceutical products on the international market instead of being confined to products available in South Africa. * The control procedures to be observed by the Medicines Control Council to ensure quality, safety and efficacy of imported drugs. * The licensing procedure for doctors and other health professionals who intend to dispense medicines. * The provision that obliges pharmacists to offer clients the generic product where the prescription refers to the more expensive patented product. * The composition of the Pricing Committee, which will play a key role in advising the Minister on the purchase and pricing of drugs.
When all is said and done, our basic motivation for this legislation is: * To bring down the cost of medication and to make health care more affordable in both the private and public sector. * To protect the public by ensuring the safety, quality and effectiveness of drugs. * To further protect the public by creating conditions for good pharmaceutical practice.
We have consistently taken the position that we can fulfil all of these objectives and still adhere to our international obligations in terms of intellectual property rights. And we remain convinced that the regulations we produce will achieve this balance.
This week we also launched the pharmacy week where we are working together with Pharmaceutical Society of South Africa and South African Pharmacy Council in raising community awareness about pharmaceutical products and services. Our aim is to ensure that the majority of our people are aware of their rights and responsibilities when it comes to the use of drug products.
National Health Laboratory Service Amendment Bill
Last year Parliament passed the National Health Laboratory Service Act that provided a framework for the amalgamation of 234 public sector laboratories and various research facilities into a single public enterprise known as the National Health Laboratory Service (NHLS, for short).
The Act was promulgated earlier this year and the rationalization process is now well underway. The NHLS will be the preferred service provider for the public sector and all health authorities will buy their laboratory services from this organization. Fees for these services will therefore be the main source of income for the NHLS although some research activities will continue to be funded directly by Government.
The underlying purpose of this rationalization was improved co-ordination among laboratories and the achievement of a good standard of laboratory support in all parts of the country.
The NHLS is supervised by a board of up to 22 members (including three representatives of the public) who are appointed by the Minister of Health. The Board has been running since May and among its first tasks was the appointment of a chief executive officer. The position has been filled by Cassim Gassiep, who was Director-General for State Expenditure until November 1999 and has since worked in the private health sector. He took up his post at the start of September.
The Amendment Act secures the rights of employees of the NHLS to remain members of the public service pension fund. In concluding this section of my presentation I should mention that we tabled the National Health Bill to Cabinet. The Cabinet recommended that we should have further discussion with Local Government and Provincial Affairs. This process has taken place and outcome will be presented to the Health Minmec tomorrow.
SECTION 2: PROGRAMME DEVELOPMENTS
TB Control programme We are taking decisive measures to improve our TB Control Programme and we want to ensure that the resources that we put into this programme give us the outcomes we expect. As you know, we are closing one hospital in the Eastern Cape because of its bad condition. We have also suspended funds paid to SANTA for Betterment and Community Service because there was an indication that this money was not going into targeted services. We are closing at least one TB hospital in the Eastern Cape, which we have found to be unsuitable to accommodate patients.
We have already awarded a tender for the forensic audit of SANTA and we hope that this investigation will not run for more than two months. The outcome of this audit will guide us as to what action we should take including a decision on whether we should investigate individual TB hospitals.
One of the challenges we face is the emergent of Multi-Drug Resistant TB, which represents the legacy of poor treatment practices from the past. A national survey of TB drug resistance has been conducted to better understand the magnitude of this problem. We will be discussing with the World Health Organisation about the possibility of getting concessionary prices for the drugs used to treat MDR TB. These drugs cost us up to R25 000 just to treat one MDR TB patient.
I should mention also that representatives of the WHO are currently in the country to monitor the progress we have made in TB control and advise on the way forward. They have visited all the provinces and met with our officials to look at the Medium Term Development Plan. They will be presenting their findings to the Health MECs and myself later today. Malaria control
Malaria is one of the major challenges facing the health services in at least three of our provinces and about 10 percent of our population live in what is called malaria risk areas. Malaria cases have increased steadily in the country since 1996 with the highest number of cases reported at 61 447 in 1999/2000 malaria season largely due to climatic conditions conducive to its spread.
