- Introduction to essay on Politics, Human Rights and Poor Global Health by Mark Heywood
- Update on the Support Good Governance -- Support Nozizwe Madlala-Routledge Fund
- Resolutions of the 12th Joint Civil Society Monitoring Forum
Can Campaigns to Prevent and Treat HIV and AIDS Revive and Strengthen Campaigns for the Right to Health, Access to Legal Services and Social Justice?
By Mark Heywood
Executive Director, AIDS Law Project, South Africa
Treasurer, Treatment Action Campaign, South Africa
In coming weeks TAC will publish a series of articles by Mark Heywood that look at issues of global health, politics, human rights and the law. The aim of the articles is to set in motion a discussion among TAC activists and supporters about the broader political and social context to campaign work on HIV. The articles are still in draft form and Mark invites responses that either support or contradict the arguments made in the articles, as well as advice about missing information that supports or undermines the arguments. He can be contacted directly at firstname.lastname@example.org.
The articles are published on the TAC website at:
Readers can view the articles and also comment on them there.
Today we publish the introduction. The next installment will be posted next week.
Coming over the next few weeks:
- Chapter 1: Politics and the Global Public Health Crisis
- Chapter 2: Health and the Inequality of Poverty: Towards a Rights Based Convention on Global Health
- Chapter 3: South Africa’s Treatment Action Campaign: An example of a successful human rights campaign for health?
- Chapter 4: Health and the Law: Using the law to Protect and Fulfill Human Rights; Using Human Rights to Health to Strengthen the Law
- Chapter 5: AIDS in the Time of Freedom: Law and Politics in the Response to South Africa’s AIDS Crisis
In 1845, in his thesis on Feuerbach, Karl Marx wrote the now famous maxim that: “Philosophers have only interpreted the world, in various ways; the point is to change it.” Over 160 years later, much the same criticism can be laid at the door of public health analysts. Prompted in large part by the HIV pandemic, the growing crisis of world health, particularly ‘third world’ health, and its social determinants has become a subject of an enormous amount of research and writing. Within this writing there is a growing consensus on the social and economic determinants of health, a consensus that is likely to be strengthened when the World Health Organisation (WHO) Commission on the Social Determinants of Health (CSDH) publishes its final report in May 2008.
But sadly there seems to be an avoidance of analysis of health’s political determinants.
[END OF HEYWOOD ON HEALTH]
In August 2007 the “Support Good Governance -- Support Nozizwe Madlala-Routledge Fund” was launched in the wake of the dismissal of then deputy health minister Nozizwe Madlala-Routledge. The fund was primarily established to reimburse Ms Madlala-Routledge for her July/August ministerial salary which was being unjustly withheld from her.
The fund was set up under the AIDS Law Project with Dr. Adila Hassim, the acting-Director of the AIDS Law Project, Andrew Feinstein (former ANC MP), Vuyokazi Matiso (TAC NEC Member and Eastern Cape Chairperson), and Cheryl Gillwald (former ANC MP and deputy minister of Correctional Services) acting as the trustees.
The fund raised a total of R 87,034.25 in South Africa, $ 1,845 in the United States and ₤ 450.00 in the United Kingdom. On the 6th of September an amount of R 40,000.00 was paid to Ms Madlala-Routledge in view of the loss of her deputy minister’s salary in July/August.
Since removal from her post as Deputy Minister Ms Madlala-Routledge has been serving as an ANC MP doing work both in Parliament and her constituency. She has also been elected to the Central Committee of the SACP and to the NEC of the ANC. Her election to both positions is an affirmation of support for the principled position she adopted as Deputy Minister of Health. However, both bring additional responsibilities. Therefore the trustees of this fund have decided to make a further disbursement of R 30,000.00 so as to assist her to establish a Parliamentary office so as to strengthen her capacity as an MP.
The remaining monies are being kept in trust pending any legal action against Ms. Madlala-Routledge. We remind you that the government had initially demanded that she reimburse R 312,000.00 for her ‘unauthorized’ trip to the International AIDS Vaccine Conference in Madrid, as well as other outstanding amounts that were suddenly discovered. Although there has been no further action on this, the matter is still pending.
