Duration 4min 47sec

KB: When the Operational Plan was announced on November 19th 2003, a schedule of implementation had already been drawn up. It included a pre-implementation phase that was meant to begin immediately upon Cabinet’€™s decision to proceed with the programme. However, according to Dr Nono Simelela, the Chief Director of the HIV/AIDS and TB Directorate in the national Department of Health, there was additional preliminary work that was also necessary. It is important to note that time references ‘€œtoday’€ and ‘€œtomorrow’€ in the following sound-bite mean February 05th and 06th.      

Dr NONO SIMELELA: First amongst these, obviously, is development and finalisation of the treatment protocols, which we have managed to do with support from experts from the HIV Clinicians’€™ Society and other experts in the country’€¦ We’€™ll start printing those guidelines in the second week of February.

The training manuals: We have also asked for a tender for service providers, which will be advertised next week to get universities and other institutions to assist us with training. The issues around the procurement: The team has met today and they are meeting tomorrow to finalise the issues around procurement. And we are hoping that as soon as they’€™ve done with this and the tenders are out – probably in the next week, or so – for drug procurement, we should start seeing forward movement. Obviously, the accreditation that has taken place should finish by the second week of February. Of the 105 facilities, we have completed about 82 service points that we have evaluated.            

KB: It would seem like by the end of this month, February, much of the groundwork would have been completed. But even so, the initial target of reaching some 50 000 odd patients by the end of March 2004, will never be met.

SIMELELA: Yes, I think it’€™s important to remember that when the Plan was developed, it wasn’€™t developed in November. We started developing this Plan after the Cabinet had endorsed the Treasury report. So, it’€™s been almost four months in the making since July. So, when we made those calculations we made them based on an assumption that we would be much further in the Plan than we are right now. So, a decision came in November and unfortunately, it was like a week that was left after the 19th and then, a lot of the services closed down for Christmas. So, we actually are lagging behind in a way, but it was not because people didn’€™t do anything. We really were hit by the festive season where there wasn’€™t much that we could do. People were away and all sorts of things, which are not really excuses but the reality that we couldn’€™t move as fast as we had wanted’€¦      

KB: In that case then there should be a revised target. And if so, can you tell us about that, what you aim to actually achieve?

SIMELELA: You know, the numbers shouldn’€™t be something that we bind ourselves to at this point because some things don’€™t work as fast or as much as you imagine. You know when you write something on paper the reality is slightly different’€¦ And I think, that’€™s what I would love people to understand, that people are working hard on this Plan. There is no complacency. There is no sense of a lack of urgency. But, unfortunately, to get it right we need to make sure at the beginning we do the best we can to get things right.

KB: At least, Dr Simelela, by when can we really see the first sites opening up to provide the service?

SIMELELA: Well, as soon as we get the drugs into the country. We’€™re keenly awaiting the team to finish their discussions and tell us what their strategy is going to be’€¦ It depends on the pharmaceutical companies that will get the tender ‘€“ how soon they can get the drugs into the country. So, I don’€™t necessarily want to bind myself to a time-frame that if I don’€™t meet it, we then get attacked again to say you’€™re not sticking to the time-frames that you promised the country.

KB: For Simelela it’€™s a case of once beaten, twice shy. But for those sick with AIDS-related illnesses, implementation of the Care and Treatment Plan is literally a matter of life or death. One of the companies waiting for the government to issue tenders for drug procurement is Merck Sharpe & Dohme or MSD, marketers of the drug Efavirenz for both adults and children, in South Africa. Chirfi Guindo is the company’€™s Chief Executive Officer.

CHIRFI GUINDO: We have had meetings with the Task Force and I have personally had discussions with the decision makers in the Task Force. And I’€™ve told them: ‘€œLook, we have the facilities. We have invested in Midrand. And please, please, please give us the numbers, please, so we can start the production scheduling because you do not make these medicines in just a couple of days. You do need a planning process in place.’€

KB: A source within the national Health Department says the treatment programme will only start rolling out in April. But, nobody is really certain. What is clear, though, is that the Department has to play catch-up in order to fast-track implementation of the Plan.

E-mail Khopotso Bodibe


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