However, with the re-introduction of DDT and the investment of an additional R39 million into the Lubombo Spatial Development Initiative we have been able to reduce the cases of malaria by 70% in the northern parts of KwaZulu-Natal where most of the cases were reported. The LSDI has also led to a substantial decrease in malaria cases in Swaziland and Mozambique with the southern parts of Mozambique reporting a 43% reduction this year.
Because of the success of our malaria control programme in KwaZulu-Natal, we have decided to introduce DDT for malaria control in Mpumalanga and Northern Province as part of our campaign to roll back this disease. I would like to re-assure you that we are using this insecticide with much care to ensure that there is no threat to the environment.
The progress we have made in this regard was the reason behind the WHO award for the Best Malaria Control Programme being given to South Africa during the Southern Africa Malaria Control annual meeting held in Zimbabwe recently. At this meeting we also launched an SADC regional plan to combat malaria. The plan aims to reduce deaths from malaria in Southern Africa by half before the end of the decade and will be useful in co-ordinating regional efforts for the control and prevention of malaria including the SADC Malaria Week that we will have between 5 and 9 November.
SADC and International role Malaria is just one of various areas where we have played our role as chair of the SADC Health Sector. We have worked together in curbing cholera that affected many countries in the region. We have adopted a regional strategic framework for HIV/AIDS and regional guidelines for negotiation with the pharmaceutical companies.
There regional guidelines for negotiation with the pharmaceutical companies that are used by individual countries and SADC as a bloc in engaging with the pharmaceutical companies. One of such encounters was a unique face-to-face meeting between Ministers of Health of the SADC countries and representatives of seven multinational pharmaceutical companies, which was hosted by South Africa in June this year.
This meeting agreed that the complexity of HIV/AIDS programmes was often not appreciated and was reduced to an oversimplified public debate focusing solely on the prices of anti-retroviral drugs. It concurred that in order to address HIV/AIDS effectively, a comprehensive approach founded firmly on strong prevention programmes is imperative. While the benefits of anti-retroviral therapy were acknowledged, the obstacles to implementing this therapy were clear to both the Ministers and pharmaceutical companies.
As you may remember that one of the conditions under which we accepted a free diflucan offer from Pfizer was that this donation should be made available to all other SADC countries. We have been able to facilitate discussions aimed at extending this programme to other countries and SADC countries that have interest in this offer are now discussing directly with Pfizer.
Our efforts outside of South Africa have not been limited to the SADC region. We chaired the drafting committee that produced the Abuja Declaration on HIV/AIDS, Tuberculosis and other related infectious diseases and its programme of action. These documents have fed into other international initiatives including the Declaration of Commitment adopted during the first United Nations Special Session on HIV/AIDS in June this year.
Developing countries and South Africa in particular, played an active role in the drafting of this Declaration and ensured that as a blueprint of a global response to HIV/AIDS, it is relevant to social conditions in most of the highly affected countries.
I would urge you all to compare our national HIV/AIDS and STI Strategy (and resulting programme) with the UNGASS Declaration of Commitment.
The Declaration highlights poverty, underdevelopment and illiteracy as main contributing factors to the spread of HIV/AIDS; acknowledging the primary role of prevention; and a need to strengthen health systems and improve social conditions as part of an integrated response to the epidemic. It urges countries to develop and accelerate the implementation of national poverty eradication strategies to address the impact of HIV/AIDS on household income, livelihoods and access to basic social services by 2003.
With regard to antiretroviral therapy, the Declaration states that it should be provided "in a careful and monitored manner to improve adherence and effectiveness and reduce the risk of developing resistance." National, regional and international strategies should be developed to strengthen health care systems and address factors affecting the provision of HIV-related drugs including antiretroviral drugs. These factors include affordability and pricing as well as technical and healthcare systems capacity.