As you are aware the health sector is in a state of crisis. In her position as deputy minister of health Nozizwe Madlala-Routledge worked to achieve the progressive realisation of free and quality health care for all. Her work in HIV/AIDS, support of the National Strategic Plan and frank outspokenness on the issues is to be commended. We still consider Ms. Madlala-Routledge an important ally both in her personal capacity and as a Member of Parliament.
To all those who contributed to the fund or supported Ms. Madlala-Routledge in other ways we extend our heartfelt thanks.
Together let us work to make 2008 a year where the objectives of the National Strategic Plan on HIV and AIDS and STIs can be advanced and lives can be saved.
Dr. Adila Hassim Andrew Feinstein Vuyokazi Matiso Cheryl Gillwald
[END OF UPDATE ON SUPPORT GOOD GOVERNANCE FUND]
All founding members have endorsed these resolutions.
The Joint Civil Society Monitoring Forum (JCSMF) met on Friday 18 January 2008 at the Institute for Democracy in South Africa (IDASA) in Cape Town. The theme of the meeting was Drug Supplies, the 2008 Antiretroviral Tender and Availability. The meeting was attended by approximately 60 people from 35 different organisations representing a wide cross-section of sectors and interests.
The meeting was addressed by experts who reviewed the experiences and lessons learnt with the first antiretroviral (ARV) tender, current international consensus regarding first line ARV regimens and a number of inter-related issues such as registration of new products and intellectual property licensing agreements. All these have considerable bearing on the prospect of achieving universal access to sustainable anti-retroviral treatment programmes and services in future. The meeting was also briefed on progress in the development and adoption of new treatment guidelines by members of the Treatment Task Team of the Programme Implementation Committee (PIC) of the South African National AIDS Council (SANAC), amongst others for the Prevention of Mother to Child Transmission of HIV (PMTCT).
The 12th JCSMF meeting took the following resolutions:
1 PMTCT treatment guidelines
The meeting expressed its deep dismay at the ongoing failure of the National Department of Health to finalise and issue the updated PMTCT guidelines. At the most recent SANAC plenary meeting held on 28th November 2007, the Director General of Health assured the Deputy President and all other SANAC members that his department undertook to make the guidelines available within two weeks. That deadline was passed six weeks ago.
The JCSMF calls for an immediate announcement of the new guidelines giving the go-ahead to clinicians, facilities and provinces that have made the necessary preparations and have the requisite capacity, to begin implementation of the new guidelines.
We support health workers in many parts of the country who feel able to provide services following what is now the overriding national and international consensus on the new approach to PMTCT.
We also reiterate our ongoing concern with the poor coverage of PMTCT services in many parts of the country and will support a campaign led by SANAC to actively encourage health facilities to advertise and offer the services to all pregnant women. This is an eminently achievable National Strategic Plan for HIV and AIDS & STIs (NSP) target.
2 ARV tender
The JCSMF will shortly be issuing a fuller Concept Paper regarding the 2008 ARV tender. Given a rapidly changing field in which simpler and safer ARV regimens are becoming available and cost-benefit ratios constantly changing, the appropriate management of the ARV tender will have a crucial bearing on the future accessibility and quality of ARV treatment in South Africa.
To this end, we call on government to:
2.1 Engage in an open and transparent process around the 2008 ARV tender, which hitherto has remained closed to public scrutiny;
2.2 Accept the recommendations made more than 12 months ago by experts convened by the Department of Health on updating the current treatment protocols;
2.3 Immediately make available the updated adult and paediatric treatment guidelines that will form the basis of the 2008 tender specifications;
2.4 Immediately make available the envisaged timelines for the various stages of the 2008 ARV tender process;
2.5 Convene an Expert Committee, bringing together the highest-level expertise from government, civil society, and clinicians (including specialist in the care of adults, children and pregnant women) nationally to develop the most appropriate approach to the 2008 ARV tender;
2.6 Implement the mandate of the NSP, namely to review HIV clinical and management guidelines on an annual basis.
The JCSMF undertakes to mobilise the best of the available civil society expertise to inform the tender process.
