SAHR 2007 - Health Systems Trust

HIV and AIDS
The HIV & AIDS and STI Strategic Plan for South Africa 2007-
2011 (NSP) has been hailed as a brave new start, the result
of a widespread and inclusive consultation process. The NSP
has four key priority areas:
1. prevention;
2. treatment, care and support;
3. research, monitoring, and surveillance; and
4. human rights and access to justice.
The first two priority areas lend themselves to quantifiable
targets, which are:
➤ to reduce by 50% the rate of new HIV infections by
2011; and
➤ to provide appropriate packages of treatment, care
and support to 80% of HIV positive people and their
families by 2011.
In addition, there is a commitment to allocate 4-7% of the
NSP budget for monitoring and evaluation. The targets have
been stated in more detail, with intermediate targets for
each of the 5 years of the programme, including targets that
involve private sector actors. Some selected examples are
shown in Table 17.
Although laudable, some of these targets may prove difficult
to measure or to reconcile. For example, is the target to enrol
420 000 new adult patients on ART by 2011, or to treat 80%
of new AIDS cases? If the latter, how will “new AIDS cases” be
quantified? How might this be affected by possible changes
in the target CD4 cell count, as defined internationally (e.g. as
less than 350 rather than 200 cells/µl)? A number of “primary
indicators” for the NSP have been identified as new DHIS
indicators, such as “Percentage of most at risk populations
that have received an HIV test in the last 12 months and
who know their results”, “Proportion of new TB / STI / pregnant
women tested for HIV” and “Proportion of HIV-positive
TB / STI and pregnant women receiving CD4 testing”. This
will put additional stress onto a system that is as yet not well
established or operating at optimal levels of quality and
reliability.
The Department of Health Annual Report 2005/06 already
contained some measures of claimed success. For example,
it was stated that 80% of facilities in the public sector
already offered VCT. The shift to “provider-initiated testing”
still requires planning and execution. It was also stated that,
2 years after the introduction of ART, “200 facilities were
Table 17: Selected targets from the HIV Strategic Plan 2007-2011
Objective
Increase the accessibility
and availability of comprehensive
sexual assault
care including PEP and
psychosocial support
Scale up coverage and
improve quality of PMTCT
to reduce MTCT to less
than 5%
Increase access to VCT
services that recognise
diversity of needs
Scale up coverage of the
comprehensive care and
treatment package
Intervention
Increase the proportion of
facilities offering the comprehensive
package of sexual
assault care in accordance
with the National Policy on
Sexual Assault Care of NDoH
Increase proportion of pregnant
women tested through
implementation of providerinitiated
VCT for all pregnant
women
Implement provider-initiated
VCT in all health facilities,
with a special focus on STI,
TB, antenatal, IMCI, family
planning and general curative
services
Increase the number of new
adults starting ART
Increase the number of new
children starting ART
5 year target
2007 2008 2009 2010 2011
40% 60% 80% 90% 95%
70% 85% 90% 95% 95%
60% of
all health
facilities
in country
(public,
private,
NGO)
120 000
(24% new
AIDS cases)
75% 90% 95% 95%
180 000
(35%)
285 000
(55%)
370 000
(70%)
420 000
(80%)
17 000 24 000 33 000 38 000 40 000
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