These are issues that we have been trying to explain with no much success to those who advocate the wholesale use of antiretroviral drugs in our country without considering the lack of capacity to procure, administer and monitor these drugs in the public health sector. These are no excuses but real challenges facing almost every developing country, and South Africa is no exception.
One of the main areas of focus for the New Africa Initiative (NAI) is challenge of communicable diseases in the continent. We have been instrumental in formulating the policy on the Africa's response these emerging and re-emerging diseases within the NAI and we will be investing further in this process.
Global Fund for HIV/AIDS and Health We are also proud of the contribution we have made in working towards the formation of the Global Fund for HIV/AIDS and Health. We are now listed amongst 13 countries and organisations that constitute a Transitional Working Group for the Fund. We are working within this group to ensure that this fund is launched by the end of this year.
As the chair of SADC Health Sector, we want to ensure that our regional views on how the Global Fund should operate are incorporated into the final terms of reference for this Fund. This will ensure that the Fund is of real benefit to many countries in Africa who are most affected by HIV/AIDS, Tuberculosis and other related infectious diseases.
HIV/AIDS The UN Declaration on HIV/AIDS says that prevention should be the mainstay of our response to this epidemic. Countries are urged to establish time-bound national targets for prevention by 2003. These targets should aim at reducing HIV prevalence by at least 25 percent among young men and women aged 15-24 in the most affected areas. Our survey of HIV prevalence amongst women attending public antenatal clinics has found that HIV prevalence amongst teenagers has decreased from 21% in 1998 to 16% in 2000. This trend is consistent with surveys that indicate a high degree of awareness and concern about HIV among teenagers and a gradual increase in reported condom use. The challenge is to intensify our campaign and sustain the gains made in the teenage years through to early adulthood and beyond. AIDS Communication Tenders
The Department of Health has recently awarded communication two-year tenders worth more than R90-million to strengthen the prevention component of our AIDS Programme. We believe that the successful consortia combine media clout with community connections, creative ability and some of the best research and health promotion expertise around.
Two of the three tenders - for a mass media campaign and for production of materials that enable organizations to engage communities -- have been awarded to consortia headed by Johnnic Communications.
The third tender is for the implementation of a social advocacy programme and it has been awarded to Meropa Communications Consortium.
Other familiar names in these consortia include Soul City, TBWA Hunt Lascaris, National Association of People with AIDS (NAPWA), National Community Radio Forum, Kagiso Trust and research groups Social Surveys, CASE and Abt Associates.
The out-sourcing of AIDS Programme campaigns and advocacy activities is not a new departure. Over the past five years two consecutive tenders under the banner of the Beyond Awareness Campaign were awarded.
Prevention of mother-to-child-transmission of HIV The UN Declaration also calls for the reductions of the proportion of infants infected with HIV by 20% before 2005. This can be achieved by ensuring that 80% of pregnant women accessing antenatal care have information, counselling and other HIV prevention services available including treatment to reduce mother-to-child-transmission of HIV.
We already have guidelines for prevention of mother-to-child-transmission and management of HIV positive pregnant women that are currently used in our facilities. We are also moving forward with our research on the use of Nevirapine for prevention of mother-to-child-transmission of HIV and all the provinces now have their research sites operating.
Because of varying challenges facing different provinces, the research sites had to start operating on different dates ranging from May through to September this year. This process is beginning to indicate to us that there is indeed a need to understand varying operational challenges in the implementation of this programme in urban and rural areas as well as across provinces.
Protocol to monitor resistance in the use of this drug has been developed and the resistance studies will be jointly funded by the Department of Health and Boehringer Ingelheim, the manufacturer of this drug.
The package of care provided in these sites includes voluntary counselling and testing. HIV positive women are given nevirapine, multivitamins and treatment for opportunistic infections. Because they are prone to infections, these women are advised to go for post-natal care within 3-14 days and they are educated on observing signs and symptoms of infections.