3 Drug registration
Innovations in the manufacture and packaging of ARVs, such as fixed dose combinations, blister packs and heat stable drugs, greatly enhance the possibility of adherence. These innovations have passed rigorous approval processes of other national and international agencies; yet still require lengthy processes through the South African Medicines Control Council (MCC). The meeting expressed its concern with the inordinate delays in the registration of new products through the MCC, delaying the availability of life-saving essential technology to millions of South Africans.
The JCSMF calls for:
3.1 The fast tracking of registration processes relevant to the 2008 ARV tender by the Minister of Health and the MCC;
3.2 The development of mutual recognition agreements with countries with stringent national drug regulatory authorities that have already completed the necessary processes of evaluation to register new products;
3.3 The institution of better mechanisms to track progress in the registration of new products by the MCC;
3.4 Concerted action to address the capacity constraints of the MCC, in particular the retention of skilled staff. One strategy to achieve this would be to increase the managerial autonomy of the MCC while retaining accountability to government, similar to structures such as the Medical Schemes Council.
The JCSMF also called for the rapid development and introduction of much simpler and easy to read patient information leaflets and a national media campaign to promote ARV treatment literacy and adherence.
4 Licensing of generic drug manufacturers and importers
The key driver of affordable medicine prices is competition, which ordinarily requires that several manufacturers produce and market the same drug simultaneously. The JCSMF voiced its concern about the lack of competitive pressure keeping the prices of certain patented ARVs (notably efavirenz) unnecessarily high and the implications of this for affordability. It also noted the complaint filed at the Competition Commission against MSD regarding its refusal to license the key ARV efavirenz on reasonable terms. Contrary to established practice in other middle-income countries, the South African state has not made use of the regulatory tools at its disposal – such as government-issued compulsory licences – to ensure adequate competition.
In addition to its concerns regarding price, the JCSMF noted the link between reasonable licensing agreements on the one hand and security of supply and the availability of a wide range of appropriate ARV products (such as fixed dose combinations and blister packs) on the other. The failure of companies such as MSD to license on reasonable terms prevents these key ARV products from coming to market.
The JCSMF calls on government to review its failure to license generic competitors and the impact of its inaction on the affordability and sustainability of the national Comprehensive Care Management and Treatment (CCMT) Programme in South Africa.
5 Management systems
The JCSMF noted the many gains of the CCMT Programme. It also identified a number of managerial weaknesses that jeopardise future programme expansion. In this respect, we call for:
Monitoring and evaluation systems
5.1 A national review, under the aegis of SANAC, of the monitoring and evaluation (M&E) systems currently in place for the CCMT Programme across the nine provinces;
5.2 The development of prototype M&E standard operating procedures and tools for facilities, districts and provinces;
5.3 Opportunities for sharing of best practice between provinces;
5.4 Greater capacity at national level for aggregation and reporting so that reliable data can be obtained on ARV coverage nationally.
Drug supply management
5.5 Mechanisms to resolve the “Standard Stock Account” difficulties being experienced in provincial drug depots, where ARVs are consuming an increasingly larger share of the allowable monetary value of stock, thus crowding out the availability of other medicines.
6 Other outstanding issues
The meeting noted with concern the ongoing legal and regulatory barriers preventing nurses prescribing ARVs and community health workers doing HIV testing. We reiterate the resolution of the 11th JCSMF where we called for urgent attention to the human resources crisis nationally, and in particular, action by regulatory councils to review the scopes of practice of health workers and to bring them in line with the NSP.
The JCSMF also noted the need to maintain a gender lens within the continuum of prevention, treatment, care and support. This includes the vulnerability of young women and girls to HIV, sexual and reproductive health needs of women on treatment, more vigorous testing, staging and treatment initiation in antenatal services and addressing the relatively low uptake of treatment by men.
For further information contact:
Molly Slingsby email@example.com or 083 522 2550
[END OF JCSMF STATEMENT]