Home / Episode 23

Episode 23 - NSP

With a shift in the political landscape recently the government has started to address HIV/AIDS with urgency.  It will, however, take unprecedented effort and people to repair the damage caused by inaction, incompetence and in some cases downright denial.  The figures too appear overwhelming: 345 000 AIDS-related deaths last year, 1 in 10 South Africans are HIV positive and 30% of pregnant woman at government facilities are HIV positive.  The waiting lists for ARVs are too long and clinics are too often understaffed with only 370 of the accredited 4000 able to administer ARVs.  This week on Siyayinqoba Beat It! the National Strategic Plan (NSP) is under the spotlight as we discuss all the aspects of this potential lifeline to millions.  Joining Shalom and the Support Group is Mark Heywood who is the deputy chairperson of SANAC, the South African National AIDS Council.

Shalom Ncala: Sanibonani siyanamukela ku Siyayinqoba Beat  it! Uhlelo lwawo wonke umuntu ohlangabezana nonqoba izintselelo zesandulela ngculaza. Samkela ithimba elisekelayo. Kuyasithokozisa namhlanje ukuthi sihanjelwe ngumnumzana u-Mark Heywood ungusekela sihlalo womkandlo wezwelonke obekene nesifo sengculaza phecelezi SANAC. Hi Mark (IsiZulu) Hello and welcome to Siyayinqoba Beat It! The programme for everyone meeting and beating the challenges of HIV/AIDS. Welcome to the support group. We're very happy to have Mark Heywood with us today, who is the deputy chairperson of SANAC. Hi Mark.

Mark Heywood: Hello Shalom

Shalom: Namhlanje sokhuluma ngohlelo lwamasi lukazwe lonke lwesandulela ngculaza nengculaza. (IsiZulu) Today we're talking about our national strategic plan for HIV/AIDS.

Luvuyo Nibe: Sekhe nava  ngento ekuthiwa yi National Strategic Plan HIV/AIDS?  (IsiXhosa) Do you know what the HIV/AIDS National Strategic Plan is?

Girls: Ha a (IsiXhosa) No

Vuyo: Zange nakhe nava ngalento lee? (IsiXhosa) You've never seen this?

Girls: Ha a. (IsiXhosa) No

Man: Andiyazi ukuba yintoni? (IsiXhosa) I don't know what it is.

Man2: I have heard about it but don't ask me about it, that can't tell you.

Vuyo: National Strategic Plan akho mntu uyaziyo. (IsiXhosa) Nobody knows what the National Strategic Plan is.

Vuyo: Namhlanje sincokola  nosisi Busisiwe Maqungo apha e-Rondebosch esenza itraining nabantwana besikolo nge NSP. Masembe soveni. (IsIXhosa) Today we're talking to Busisiwe Maqungo in Rondebosch. She's training school kids about NSP. Let's go inside.

Busi Maqungo: Sizo trainer abantwana lusuku  lwethu lokugqibela namhlanje besitrainer abatwana  babezi peer educators ezikolweni zabo. These are the kids from different schools abanye koma mfuleni  abanye koma Hermanus njalo njalo. The information abayifumeneyo apha bayidlulise ngoluhlobo senza ngalo nathi ezi kliniki. Ukhona umntu onofifa ukuthi yintoni i-NSP? Xa sithetha nge NSP kebethunana sithethatha nge National Strategic Plan.  Ithe isabe iboniwe le HIV ukuthi ingathi yingxaki, andithi sithe you identify the problem. Iyingxaki le HIV apha eSouth Africa and we needed to up with a plan, with a national strategic plan eyokuba how do we handle lento ye HIV because ngoku iyaphuma ngoku asikwazi ukuyi controla. Sithe ke I strategic plan sethu sesika 2007 and 2011.Nantso iplan yabo abayiekilelyo ukuthi within the next five years these are the things esifuna ukuthi size achievile kule five years. Sizakuzijonga sizakusimonitorisha apha ekuhambeni kwendlela intobana ingaba iyenzeka na lonto. Sine PMTCT, that  is njengobana lomama eHIV positive asifuni ukuthi azale umntwana o-HIV positive. Ngoba siyayazi into ekuthiwa xa ibizwa yi MTCT where apho umama asulela khona umntwana nge HIV sithi xa siyibiza yi MTCT mother to child transmission, umama uthini udlulisa I-HIV emntwaneni. We want to prevent that kuthiwa mayenzeke nini lonto leyo sithi sifika 2011 at least about 95% yomama abaya ezi kliniki bekhulelwe ku antenatal clinic babe bayatesta for HIV. Siphinde kwakhona sibe ne VCT uptake. Nayo ke i-VCT  uptake nayo kuthiwa at least funeka ibengu 95% Azuba ndibiza amanani aright nah apha? (IsiXhosa) Today is our last day; we came here to train school kids to be peer educators in their schools. They come from different schools in Mfuleni, Hermanus and so on. They are going to spread the information they got here, just like we also do in clinics. Does anybody know what the NSP is? It is the National Strategic Plan. When HIV was indentified as a problem in South Africa, we needed to come up with a plan, a national strategic plan to help us handle this HIV because it was getting out of control. The National Strategic Plan is for 2007 to 2011. That is the plan and these are the things we want to achieve within 5 years.  We will monitor them along the way to see how far we are. First up we have PMTCT. If a woman is pregnant and HIV positive we don't want her to give birth to an HIV positive baby through what we call mother to child transmission of HIV. We want to prevent that so the plan is that by 2011 at least about 95% of all women who visit antenatal clinic be tested for HIV. We also have VCT uptake. VCT take must also be 95% I hope I'm right.