Counselling is given on safe infant feeding practices and women who choose exclusive formula feed are given adequate breast-milk substitutes for six months. Some women who have delivered under this programme have opted for exclusive breastfeeding while others chose exclusive formula feed.
The figures collected from 12 sites last month indicated that more than 9 000 women visited the antenatal clinics and about 6 400 of these had opted to be counselled and tested for HIV.
HIV/AIDS figures and vital statistics It is ironic that government should be accused of trying to hide the figures on HIV/AIDS at a time when we are putting a lot of effort into improving our surveillance of HIV/AIDS and our general statistics. The question of enhancing the reliability of our statistics - necessary for our proper planning - was one of the recommendations of the Presidential Aids Panel, which we are following.
South Africa already conducts particularly sound national surveys on HIV prevalence among pregnant women. We have consistently improved the design of our survey, to the extent that WHO has adopted it as a model for other countries. This year we intend to take the survey a step further by incorporating private sector health services into the sample in order to correct any possible race and class bias that may result from our previous sampling.
In addition to this we have begun surveying HIV rates among men using some of our STI clinics and we have commissioned a study of the actual impact of HIV/AIDS on our health institutions. There is patchy evidence on this and there is some modelling that has been done - but the hard data is what we are after.
When it comes to mortality data, the issue is more complex than it looks. Until recently the reporting of births and deaths covered only a minority of our population. In a co-operative project with the Department of Home Affairs we have improved birth and death reporting to somewhere between 80 and 90 percent. This substantially strengthens the foundation for research on mortality trends.
Treatment, care and support I referred earlier to the Diflucan Partnership with Pfizer, in terms of which fluconazole is prescribed at public sector facilities for individuals with cryptococcal meningitis and candidiasis of the oesophagus.
This partnership brought relief to quite a large number of people living with HIV/AIDS - with 4 369 scripts being issued in the first three months of the programme. The drug is being used in 289 health institutions.
In addition to this, the partnership involves training of health workers about the relevant health conditions. More than 60 training sessions have taken place and 3 035-health workers attended them. This training it is proving enormously beneficial in addressing health workers general concerns about assisting people who are HIV-positive.
As the Department that needs to care for many poor people in this country, we cannot forget to address other factors that impact negatively on the health of people and even reduce the effectiveness of medical interventions. One of the areas we are trying to address is the challenge of under-nutrition that has major influence in the burden of disease and undermines our interventions.
We have therefore launched National Guidelines on Nutrition for People living with Tuberculosis, HIV/AIDS and other Chronic Debilitating conditions. These guidelines provide effective and inexpensive ways of tackling the link between diseases and poor nutrition.
National Food Fortification Programme The National Food Fortification Programme is part of a broader nutrition strategy endorsed by Cabinet after many studies identified critical micronutrient deficiencies in South Africa.
This programme will entail mandatory fortification of maize meal and wheat flour with various vitamins and minerals. The costs are relatively low - ranging from an estimated 0,4% on white bread to 1% or less on maize meal. But differences on who should carry these costs.
Government departments involved in the programme believe fortification costs should be factored into the production costs of maize meal and bread flour. This would be consistent with interventions such as the addition of fluoride to drinking water and iodine to table salt.
Concluding comments I would like to conclude with an area that is close to my heart and that is empowerment of women and gender mainstreaming in our Department. We have launched a gender policy for the health sector that will introduce gender analysis of all our policies and programmes. As part of our effort to improve the services rendered to women, we have also introduced forensic training of our nurses in order to empower them to deal with cases to violence against women. This training is available in at least two provinces (Northern Cape and KZN) and we will be standardizing it at a national level quite soon.
I have selected programmes in which there is consistent media interest - but this review has necessarily been limited by time. I would welcome questions on any matter - including subjects not covered in the briefing.