One of the best ways to fight stigma and discrimination
against people living with HIV and most-at-risk populations is to engage them
in the response. More effective health services can only be designed with the
input of the community.
In his taped address to the conference, Deputy
President Motlanthe demonstrated his firm grasp of what is needed to move the
HIV/AIDS response closer to its goals, and perhaps fix the South African health
system as well.
“Collective ownership of the strategic interventions adopted
must therefore speak to our ability to attain the highest impact and address
those most at risk. Issues of resource allocation and mobilisation, leadership,
accountability and improved service delivery by way of enhanced implementation
of healthcare services are some of the key deliverables that we need to
address,” he said.
One of the more recent goals of the South African health
system, which was discussed in at least one session of the conference, was the
re-engineering of primary health care so that it effectively meets the needs of
communities. This is an indication of the ambition and growing self-confidence
of South Africa’s Department of Health.
“It is probably one of the most profound changes that has
been proposed by a healthcare system in the last 20 years,” said Prof. Venter.
“This is something we all are going to have to engage with and which is a very
exciting community-led development which I’m hoping is going to mean that it’s
going to make healthcare much more available to the public.”
But he also thinks the re-engineering of primary health care
is one area where South Africa may be able to succeed precisely because of its
experience with HIV/AIDS.
Prof. Venter also commented on the 'AIDS backlash': the
complaints from some academics and public health specialists who claim that
HIV/AIDS has received too much attention and weakened health systems, and that
funding should instead be directed to other global health priorities.
Most of these complaints are unfounded, but Venter said the
HIV world should take ownership of some of the criticisms, such as the need to
increase efficiency — which is one of the reasons why task shifting needs to be
scaled up. Additionally, HIV has received attention that other diseases also deserve. But this should be seen as
an opportunity to apply the AIDS industry’s experience to these other health
needs and the health system in general.
“Part of the challenge for us in
the HIV world is to go and repair the rest of
the healthcare system. We’ve made some real strides forward in terms of understanding health care for chronic illnesses.
Diabetes, hypertension, asthma are crying out for the same sort of initiative,”
he said. “If there’s a preventable disease out there I would hope that all of
us will be out there to try and fight as hard for our other patients with other
diseases that
are not HIV as we do for HIV. And I think that that’s what this primary health
care re-engineering is about — it is an opportunity to take those lessons out.”
“Sometimes when public
health people, come to me and say:
‘You know we’ve tried. Why couldn’t we do this thirty years ago?' Well the
reason is, you didn’t get everyone in the room who needed to be in the room!
You can’t sit and make a policy at the top level in a room and then expect it
to be implemented at
primary healthcare level. You have to
get everyone in the room and you need
lots and lots of players. That is why the South African AIDS response
has improved —
we’ve got everybody in the room together. And I think that public health needs
to take a lesson from us,”
said Prof. Venter.
While the backlash against AIDS funding is less prevalent within South
Africa, it has contributed to weakening global commitment to the HIV response
and must be confronted. A very real consequence of the AIDS backlash might
require another kind of leadership from South Africa.
“I think in every country, except South
Africa and Botswana, whose entire
antiretroviral programme is funded from their tax payers, the fact that the
donors are starting to say: “Enough already!”, is something that should make us
all very, very scared. Because it’s all very well to handle this in South
Africa but I think we recognise the obligation we have to the rest of Africa, to
try and help them dig themselves out of the sand pot we were in at the beginning,”
he said.
South Africa’s
lobbying at the UN
This was the sort of situation the Deputy President was
trying to prevent with his trip to New York. At the close of the conference,
Prof. Venter gave a glowing report of how the Deputy President had acquitted
himself at the meeting in New York.
“The first thing he did, which is a direct firing across the bows, on
everyone who thinks that we should inhibit and use our culture to oppress
women, to oppress gay men, to oppress sex workers -- he went out and he asserted that this is what’s in
our constitution,” said Prof. Venter. In addition, the proceedings from the conference informed the
Deputy President’s testimony to the UN. “It’s something we do need to report,
that it came straight out of this conference, straight through his lips and straight into the UN.
The Deputy President also told the UN meeting that South Africa is
currently considering how it might introduce treatment for all at a CD4 count of 350,
and plans a social mobilisation strategy to get people
to access treatment before they get very ill. South
Africa’s mass testing and counselling campaign will continue, and efforts to re-engineer primary health care will be
stepped up.
He emphasised: “Global solidarity is critical and as we
continue to explore alternative ways of resourcing this major crisis, we must
work in partnership with communities, development partners and civil society. An AIDS-free world is an attainable goal: let us
remain committed to this vision.”
How much of an impact South Africa will have on the
international global health policy front has yet to be seen. But having
corrected the course of its AIDS policy, the country recognises the threat that
the AIDS backlash represents, realises that it has to represent its own
interests and is becoming increasingly confident of what it has to offer.
The Community Exchange Encounters rapporteur of the conference expressed the new sense of possibility and promise, saying: "We must create a forum for civil society to set strategic and common goals that will allow South Africa to be the activist nation of the African continent".
Perhaps the rising young power will negotiate a better deal
for the region. If not, perhaps South Africa can join together with some of the
other emerging BRICS economies to fund and implement health policies that are
not so dependent on the fickle whims and trade policies of the wealthiest nations
and multilateral organisations.