Shalom: Can you take us through the goals of the NSP?

Mark Heywood: First of all the NSP is a five year plan. It's from 2007 to 2011. And it has two major objectives; one objective is to get treatment for people who have HIV and AIDS. And the other objective is to try to cut massively the number of new HIV infections. When it talks about treatment the NSP says 2011, 80% of people who know they are HIV status, should be able to access treatment. But the NSP it looks frightening and big and so on. But really it's quite simple. People can't get treatment if they don't know their status. So the NSP says I forgot the exact figures but it says we want to get to a point where everybody in South Africa has tested for HIV, everybody knows positive or negative. We want to get to a point where it becomes routen that if you get pregnant you are offered a test for HIV as a woman. So they are quite simple things really but the simple things if we plan around them we would be able to make a difference with the epidemic.

Pholokgolo Ramothwala: (SeSotho) Can you speak more about business participation, because there are people in the private sector accessing treatment and what can business do to increase the number of people.

Mark: That is a good question Pholo because the National Strategic Plan it has to be led by the government obviously but it makes it very clear that its plan that everybody has to take up responsibility towards. So the NSP makes it clear that there is a responsibility for workplaces, for employers, for the private sector to try and get people on treatment as well.

Victor Lakay: (Afrikaans) Mark, we've spoken about prevention and we've spoken about treatment. Let's talk more about priorities of the NSP.

Mark: The other priority apart from treatment and prevention is called human rights and excess to justice. That priority area talks about important things such as campaigning and stopping violence against women. And it says that we must work with the police we must work with the justice system to make sure that where there is violence the people are prosecuted and so on. It also says that we must stop discrimination in the workplace against people with HIV positive. That we must have campaigns thought the country to reach people who have a higher risk of being infected with HIV. Up to now we talk as if we all have the same risks but we know that if someone is a sex worker she or he will have a higher risk if she doesn't know about HIV. So the NSP this what it calls the higher risk groups some mobile people, men who have sex with man, prisoners, sex workers, girls and so on.

Shalom: Unganyakazi Siyabuya khona manje (IsiZulu) Don't go away. We'll be back soon.

Shalom: Siyanamukela futhi ku Siyayinqoba Beat It! Namhlanje sikhuluma ngohlelo lwamasi lukazwe lonke. Akhe sibheke indaba yethu elandelayo. (IsiZulu) Welcome back to Siyayinqoba Beat It! Today we're talking about the national strategic plan for HIV/AIDS. Let's take a look at our next story.

Merisha Lalla: Sanibonani. Today we are in Mvulindlela just outside of Pietermaritzburg to take a look at a nurse driven ARV program. What is the background of this particular project?

Dr Janet Frohlich: Caprisa always looked at a nurse driven module in seeking that opportunity and taking opportunity being in a primary health care setting to ensure that ARVs would be accessible even with rural communities.

Dr Bonginkosi Mduli: We do not have enough doctors in our country to run the program.  Secondly we have to make it a point that the ARV roll out is done at primary health care level which is the program that is run by the nurses.

Merisha: How has the nurse driven program help the patients, are patients comfortable with receive mediation from the nurse compared to a doctor?

Gladness Marhwa: It seems to be working very well because patients appear to be more open with the nurse, sometimes they are afraid of the doctor. When we first started the patients would come in very sick but now we can see that they are getting used to the program, they are coming early and we can still help them sooner time. The challenges that we face is the non adherence of patients and most of the times the reason for the non adherence is that the patients don't have money to come here and getting our patients to the grant system is another challenge that we face.

