The preliminary report, released at the Treatment Action Campaign’€™s Health Summit at the weekend, is the first in a series that will monitor the implementation of the Operational Plan.

The report, researched and produced by the AIDS Law Project and the TAC, deals with the first seven months since the Department of Health’€™s announcement of the Operational plan in November 2003.

It focuses on the numbers of people who have begun to receive ARV treatment in the country and also the degree to which information about the plan is being made available.

‘€œIt is worrying that several months after the Operational Plan was publicly released, information relating to time-lines and targets have not been made public,’€ said Fatima Hassan, of the Law and Treatment Access Unit of the AIDS Law Project and one of the authors of the report.

She said that the people who were to benefit most from the plan were the poor who needed treatment in the public sector and that they needed accurate and reliable information in order to make important decisions about accessing treatment.

TAC and the ALP began corresponding with provincial health departments as well as the national department of health early in 2004. Provincial governments that formally welcomed efforts to help implement the Operational Plan were Gauteng, Mpumalanga, Northern Cape while informal relationships were forged with the Western Cape and KwaZuluNatal.

By the end of March 2004 researchers found that substantially less than the 53 000 people government announced stood to benefit from the plan were on ARV treatment in the public health sector.

In President Thabo Mbeki’€™s State of the Nation address to parliament on May 21, 2004, he said government hoped to reach the initial 53 000 target a year later, that is in March 2005.

However, during the seven months from the November 2003 announcement, less than 10 000 people commenced ARV treatment in the country.

Researchers found that although the Minister of Health, Manto Tshabalala-Msimang had confirmed that 27 sites were accredited to provide ARV treatment TAC was still in the process of confirming that this was the case.

In KwaZulu Natal, 12 sites that had been accredited earlier in the year had not been given the go-ahead to begin treatment until June 2004.

The report found that ‘€œa great deal of effort is going into implementing the Operational Plan at a district and provincial level’€ but that ‘€œunfortunately this effort was not being matched at a national level’€.

It also found that communication about the plan was ‘€œextremely weak’€ in most provinces and that the Department of Health continued to ‘€œviolate the right to access health care services by operating secretly and refusing to make important information available’€.

Another obstacle was that although hospitals and clinics were under pressure to provide ARV treatment, they were not getting additional capital or staff.

‘€œThis is a critical management question ‘€“ the plan is meant to better the health service, rather than further overload it.’€

The report also found problems with drug supplies and that accredited sites that had capacity were holding back because they could not guarantee sustainability.

Below is a summary of the report’€™s findings on the various provinces.

To read the full version click here

Northern Cape.   The report found the slow pace of rollout worrying.

‘€œThe small numbers of patients are also worrying because reports by community organisations indicate a substantial need. They cite the travelling distance to the Kimberley complex (of treatment sites) as a barrier coupled with the reluctance of patients to seek the assistance of health care workers in Kimberley who they perceive as unhelpful.’€

While the Northern Cape Health Department had set a target for 790 people to be treated by March 2004, only 51 people had so far received ARV treatment.

North West Province. The study found only 30 people on treatment. There is an apparent shortage of paediatric formulations, which has resulted in very few children getting treatment. There are 50 treatment sites. The province has had difficulty in attracting doctors and posts advertised have not been filled. Taung has not been accredited, as it has no specialist doctors.

Western Cape. At end of May 2004 there were 3059 people on treatment at 17 sites. The province has the largest number of people on the treatment programme as it adopted a treatment plan before the Operational plan.

There are plans to expand programme to 45 sites by the end of 2005. This was the only province to have regular public briefings. An area that requires attention is the integration of treatment programmes for mothers and children. The province had exceeded the Operational Plan number of 2728 and had over 3000 people on treatment.

Gauteng. As of June, 4000 patients had been assessed and 1221 were receiving ARV treatment. About five to 10 percent are children. There are currently five sites. The premier has indicated that several other sites will begin operating in the second, third and fourth quarters of the 2004/5 financial year and that 15 hospitals and eight community health care centres will provide treatment for 10 000 patients by the end of the 2004 financial year.

The province had procured medication and had placed advanced ordered of Efavirenz.

In Gauteng waiting lists at some sites run into 2005 due to a lack of staff. The province’€™s ability to scale up the plan in being hampered by the slow pace of staff appointments. There have been complaints about the bureaucracy.

Free State. By May 1, 2004, because of an active recruitment strategy, 95 per cent of vacant pasts had been filled. The province has five sites and had about ninety patients on treatment by June 14. The province’€™s budget for ARV implementation is R30 759 740 million with less than half to be spent on drugs, lab costs and nutritional supplements. Estimates are that 2166 patients will be treated in the 2004/5 financial year. The province has 2.8 million inhabitants, 470 000 are HIV positive with 31 000 ‘€œAIDS sick’€.

Limpopo. There is almost a complete blackout on information. According to presentations made at a national meeting on March 4 and at the Parliamentary briefing on June 8, it ‘€œappears’€ that the province has eight accredited sites. TAC has accused the provincial department of a lack of co-operation and transparency but says that there has been more openness and a willingness to work with civil society in the district level.

The province’€™s own plan indicates that it aims to assess 5450 patients in the first six months and that 2140 will be put on treatment the same period. The plan provides for 5330 patients to be put on treatment. Researchers have been unable to establish numbers of patients on treatment.

Mpumalanga. Treatment has been delayed until June 2004 due to lack of a supply of medicines. Twelve sites have been identified, six accredited. A shortage of doctors hampering the process. The province has about 16 people on treatment.

KZN. Has eight accredited sites. Paediatric supplies only received in June 2004 and there are about 200 children on waiting list for ARVs. At   the end of May 2004, there were 120 adults on treatment. Twelve other sites were given accreditation on June 27. The province is having trouble filling posts.

Eastern Cape. In Lusikisiki there are 13 service points provided by MSF. By the end of May, 227 adults and 11 children were on treatment.

Only 20 adults were on treatment in public sector hospitals in the Nelson Mandela Metropole. There is a critical shortage of staff and also pharmacy assistants. The TAC has received no response to two requests for information and data on sites, patient numbers and budget allocations.

ends