SAHR 2007 - Health Systems Trust

Health and Related Indicators 15
treating more than 120 000 people”. The Joint Civil Society
Monitoring Forum (JCSMF) reported that, as at the end of
February 2007, 257 108 patients were receiving ART in the
public sector. Some figures reported in the DoH Annual
Report are difficult to accept. For example, the report states
that “The Department ensured that the percentage of stock
outs of medicines in the Essential Drug List (EDL) was kept at
0% during 2005/06. In addition, there were no stock outs of
antiretrovirals at accredited Comprehensive HIV and AIDS
Management and Treatment Plan sites.” While the latter may
well be true, the means to measure this performance is not
easily identified. The first claim seems to be based on the
DHIS indicator which measures the availability of a list of key
drugs, not the availability of the entire EDL. Data on private
sector treatment coverage is also not routinely reported to
the Department of Health, although they are tracked by the
JCSMF. Some figures have entered the public domain via
a publication in the South African Medical Journal in 2007
[SAMJ 97(358-9)]. Based on data from 13 disease management
programmes (DMPs) and a number of community treatment
initiatives, the authors concluded that, by mid-2006,
a total of 67 600 patients were receiving ART outside of
the public sector. Of these, 11 600 were being treated by
community treatment programmes. The 13 responding DMPs
Health Status – HIV and AIDS
reported a total of 55 900 patients on treatment. The 5 DMPs
that did not respond were expected to be treating less than
5 000 patients. This paper also attempted to establish the
proportion of patients in need who were being treated. In
June 2005, medical schemes reported to the Risk Equalisation
Fund (REF) that 32 844 beneficiaries met the requirements
of the national ART guidelines. The authors estimated that
“[e]xtending the REF study figures to the industry as a whole, it
is estimated that in 2005 there were 59 671 medical scheme
beneficiaries in need of treatment. The authors also noted
that “[n]o attempt has been made to estimate the number
of individuals who are currently paying for their own treatment
and not belonging to DMPs, community treatment
programmes or public sector programmes”. These patients
will only be identified in future “through surveys of general
practitioners or studies of antiretroviral drug sales”. If the NSP
is truly to reflect a national effort, and involve the private
sector in a meaningful way, then the means to capture all
relevant data will need to be devised. The extent to which the
previous treatment targets were missed provides a salutary
lesson. In addition, measures of treatment outcome, such as
the development of toxicity and resistance, will be important
for the longer-term management of the programme.
Figure 6: Antiretroviral treatment gap for SA, 2004-2007
800 000
40
Patient numbers
700 000
600 000
500 000
400 000
300 000
200 000
100 000
0
7%
125 814
8 413
19%
12%
149 751
18 113
161 719
30 002
197 624
42 989
29%
25%
22% 22%
261 631
48 410
304 302
59 663
389 644
111 786
36%
33%
31%
453 650
141 774
535 291
178 635
616 932
224 885
257 108
SEP NOV DEC MAR JUNE AUG DEC MAR JUNE OCT FEB
2004 2005 2006
2007
716 771
36%
35
30
25
20
15
10
5
0
Percentage
Operational Plan Target
Actual ARV roll-out (public sector)
Actual as % of Operational Plan Target
Source:
Joint Civil Society Monitoring Forum. http://www.jcsmf.org.za/
243