Dr NOMONDE XUNDU:

Really, I didn’€™t want to talk about this at this stage. It’€™s still very early days. I’€™m still defining my area of responsibility myself’€¦

KHOPOTSO: As we continued talking, I discovered that the ‘€œI didn’€™t want to talk about it’€ stance would punctuate our conversation with Dr Nomonde Xundu. I was reminded of the fact once again, when I asked the following question: Tell us about the challenges that are making it difficult to reach the target of 53 000 people’€¦

Dr. NOMONDE XUNDU:        

Although we really have not agreed to talk about this, perhaps I should just say to you it’€™s basically the way people look at it. When we talk about targets, the first thing people think about is numbers of people on treatment, which is not all that the Plan had set out to do. There are two main objectives in this Plan. It’€™s basically to strengthen the National Strategic Plan that was on the table at the time; and to also strengthen the health system within which all of these services are being provided’€¦ And we are in the situation where our patient information systems are not perfect. So, even the numbers that I could give you, I cannot say to you that these are indeed the numbers to the last patient by such and such a time because of the challenges that we have with the patient management system. That is one thing. The second thing is (that) when you look at targets you ask yourself what has the Plan then done towards strengthening the health system in the country? What about the other components of the Comprehensive Plan, which is STI’€™s management, condom distribution, PMTCT, social and community mobilisation, home-based care, NGO support’€¦? And if I can tell you how much has been accomplished you won’€™t believe (it)’€¦ If you want to go back to patient numbers, in the nine months since the Plan has started I don’€™t know of any other country that has managed to put more than 30 000 thousand people in nine months on a complex programme like people have been put on antiretroviral therapy. That is now giving you just a ball-park figure because of the issues that we have with numbers.

KHOPOTSO: Dr Xundu had to be reminded that it’€™s actually not the people that put the targets on the table, but the Department of Health that promised to have 53 000 people on treatment by the end of March 2004, and then made the same promise for the same period this year.

Dr. NOMONDE XUNDU:

If that’€™s the only thing, once more, that you look at when you assess this Plan you’€™re going to miss the whole plot. But back to numbers: The numbers were informed by some modelling that was done by the Actuarial Society of South Africa, who, in fact have come back and said it was an over-estimate, by about 30 %, for that matter.

 So, was our target out by about 30 % of it? It’€™s possible.

 So, it’€™s the issue that we have with the figures that we work with, which are not accurate. That is one thing.   And the other thing is (that) it was a figure that was used so that we could put together a resource plan. We needed to provide resources for the service. And in fact, we can now say that we’€™re not short of resources, basically because of that. And if we reach those targets – fine and good. But then, also, people need to remember that it’€™s the decision of the people to take antiretroviral therapy. You cannot force people, once you have assessed and found they are eligible for treatment. At the end of the day it’€™s a voluntary decision for people to take on treatment’€¦ So, if you look at the Plan in terms of what it has accomplished, I would urge people not to look only at the numbers of (people on) treatment because they’€™re missing the whole plot.

KHOPOTSO: What jumps immediately into my mind here, is the issue of communication. What you’€™re saying to me now is something that we haven’€™t heard over the last year. And I guess that is what actually causes the kind of confusion that we have. Do you agree that communication is the main issue, perhaps, that the Department will need to be looking at in order to make South Africa understand what is happening in terms of health policy and particularly, on the issue of HIV and AIDS?

Dr. NOMONDE XUNDU:

We do have communication strategies. Whether we have communicated efficiently on patients’€™ numbers, which I think, is what people are looking at, perhaps may be debatable. I take the point that, perhaps, we could have communicated better in terms of what the Plan is about.    

e-mail: Khopotso Bodibe