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Clinicians Urge Oversight of AIDS Patient Care in Provincial Hospitals

  • Darren Taylor

The president of South Africa’s HIV Clinicians Society, Prof. Francois Venter, was “outraged” by some of a provincial health minister’s comments in an interview with VOA

The president of South Africa’s HIV Clinicians Society, Prof. Francois Venter, was “outraged” by some of a provincial health minister’s comments in an interview with VOA

South Africa’s national government protocol requires state health facilities to provide antiretroviral medication to ill, HIV-infected people. However, independent health groups continue to receive reports of HIV-infected people dying because certain state clinics are not giving them life-prolonging antiretroviral - ARV medicine. Some nurses are rationing the drugs fearing shortages in the near future while some local South African health officials deny there is a crisis. In the final part of this week’s series, VOA’s Darren Taylor speaks with one of the country’s leading HIV/AIDS experts. He sketches a “deadly culture of denial” that he says is still present among some health officials in South Africa regarding the epidemic.

Professor Francois Venter, the president of South Africa’s HIV/AIDS Clinicians Society, says he is concerned by the “laissez faire [hands off] approach” of some South African health care officials to antiretroviral therapy, or ART, needed to contain the spread of the disease.

The president of South Africa’s HIV Clinicians Society, Professor Francois Venter, says he was “outraged” by some of a provincial health minister’s comments

The president of South Africa’s HIV Clinicians Society, Professor Francois Venter, says he was “outraged” by some of a provincial health minister’s comments

However, Venter said when he presented reports illustrating the problem in eight provinces to the national health ministry, officials did make a commitment to make changes.

“We told them that the national ministry needs to communicate very urgently with the provincial departments that they mustn’t stop programs. And my sense from the national department of health was that there’s a firm commitment to do that.”

The national government aims to get anti-retroviral medications to 80% of all AIDS patients within two years. It also provides funding to provincial health departments to implement those goals. But, there are reports that some state-run hospitals in the provinces are rationing the medications because of a concern over shortages. There are also charges of mismanagement of funds at the provincial level. The national health minister Aaron Motsoaledi has said that while the national government provides funding, it is local governments which determine how those funds will be spent.

Venter said it’s been his experience that “communication with people who actually do the implementation (of ARV programs) doesn’t always happen, and they start rationing just because they’re terrified that they’re going to be caught short.”

Venter remains convinced that national health minister Motsoaledi is committed to reversing this “fatal” scenario, despite the difficulties of implementing a relatively new and comprehensive policy countrywide, in states that struggle with a shortage of medical staff, clinics, medicines, and local officials who don’t always carry out national health policies as they are intended to be implemented.

ARV implementation criticized in Free State

Venter based his views in part on the reaction of Motsoaledi to controversial comments made recently by the health minister of Free State, Sisi Mabe.
Despite evidence to the contrary, South African provincial health minister Sisi Mabe denies there are any shortages of ARVs in the Free State

Despite evidence to the contrary, South African provincial health minister Sisi Mabe denies there are any shortages of ARVs in the Free State

VOA asked Mabe about reports that HIV-infected people are illegally being refused ARV treatment in several state medical facilities, with the result that many have become very sick and some have died.

In the interview, Mabe made a number of points that have caused concern in South Africa’s health sector. For example, when asked why some hospitals in the Free State were not giving ill HIV-positive people ARVs as soon as possible, Mabe said that to do so would always cause “negative reactions” in those patients. Health officials say her comment is scientifically incorrect.

They say patients with weakened immune systems should be given ARVs as soon as possible. A delay of weeks or months could mean death.
She also denied that there were any problems with drug supplies in the province, despite statements from nurses acknowledging that they were rationing ARVs because they feared stocks would run out before new funding materialized. Mabe acknowledged that it could take three months for her department to get ARVs to patients, but said the delay was not significant.

Official reaction

National health minister Motsoaledi was quick to criticize Mabe’s refusal to recognize any problems with the delivery in Free State of ARVs, and her views on delaying their use.

Motsoaledi said that South Africa, with 5.5 million HIV-positive people and ever-increasing numbers of infections, is “losing the battle” against the epidemic. He has also acknowledged that, due in part to a lack of trained nurses and other staff at state hospitals, his department won’t meet its target of providing 80 percent of HIV-infected people with ARVs within the next two years.

South Africa’s relatively new national health minister, Dr. Aaron Motsoaledi, has been praised for his approach towards the country’s HIV/AIDS crisis

South Africa’s relatively new national health minister, Dr. Aaron Motsoaledi, has been praised for his approach towards the country’s HIV/AIDS crisis

Motsoaledi has publicly admitted problems in implementing government reforms. A report released in July 2009 called Saving Mothers noted that HIV/AIDS remains a key contributor of maternal mortality in the country, despite efforts by the government to make them key targets of national health policy.
Besides Motsoaledi, Professor Venter said other top officials in the national health ministry have also criticized the statements that Free State’s minister of health made to VOA and other media.

“They were horrified at certain statements,” Venter said. He added that the acting director of HIV/AIDS in the national health ministry, Thobile Mbengashe, expressed dismay over some of Mabe’s comments. Mbengashe declined further comment.

Many HIV infected South Africans can’t access antiretrovirals, even though it’s government protocol to provide them to all who need the life-prolonging treatment

Many HIV infected South Africans can’t access antiretrovirals, even though it’s government protocol to provide them to all who need the life-prolonging treatment

But the “immediate” attention given to the matter by the national health ministry, said Venter, was “extremely refreshing.”

Policy change

The views of the national health ministry on fighting HIV stands in stark contrast to those of the health ministers of former president Thabo Mbeki. One of his last, and most publicized, ministers is Manto Tshabalala-Msimang, who in 2006 suggested that the best remedies for HIV-weakened immune systems were healthy traditional foods, including beetroot, lemons, and garlic. Eighty-one prominent scientists petitioned for her dismissal.

South Africa’s controversial former health minister, Manto Tshabalala-Msimang

South Africa’s controversial former health minister, Manto Tshabalala-Msimang

In contrast, President Jacob Zuma has committed his administration to an ambitious National Strategic Plan to fight HIV/AIDS. Among its goals are the reduction – by half – of all news cases of infection and reaching 80% of those who need treatment with anti-retrovirals by 20011. It also aims to work with provinces to reach up to 80 percent of all children exposed to HIV who need a two-drug combination including neviripine.

The government also plans to continue working to bring public hospitals up to basic health care standards, while the health ministry recently announced plans to improve the training of nurses, who play a critical role in teaching patients how to use ARVs.

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