Transcript

KB: The announcement by the Minister comes as a relief to activists, people living with AIDS and to the medical community, as procurement of the drugs is widely viewed as a crucial determinant of whether the Plan will get off the ground. Now that that hurdle is out of the way, the challenge is to focus on acquiring some of the scarce skills needed to provide the best service. For instance, the Plan makes provision for the use of three modes of treatment ‘€“ nutrition, traditional medicines and antiretrovirals. It further states that for every 500 clients there will be one dietician or nutritionist. Dr Nono Simelela is the co-ordinator of government’€™s HIV and AIDS Care and Tretment Plan and Chief Director of the HIV/AIDS, TB and STI’€™s Directorate in the national Department of Health.

Dr. SIMELELA: The Human Resources cluster has been working very closely with the provincial health Human Resource departments to look at the scarce skills… What we’€™ve done in the training is that we will train even our lay-workers to understand nutrition issues. We’€™ll train the nurses as well. So, where you don’€™t have a specialised nutritionist the nurses will know how to give advice, the counsellors will know how to give advice, and we are doing a training also for NGO’€™s to focus on nutrition issues. So, we’€™re trying to multi-skill the health workers.

KB: The South African public health sector has little experience of administering AIDS treatment, particularly anti-retrovirals. The drugs have been used in specific settings such as preventing HIV infection after rape and interrupting mother to child HIV transmission. According to health minister Dr Manto Tshabala-Msimang, only 10 % of the 20 000 doctors in the public service have this knowledge. Independent confirmation of this figure was not available at the time of broadcast. Dr Des Martin, of the HIV/AIDS Clinicians’€™ Society agrees that training in this regard, should not be limited to doctors or specialists.

Dr. DES MARTIN: This training involves a number of levels of health care workers, right from specialists, to medical officers, to nurses, to counsellors, to pharmacists, to data capture people, to laboratory personnel, etc. So, one can see that there’€™s a wide spread of diverse training that is going to be necessary.

KB: Dr Martin went on to say that ideally, this kind of training would take up to six months before a treatment programme on the scale envisaged by government could begin. Coupled with training of personnel, is the need to identify and accredit sites at which treatment will be rolled out. The Plan calls for at least one site in each of the 54 health districts of South Africa. Dr. Simelela gives us an update.

Dr. SIMELELA: People are in the provinces right now as we speak’€¦ At the last count two weeks ago they’€™d done 77. They’€™ve gone now to the next phase of the provinces. There are people in Mpumalanga and the Western Cape. They’€™ve done Limpopo. There are people finishing off in the Free State. I think they’€™ll finish Northern Cape next week. So, the numbers keep increasing as we get reports. But, we haven’€™t had time to come back to base and say ‘€œOkay we’€™ve finished. This is what we’€™ve found’€¦’€ We will re-group, probably, in the middle of next week because people are out as we speak.

KB: What do you seek to identify with the accreditation process?

Dr SIMELELA: The accreditation process is not meant to exclude. It’€™s really meant to identify what is missing, so we can actually bridge that gap. It’€™s not something that’€™s meant to say, ‘€œNo, you can’€™t do it, you’€™re too poor.’€ No. It’€™s a tool that’€™s meant to identify things that are critical for us to provide the best service. And remember, when I say best service, it’€™s not just for AIDS. Because if there wasn’€™t a laboratory there, and we can get a laboratory installed, it will do the specimens for everybody ‘€“ for people with TB, with hyper-tension, with heart disease, whatever. So, it’€™s a broad strengthening of the entire health system’€¦ This is an opportunity for the health sector to improve. If the route is through a grant for HIV, then so be it.

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