Merisha: Is there a waiting period for receiving ARV's at the clinic?

Bonginkosi: Fortunately for us we do not have a waiting period. Whoever has been screened is put in a particular treatment and gets treatment straight away. Since the site was started we have received about two thousand seven hundred people and we are happy to say that we have one thousand forty people on ARVs.

Janet: This was a certificate of appreciation from the Umgungundlovu health district for Caprisa in able ling and accessing and accelerating the roll out of ARVs in this district. So if we are going to win the battle the new battle and new struggle is through partnership.

Bonginkosi: If I had a chance I would duplicate this kind of a sector and put it in another place so that other people in rural areas can excess the same help that they are getting here.

Shalom: I would like to know from you in terms of in relations with the insert in terms of use getting a fully fleshed nurse controlled ARV program how far are we?

Mark: Well we not far enough to be honest Shalom. I mean what you saw in that insert is the exception in South Africa that there are good examples that nurse driven program work. The NSP says this quite clearly it uses this word called task shifting. Task shifting means that nurses should be able to do what the doctors do, community health care workers should be able to do what nurses do and so on and on. So the NSP mandates that there must be task shifting. NSP also mandates that treatment should be driven by nurses. The problem is that until very recently we still have problems with our minster of health and the department of health so some of the things that the NSP said should happen have not happed to this point. We have to hope that those things begin to happen because otherwise we will never meet the targets and many people will continue to die of AIDS as it is happening now.

Luckyboy Mkhondwane: Ndiyacabanga ukuthi lama goals a setwe ngu NSP asungu government uphela like okufanele iphushe  ukuthi afinyelele. Even nathi singumphakathi theres a role that we are supposed to be playing. So imiphakathi yethu ayikho into angayenza if abazi ukuthi i-NSP yini . (IsiZulu) Reaching the NSP goal is not the government's responsibility alone. Even as a community, there's a role that we're supposed to be playing. So our communities can't do much if they don't know what the NSP is.

Busi Maqungo: But ukukuphendula wena Lucky kuloo ndawo ye role yomphakathi . Thina size TLP's zika Siyayinqoba kukho into ethi nokuba ekliniki namhlaje itopic is solely about ARVs but have at least 5 minutes everyday noba itopic yakho ibinge ARV ne PMTCT ne PEP but have something about NSP ozakuyithetha ebantwini  so by doing that abantu baya befunda that there is something called NSP , what is NSP and what are the goals of NSP. (IsiXhosa) To answer your question about the role of communities. We as Siyayinqoba TLP's, if today we're at a clinic and our topic is solely about ARV's, but have 5 minutes everyday, regardless of what your topic is, but have something about NSP to talk to the people about.  By doing so people learn that there is something called NSP, what NSP is and what the goals are of the NSP.

Andile Madondile: But also ndicinge ukuthi ne media at the same time should play an important role in getting information out NSP because i-radio ne TV those two important things can play an important role to pass the message over (IsiXhosa) The media should also play an important role in getting the message out there because radio and TV those two important things can play an important role to pass the message over.

Busi: So mayingabiyo pocket version kuphela e-simplified NSP. Mayithethwe nangomlomo ukuze ingene ingxinisiseke apha ebantwini. The same thing eyayisenzeka ngelantuka uku introduswa after 94 kwe constitution lancwadi. Mna I never read lancwadi but xana yayithethwa zonke izinto ezi container yila ncwadi ndiyazazi kodwa there is never a single day where I read  lancwadi incinci. Kwakusithiwa go to a post office uyofumana icopy yakho ye constitution go to wherever. I had copies laying around ut I never read them. But as ubazithethwa ngabantu into youkuba u-section bani bani iright yakho ithi ndiyayazi. (IsiXhosa) There shouldn't only be a pocket version of the NSP. It should be spoken about so that people can hear and understand it. The same thing happened after '94 when the constitution was introduced.  I never read it but because it was spoken about I know everything contained in there, but I never read it. They would say go to the post office and get a copy of the constitution. I had copies lying around but I never read them, but as people spoke about it I understood and learned.

Victor: I want to ask what point do we actually measure our progress where we stop and say okay the intention of the NSP is to provide 50% to half new infection by 50% by 2011. When do we stop and take check how far are we in those targets.

Mark: NSP for every year has different targets for every year in every area, prevention, treatment it has its targets. At the end of 2008 we should stop and say did we do what we were meant to do in 2008. In fact I am just working in a report this moment that looks at each of the targets and says are we making progress. Unfortunately the report says we are not making enough progress. But that has to change; you are right Victor we have to look all the time. We have to find a way to say are we cutting the number of new HIV infections, are we getting people what numbers of people are we getting onto treatment. That is critical information.

