HIV doctors estimate that at least 30 people die each day in the province of AIDS-related illnesses.
Head of health in the province Pax Ramela admitted that the province would never be able to meet the backlog which he said started long before a moratorium was instated late last year.
‘There has been a backlog since the beginning of the programme. That is why we have deaths left, right and centre. From the very time that we started with the ARV programme people have been dying. It’s not a new problem,’ said Ramela, who questioned why the media was ‘suddenly’ interested in targeting his province.
‘This problem that we experience now in the Free State has just been suddenly highlighted in the media. But it’s not just beginning here. It’s happening everywhere,’ said Ramela who said he was baffled as to why the media targeted the Free State as there were similar problems in KwaZulu-Natal, Gauteng and Mpumalanga.
Ramela did however concede that his province may have been singled out because it chose to put a moratorium in place, blaming it on a lack of ‘any alternative sources of funding’.
He was not keen to engage on why the Free State treasury department had failed to assist as was the case in other provinces. ‘I cannot say anything on behalf of treasury. That explanation must come from treasury itself.’
Sources in the provinces have blamed this lack of co-operation on allegations that the MEC for Health Sakhiwo Belot is aligned with the Congress of the People while those holding the purse strings in the Free State treasury department are aligned with the African National Congress.
Ramela said they had alerted treasury to their budget shortfall in April last year, making representations throughout the year. ‘We’ve been to Cape Town, to the National Council of Provinces, to the finance committee there. We’ve been to our own Legislature to the finance committee there. We’ve been to the executive council of the province. We’ve been to treasury. We have done everything that we could do,’ he said.
Meanwhile a civil society ‘HIV and Health Coalition’ was established last week after a meeting in Bloemfontein and will have its first meeting on Friday.
Mark Heywood and Adila Hassim of the AIDS Law Project last week met stakeholders from civil society where they were briefed on what was happening at the various treatment sites.
‘The reason that the Free State became an issue is because an active decision was made to impose a moratorium on initiating new patients on ARV treatment. This decision was made unlawfully. There was no consultation, there was no explanation as to the basis upon which some services were cut,’ said Hassim.
‘There was no protocol to guide health care workers as to how to respond to those in urgent need in the context of the rationing of ARV treatment. We are similarly concerned by the cutting back of other essential health services.’
With regard to whether the provincial health department is to blame or the provincial treasury, Hassim said patients who are unable to access essential health services would seek accountability from the department that is directly involved.
‘What is clearly needed in the Free State is an independent inquiry to establish who is accountable for the crisis and what gave rise to it. The duty of accountability is a fundamental constitutional obligation that rests on government. If the Free State treasury is responsible for this, they must be held accountable. The protection of socio-economic rights by the Constitution is meaningless if those rights are not effectively budgeted for,’ Hassim said.
Trudie Harrison of the Mosamaria AIDS Ministry in Bloemfontein and member of the coalition’s interim committee said there seemed to be a lack of any workable plan to reduce the huge backlog. ‘There is also absolutely no understanding in the province of the urgent need to integrate HIV and TB treatment in the province. Undiagnosed TB is killing our people with HIV at a rapid rate,’ said Harrison.
She said there was also no indication when the moratorium on other health services such as elective surgery would be lifted. ‘So in the meantime you have cases such as a 32-year-old lady who is HIV positive and needs a hysterectomy to stop her cervical cancer from spreading. She is simply being turned away,’ said an exasperated Harrison.
‘Unfortunately we cannot afford to simply muddle along. A lack of service delivery in the health sector directly results in people dying,’ added Harrison.
Asked if he knew how many people were dying in his province as a result of the moratorium, Ramela replied: ‘People have been dying, even when ARVs were available, people were dying’¦Unfortunately you can bring me a sob story every time. You can go and isolate one person who died because there were no ARVs. I can show you another person who has died for alternative reasons. My biggest concern is that there appears to be no sympathy with everybody else that is outside of the ARV program.’
Looking ahead Ramela said the province’s health services faced a shortfall of R83-million of which R63-million is for the ARV programme.