Mainstreaming of Measures To Combat HIV / AIDS in South Africa Managing HIV/AIDS in the workplace Dar es Salaam 26 / 28th May 2004
HIV prevalence rate in South Africa Total 11% Male Female 10 % 13 % The age-group between 15 and 49 years Male 13% (15%)* Female 18% (21%) Data Source: Survey by NMF / HSRC 2003
AIDS orphans in South Africa 2000000 1500000 1000000 500000 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Life expectancy in South Africa in 2000 and 2010 80 70 60 50 40 30 20 Without AIDS With AIDS 2000 2010
Projected population of South Africa, with and without AIDS in 2020 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 Males Females 0 2500 2000 1500 1000 500 0 500 1000 1500 2000 2500 Without AIDS With AIDS
Impacts on the Macro-Economy In countries with prevalence rates of 10% among adults, the growth of national income is reduced by up to one third Economic impact of 1 salary / year => 3 x greater than the actual earning HIV/AIDS has a footprint of ca. 140 years on our planet
What is mainstreaming? Mainstreaming HIV/AIDS means all sectors/actors determine : How the spread of HIV is caused or contributed to by their activities; How the epidemic is likely to affect their goals, objectives and programmes; and Where their sector/entity has a comparative advantage to respond to limit the spread of HIV and to mitigate the impact of the epidemic.
Response of the Government Internal Measures directed at the Government Institutions: Work Place Policy Awareness Campaigns Specific services, etc. External Measures directed at the Population: Medical support (care programmes, etc. ) Awareness Campaigns Social Services Support Programmes Multi-Sectoral Mainstreaming
Range of Government Action OoP Provincial Departments & other Government Agencies External Services Development / Delivery IGCC Workplace Internal Services Policy - IDWC
Mainstreaming: Intervention Levels: Policies / Planning : Integrated Strategy on HIV / AIDS, PGDS, ISF Institutional: (Internal) Work-place policies Technical: (External) Departmental Concepts Services: Home-Based Care Providers Agricultural Extension
Reporting / Communication Lines Office of the Premier I G C C I D W C External Services Provincial AIDS Council Internal Services
WPP Models in the Private Sector Model 1: Complete Coverage of Employee and Dependents Terms of Employment + Provision of ARVs + ARVs for Dependents Model 2: Complete Coverage of Employee only Terms of Employment + Provision of ARVs Dependency on DoH/DOSD Model 3: Partial Coverage of Employee Terms of Employment Dependency on DoH / DOSD / others
Key challenges Facing the Public Sector Prevalence of HIV / AIDS increasing in country Increase in prevalence in the public sector but no factual data to quantify the extent of prevalence Impacts are three-fold: On leadership and management Individual/Personnel Possibility of burnout for HIV negative staff On service delivery
Perspectives: Impacts of HIV/AIDS 1) Management Level: 1) Development of policy and programme to deal with HIV/AIDS in the workplace 2) Reviewing strategy plans and assumptions related to the availability of Human Resources for the future 3) Focusing on capacity-building and assessing human resources to supplement where sickness/death limits staff numbers 4) Find creative ways to measure the incidence of HIV/AIDS in the department 5) Creatively encourage staff to use VCT services 6) Determine projections related to HR and the future impacts on governance and service delivery. 7) Redefining working conditions and labour relation provisions to accommodate personnel living with HIV/AIDS 8) Launching intensive and extensive awareness campaigns aimed at education and prevention
Perspectives: Impact of HIV/AIDS continued.. 2) Personnel: 1) Need to establish status 2) Discovery/Declaration 3) Infected and affected (Family members) 4) Fear,Shock, depression, sense of hopelessness: Embarrassment/Stigma 5) Progressively weakening and susceptible to opportunistic diseases. 6) Adjustment to living with HIV/AIDS 7) Loss of Productivity/Morale/Energy 8) Need for Counseling, Medication, Support and Care 9) Need for Financial Assistance-facing increased benefits cost
Perspectives: Impact of HIV/AIDS continued.. 3) Service Delivery: 1) Staff shortages, absenteeism, and resource constraints will impact negatively on service delivery. 2) In lieu of the above services in remote areas and disadvantage communities will be more adversely affected. 3) Departments facing Resource and HR constraints will be further pressurized. 4) Increased demand on an already overburdened social and criminal justice system 5) Overall costs for providing services will increase 6) Service provision strategies will need to be redefined in the light if the pandemic
Critical response needed Create enabling environment for HIV+ officials (stigma, reduce fear of victimization, etc) Facilitate access to education, support and care Maintain service delivery (now and the future) Maintain healthy and capacitated workforce Help ensure the health and well-being of all staff at all times Protect the rights and safety of all staff Review benefits (RA, pensions, leave, etc) Build capacity of management to deal with impacts of disease absenteeism, etc
MPSA response Legal response legislative framework Review of benefits (pensions, medical aid, etc) Policy guide and manual Directive to HODs re: HIV / AIDS in the Workplace Establishment of Impact and Action Project
MPSA-Impact and Action Project Vision A well-informed, supportive Public Service, where HIV/AIDS is effectively managed and Quality service is sustained. Focus On HIV/AIDS from the Perspective of the PS. Project activity Policy and legislation review Conditions of Service Capacity development, training and Support
Pilot Project Perspective at the implementation level Lend support in the development of Workplace policies and programmes Pilot the wellness programme in 3 provinces Focus on VCT as the pilot operational focus Make resources, technical assistance and support available Monitor and evaluate, derive key learning for a national roll out
Pilot project concept Comprehensive response to HIV/AIDS education, care and support Target Voluntary Counseling and Testing as pilot focus Why: Gateway to other HIV/AIDS services Concrete and defined Global experience proves VCT to be excellent access point to other HIV/AIDS services Excellent sources for establishing prevalence Can demonstrate results in the short term
Key Challenges facing MPSA Engage key partners to assist with implementation Leverage resources Ensure support by key provincial stakeholders Identify implementing agency Maintain a gold thread between guide/manual and/practice
Proposed Strategy Sanctioning / approval Structure: Intergovernmental HIV/AIDS Committee Responsibility: Office of the Premier dedicated resources/mentorship by Department of Health Accountability: DG Ownership: Provincial IGCC VCT Operation Full time resources/sessional/secondments (public liability cover) Location: non-threatening venue Target all departments and Local Councils Mobilise networks of NGOs Run communications campaign Develop sustainability plan
Immediate steps Mandate to proceed Set up Provincial IGCC Source Funding Focal Point in the Office of the Premier Mobilize experts/partners Design and programming
Challenges to leadership Lead by example Market VCT Publicly announce will go for HIV Testing Encourage others to follow