Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
Mail & Guardian (Johannesburg) - May 24, 2006
Yolandi Groenewald
Recently, Cabinet spokesperson Joel Netshitenzhe said 134 473 people were on ARV treatment in the public health sector at the end of March, and an estimated additional 80 000 were on treatment provided by the private and NGO sectors. But critics say this does not take into account the number of people who have dropped out of treatment programmes, and also question whether the figures are accurate, because of poor data capturing in the provinces.
"After two and a half years of the treatment programme, we still do not have a proper data capturing and monitoring system in place," says Fatima Hassan, an attorney at the Aids Law Project.
She argues that the Department of Health's report, prepared for the United Nations General Assembly Special Session on HIV and Aids next month, includes a table intended to provide a breakdown of the number of people being treated by the programme.
"But that table is blank, " she says. "At the bottom there is a footnote saying that the department is not in a position to supply the statistics at this stage."
Hassan believes the Cabinet's figures are inflated because of inconsistent, unverified data capturing in the different provinces. "Some clinics do not even have one data capturer, and rely on nurses to insert the data," she says. Hassan believes that parallel data capturing, which duplicates numbers, is boosting the figures. Her more conservative estimate is that there are between 90 000 and 100 000 patients on the public sector treatment programme.
She believes Brazil has the world's biggest public health ARV programme. According to the Brazilian Department of Health, about 150 000 people had received ARVs through the public health system by the end of February this year. Brazil has an HIV prevalence rate of 0,7%, while South Africa's is 21,5%.
When questioned on the figures, Netshitenzhe admitted that the statistics were based on total numbers of patients who joined the programme and not on ongoing participation.
He said no data was available on how many of those undergoing treatment remained on it and for how long, or how many had died. He added that follow-up information systems were being improved.
Sipho Mthathi, general secretary of the Treatment Action Campaign, says it is vital to have statistics on how many people had stopped treatment as well as the survival rate.
"There is no document that gives this information," she said. "We believe you cannot run a serious programme without these statistics. How would the departments evaluate themselves?"
Sibani Mngadi, spokesperson for Minister of Health Manto Tshabalala-Msimang, says the department needs a new information system that will record how many people have complied with their treatment regimen, and will track patients who move clinics or provinces. He says this information system is being piloted in hospitals in Mpumalanga.
But Hassan says that, in her organisation's experience, data from Mpumalanga has been impossible to access and verify. She believes the pilot project might be a response to this. She is also disturbed that the government is taking credit for private sector provision of treatment.
Hassan says the public sector programme is attributable to the dedication of health workers and donors. "If it wasn't for these small community and church-run programmes financed by donors, the public sector figure would have been much lower," she says.
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