National NSP Stakeholder Consultation – Speech by Dr Gwen Ramokgopa
The Minister of Health, Dr Aaron Motsoaledi
The Deputy Chair of SANAC and Chairperson of the Civil Society Forum
Fellow Trustees of the SANAC Trust
Ladies and gentlemen
The development of the National Strategic Plan for HIV, TB and STIs for the period 2017 to 2022 is one of the most important tasks of the SANAC Trust and it needs to be done in a way that ensures all stakeholders agree with the goals and objectives stated in the Plan and develop a sense of ownership for this Plan for the next five years.
It is important to reflect on the history of the HIV response in this country as in doing so it becomes abundantly clear how important it is to have a National Plan that is owned and supported by all stakeholders.
The miraculous turnaround of the AIDS response that we have seen over the last decade is undoubtedly linked to the last two national strategic plans. The breathtaking rollout of antiretroviral treatment can be traced back to the second NSP that covered the period 2007 – 2011. This NSP called for the national scale up of antiretroviral treatment as it main goal. The Plan would not have succeeded if it were not for the extensive consultation and negotiation that took place within the SANAC structures during 2006. If the Plan was supported only by government and not by civil society then it would not have made as much progress as it did over those five years.
The NSP 2007 – 2011 also saw the massive HCT campaign during which more than 15 million South Africans tested for HIV. This led to a massive surge in the number of PLHIV initiating treatment. A clear articulation of the goals of the NSP led to all partners, including the massive PEPFAR programme, supporting government’s rollout of antiretroviral treatment.
The same can be said for the 3rd NSP covering the period 2012 – 2016 which set ambitious goals for treatment and PMTCT but also set goals for prevention of HIV and a fifty percent reduction in TB incidence and mortality. Both these plans led to a substantial increase in domestic funding for HIV and TB responses.
In development the next five-year plan it is important to build on the successes of the past and to improve upon those areas where progress was slow.
The Enhanced Progress Report published by the M&E Unit of the SANAC Secretariat in May this year provides a clear analysis of what has worked and where we need to do more over the next five years. The report shows that we have more than 3 million people of antiretroviral treatment and the MTCT rate is well below the 2% target set in the NSP. The government and especially the Department of Health must be congratulated for that. So must all the NGOs who have been supporting the rollout at clinic and hospital level.
The report points out that we did not reach the target to reduce new infections by 50%. This is extremely concerning for all of us and it is widely recognised that much more needs to be done to reduce the number of new infections especially in young women where incidence is higher than 3% in most high burden communities. I would like to emphasise that whilst we focus on young women and certain key populations, new HIV infections are high across the board and no target group can be considered to be low risk. Therefore, prevention must be across the board.
Although we did not meet the very ambitious targets set for TB there are definite signs of progress and there has been a complete revolution with the use of geneXpert in the diagnosis of drug resistant TB.
One of the most neglected areas of the NSP has been the diagnosis and treatment of STIs. The SANAC Trust has discussed this and identified the need to invest greater resources in the management of STIs. The zero draft of the NSP that is under discussion at this stakeholder consultation has clearly identified the need to address all aspects of HIV prevention and treatment as well as TB and STIs. The challenge will be in the selection of priorities for programmes across the three epidemics. There is only a limited amount of resources available and whilst the plan needs to be aspirational it also needs to be realistic and implementable. It is important that we draw on the tools that we have such as the Investment Case to guide the choices we make and that we should make together.
Consensus building is a difficult goal to achieve but it is essential that we invest the time and resources to create the opportunity for all voices to be heard in a meaningful way. The Secretariat has been systematic in putting together the consultation process and the evidence of this consultation.
One of the major roles of SANAC is to build consensus as I have stated before and the consultation about the development of the NSP is one of the most important processes on the SANAC calendar. It happens every five years and the Trust is committed to raising the resources needed for this consultation process. The Trust has raised R8.9 million for the consultation process so far and has received support from the WHO, Gates Foundation, UNFPA and GIZ. As Chairperson of the Trust I would like to thank these partners for their support.
So far there have been major consultations with civil society, government, the private sector, development partners and public health specialists. We understand that civil society sectors and the government sector have requested further consultations. The Trust is working with the Secretariat to raise the additional funds required for these further consultations. I would like to thank Steve Letsike, Dr Nono Simelela and Dr Yogan Pillay for their assistance in raising additional funds. I also met with the Deputy President who has assured me of his support for raising additional resources.
I look forward to consultation that will take place over the next two days. It is important that the discussion is robust and open and that all stakeholder views are expressed in a constructive manner and in a way that is objective. It is important to choose priorities and to ensure that our inputs are grounded in the evidence and that recommendations are practical and realistic.
We have made great progress to date and what we decide to include in the next NSP will give us the results we need to be able to control the three epidemics in the next five years.