Shalom: Ninganyakazi Siyabuya khona manje. (IsiZulu) We're taking a quick break, be back now.

Shalom: Siyanamukela futhi ku Siyayinqoba Beat It! Namhlanje sikhuluma ngohlelo lwamsi lukazwe lonke. Akhe siye eMpumalanga Koloni sikhe sive udaba loweisfazane ohamba ibanga elide ukuze athole imishwanguzo yakhe. (IsiZulu) Welcome back to Siyayinqoba Beat It! Today we're talking about the national strategic plan for HIV/AIDS. Let's go to the Eastern Cape and hear the story of a woman who has to travel quite a distance to get her ARVs.

Amanda Funani: Sise Qonce kwilali yase Kwalini sizakudibana no Nomfundo Mnyaka ozakusixelela ngomgama owuhambayo ukuze afumane iARVs  (IsiXhosa) We are in King Williams Town in Kwaleni village to meet  Nomfundo Mnyaka who will tell us about her journey to get ARVs.

Nomfundo Mnyaka: Ndaqalisa ukufumana iARVs ngo 2007 ngo July. (IsiXhosa) I started on ARVs in2007.

Amanda: Ikhona ikliniki apha elalini apho nifumana khona iARVs ? (IsiXhosa) Is there a clinic where you can get ARVs?

Nomfundo: IARVs ndizifumana e Grey's Hospital apha elalini yethu asinayo ikliniki. Ikliniki ekufanele  siphantsi kwayo  yikliniki engaphaya kwa- Noncampa and kukude ukuya kwaNoncampa because yi distance, unqumla ethafeni. So kufuneka atleast kufuneka ube nento epha ku R24 ye return which is yimali esingakwaziyo ukuyi afforda abantu abninzi. (IsiXhosa) We go to Grey's hospital for ARVs. W e don't have a clinic here. The clinic we're supposed to go to is in Noncampa and that is quite a distance. A person must have at least R24 for a return bus ticket, and many of us don't have that kind of money.

Amanda: Ziyakhutswa kule kliniki yakwa Noncampa iyisebenzisayo? (IsiXhosa) Do you get ARVs at Noncampa clinic?

Nomfundo: Azikho kule yakwa Noncampa i-ARVs. Inzima ndaba yokuba singabinzo iARVs apha ekuhlaleni ingakumbi apha ezilalini,ngoba kaloku abantu abaninzi abasebenzi so indawo ezifumaneka kuzo i-ARVs zikude kakhulu kunzima ukufikelela kuzo. (IsiXhosa) No we do not get ARVs there.  It's very difficult for us not to have access to ARVs at our community clinics; especially in villages because a lot of people here are unemployed and clinics that have ARVs are very far.

Amanda: Sikwi kliniki yakwa Noncampa no-Nomfundo ndizokuqonda ukuba kutheni uNomfundo engenokwazi ukuzifumana i-ARVs zakhe kule kliniki . Yintoni unobangela owenza ukuba ningazikuphi i- ARVs? (IsiXhosa) We're here at Noncampa Clinic with Nomfundo to find out why she can't get ARVs at this clinic. Why does this clinic not supply ARVs?

Zandiswa Sisilane: Xa uzakunikeza nge ARVs kufuneka nibe yi team . Kufuneka kubekho oogqirha, kufuneka kubekho ikhansila ezinintsi , kufuneka kubekho ipharmacists yonk elonto asinako ukuba nayo kule kliniki kube leklininki incinci. (IsiXhosa) When a clinic gives ARVs to patients it needs to be done as a team. The team must consist of doctors a number of counselors and pharmacists, all of which we don't have because this clinic is so small.

Amanda: Bangaphi ogqirha benu apha? (IsiXhosa) How many doctors do you have here?

Zandiswa: Ugqirha wethu esinaye uyavisita asinaye uqirha ohlala apha ekliniki, usivizitela kabini nge nyanga. (IsiXhosa) We don't have a resident doctor, only one who visits twice a month.

Coceka Nogoduka: Ndingu Coceka Nogoduka. Senior Manager wakwa HIV/AIDS Eastern Cape department of health. (IsiXhosa) My name is Coceka Nogoduka. I'm the senior manager of the HIV/AIDS program Eastern Cape department of health.

Amanda: Apha eziklinilki zihamba njani izinto zezitheni ikliniki ezifumana i-ARVs ezinye zingazifumani (IsiXhosa) Why can some clinics administer ARVs and others not?

