Dr Nono Simelela left South Africa six years ago after resigning as Chief Director of the HIV/AIDS, TB, STI’s cluster under former Health Minister Dr Manto Tshabalala-Msimang. At the time, Dr Simelela said that she had left the Department ‘for personal reasons’. But she confirms that she was frustrated by working in a department that seemed unable to respond adequately to the AIDS epidemic. But, she says, this has changed.
‘Ever since I’ve been here there has been an amazing level of positive energy. There is a new dialogue between civil society and government. Somebody was making a joke, actually, that ‘all the people who had abandoned the Department of Health are coming back’,’ she said.
Siemelela, herself, is now back as Chief Executive Officer of the South African National AIDS Council (SANAC) on a five-year contract.
The role of SANAC includes the co-ordination of all AIDS programmes, monitoring the implementation of the National Strategic Plan on HIV and AIDS, collecting information to inform policy and advising Cabinet on the best possible action on HIV/AIDS. In the few weeks that she has occupied her modest office at the Development Bank of South Africa in Midrand, Simelela has identified the first major challenge that needs attention within this scope of work.
‘I think the biggest challenge we’re facing now is the absence of a robust monitoring and evaluation framework. That, as far as I can see, is the most critical aspect and my priority as I start here because we can only really invest properly if we know where we are and where the gaps are’, she says.
‘At the moment we know the number of patients who have been initiated on treatment, but I don’t know that we can confidently say where all those people are, whether they are still taking medication. And then the rest of the interventions by civil society and other government departments’¦ there isn’t a common frame-work where you can put all of those efforts in, document what is happening so we can measure how far we are from the targets that we’ve set’, she continued.
Is South Africa likely to meet the targets it set itself in the National Strategic Plan on HIV and AIDS, I asked.
‘Honest people will tell you, ‘no’, and I would tend to agree with that. We’ve made progress, but we set very ambitious targets in that NSP’, was Simelela’s reply.
She lamented the fact that there is nothing much that SANAC can do to ensure accountability that targets made are met. In its current form as an advisory body to Cabinet, the SANAC does not have a legal status. That means that no policy can be enforced through the SANAC, which was not the vision that inspired the inception of the body, in the first place. But as the response to the AIDS epidemic grows and more players come on board, says Simelela, there is a need to review SANAC’s status to give it more power as opposed to simply being an advisory body so as to ensure accountability.
‘We’re using information from other sub-Saharan countries that have got National AIDS Commissions ‘ some of them established through an Act of Parliament, others established in different ways – and then we’ll investigate which is the best option for South Africa. I think the key thing is, really, to ensure that SANAC is able to discharge its mandate in line with what the response requires and that does need some areas where you can tie things and make people accountable because at the end of the day we have to be able to account on the things that we have done and government has to also demonstrate how many policies were presented to Cabinet as recommendations; how many of those policies or recommendations were adopted by Cabinet; if not, what were the reasons for doing that; what have the implications been. None of that has been happening, actually. And that is what SANAC should be doing’, Simelela said.