Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
South African Press Association - August 18, 2006
Fran Blandy
The country has the largest ARV programme in the world, yet the roll-out was not as good as it could have been, said Nicoli Natrassi, of the Centre for Social Science Research at the University of Cape Town. This was because of uneven roll-out across the nine provinces, lack of mobilisation of financial resources and failure to invest in human resources.
She said this explains the anger of activists who called for the resignation of Minister of Health Manto Tshabalala-Msimang at a plenary session earlier in the day.
According to an operational plan by the Cabinet, 453 650 people were supposed to be on treatment by March this year, but only 141 000 were receiving treatment in the public sector.
If ARVs had been rolled out at the same rate as they were in the Western Cape -- which started rolling out ARVs earlier -- 75 000 lives could have been saved in 2005, said Natrassi. South Africa "could easily have rolled out faster".
The country has 5,5-million people living with HIV/Aids.
Natrassi said Tshabalala-Msimang was allocated enough money for a large ARV roll-out, yet the impetus for the ARV roll-out is still coming from foreign donors.
Substantial funding and assistance from the Global Fund to Fight Aids, Tuberculosis and Malaria, the World Bank, the United States President's Emergency Plan for Aids Relief and other private donors has contributed to the substantial increase of people on highly active ARV therapy from less than 2 000 in 2003.
There is a danger that these contributions have taken pressure off the Department of Health, she said. The department has often come under fire for underspending its HIV/Aids budget.
Natrassi accused Tshabalala-Msimang of dragging her heels by insisting each roll-out site have a nutritionist and of undermining the roll-out by promoting vitamin alternatives and policies that made people not want to take ARVs.
Natrassi agreed with Aids Law Project leader Mark Heywood that political leadership in South Africa has failed the Aids cause.
"If we had the political will at an earlier stage we could have saved thousands of lives. Instead, in South Africa we have fought ... over whether HIV causes Aids, whether ARVs work or are poisonous. We have fought and failed to provide leadership ... and the disease has grown, and grown," he said.
Nhlanhla Ndlovo, of the Institute of Democracy in South Africa, said Parliament has not played its oversight role in ensuring the government is held accountable for expenditure on HIV/Aids.
The standing committee on public accounts sees HIV/Aids as central to the health committee's agenda and the portfolio committee on health has a limited role in influencing the Aids budget or expenditure and lacks capacity for research and evaluation, said Ndlovu.
At the same time, the portfolio committee on education sees HIV/Aids as a health issue, resulting in the failure to prioritise education on the epidemic in the curriculum. There is further lack of oversight by the committee on finance, which claims HIV/Aids has not been proved to have a negative effect on the economy.
Ndlovu claimed majority party MPs cannot challenge their own government, and partisanship affects their oversight and decision-making capabilities. MPs themselves feel Parliament acts merely as a rubber stamp and is unable to influence budget decisions.
"Most MPs don't even know what they are supposed to be doing," he said.
He recommended that the concept of oversight be redefined to enable MPs to better comprehend their role. "Parliament has the ultimate role of ensuring that delivery of HIV and Aids services and expenditure match the policies and constitutional obligations of the government."
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