Coceka: Njengobana besenditsilo ndathi le CCMT program ine components ezinintsi oyena mntu ubalulekileyo nguq qirha kuba ugqirha kufuneka ejongile ukuba zimphethe kanjani umntu ezi drugs azityayo. Kufuneka sibene social worker fanele sibe ne dietician. Uyofumanisa intobana abobantu ababikho kwikliniki zethu ngoba ikliniki zethu zincinci. (IsiXhosa) The CCMT (Comprehensive Care Management and Treatment) program has different components and the most important is the doctor who will monitor the patient on ARVs. These people also need to see social worker and dieticians. And we don't have doctors here because our clinics are very small.

Amanda: Why kunga trainer ama nurse like isista zikwazi kuthi ibengabo abakhupha i-ARVs kwezikliniki? (IsiXhosa) Why can't nurses be trained to give out ARVs?

Coceka: Ugoverment into ebeyijongile kukutraina amanye amanesi. Kune courses ke uvernment azi negotiatayo ne universities esizibiza ukuthi ngo nurse clinician. Lanesi ngaphezulu ingu nesi uzakufumana itraining latraining izakumenza ukuthi akwazi ukuthi amonitarishe okanye aqalise ukunika ipatientsi. (IsiXhosa) Government is looking at training nurses in courses. They are still negotiating with universities. Once of the courses is for a nurse clinician. This nurses will be trained and monitor  dispense medication to people.

Luckyboy: Umbuzo enginawo ukuthi into endiyibonile ne njeba sisiva kukhulunya kwi insert ukuthini there this team ekufuneka ibekhona ukuze ikliniki  i-accredited ukuthi ingakipha ama ARVs . Okuyinto endiyibonayo kungenzakali kakhulu like emakliniki especially emalokishini nakuma rural areas ukuthi amakliniki amaningi abanaye udoctor ohlala khona everyday. Like  ama dieticians amanye amakliniki abinayo nama social worker. Ukuthi le team is it really necessary ukuthi ngempela ngempela ukuze ikliniki i-accredited kufanele kubekho labantu laba  abazakuba kulo team leyo? (IsiZulu) My question is as follows. As we've seen in the insert, there's this team of people a clinic needs before it gets accredited to dispense ARVs. But that's something I don't see in clinics, especially in rural areas. A lot of clinics don't have doctors there everyday. There are no dietician some clinics don't have social workers. Is it really necessary for a clinic to have all those things for it to be accredited? Are the people on the team needed?

Mark: You see Luckyboy it's not really necessary. We have to make sure that people gat good quality care. But good quality care doesn't necessarily mean that in areas where it is impossible to have dietician you must bring a dietician in people will die waiting for the dietician to come and that is not what we want. In fact this thing about the dietician the social worker and the doctor that does not come from the NSP that comes in fact from what we call the two thousand three comprehensive plan on AIDS treatment care and support . Unless every clinic provide treatment for people with HIV we are to going to be able to meet the need of people with HIV, people are going to continue to die. Government policy sys that there must be clinic within five kilometers of everybody and there is no point in having a clinic if the people have to walk pass the clinic and go another 50 kilometers to get the treatment they need. It doesn't help for Pretoria to have control over the AIDS program because Pretoria doesn't know what is going on in the village in the Eastern Cape. The decisions about accreditation of clinics and making sure meet the necessary standards must be taken at least at provincial level. Possibly even lower than the provincial level. But the provinces must be closely monitoring what is the need for treatment, the must be closely monitoring the standards of the facilities, they must be monitoring to make sure that the medicine are getting to these place. And that the medicines are not interruptions in the supply. That is not impossible to do its really not impossible to do if the is a will within our health system. You've got to find the will.

Shalom: Iningumzim Afrika izibekele imigomo esezingeni eliphezulu ngendlela emangalisayo kulohlelo lwamasi kwazwelonke. Ukuba nemigomo isinekeza into ekumele sisebenze phezulu kwayo. Ngakho ke sonke sine qhaza ukumele silibambe. Umasiqhoke lamabhengele sibonisa ukuthi sizigcina siphephile futhi silawula izimpilo zethu. Khumbula zivikele uvikele nabanye . Kuze kube yiki elizayo Salani kahle eakhaya. Bye (IsIZulu) South Africa has set itself very ambitious goals in the NSP.  Having goals gives us something to work towards.  We all have a part to play. These bangles show that we are keeping it safe and taking responsibility. Remember, protect yourself protect others. Till next week. Stay well!l