SOUTH AFRICA: Treatment crisis in Free State, again
JOHANNESBURG, 28 August 2009 (PlusNews) - South Africa's Free State Province is again experiencing a crisis in the delivery of antiretroviral (ARV) treatment, with understaffed clinics, erratic drug supplies and long waiting lists preventing many dangerously ill patients from accessing the life-prolonging drugs, according to AIDS activists.
Runaway overspending by the provincial health department in 2008 led to a moratorium on new patients starting ARV treatment that lasted from November until February 2009. The Southern African HIV Clinicians Society estimated that 30 people a day died during this three-month period because they could not access treatment.
Local newspapers reported that national health minister Aaron Motsoaledi told a meeting of the South African National AIDS Council (SANAC) in July: "What happened in the Free State last year should never be allowed to happen again in any province."
Now, several reports from the Free State suggest that many of the factors leading to last year's moratorium have not been addressed, and patients are again suffering the consequences.
"There's definitely a crisis with ARV stocks again," said Trudie Harrison, director of the Anglican Church's Mosamaria AIDS Ministry. "They're not able to initiate new clients at the rate they should be, there are long waiting lists, and one of the clinic staff members told me that people coming now will only be able to start [treatment] next year [2010]."
Harrison told IRIN/PlusNews that the crisis was the result of drug shortages and a dearth of health workers. At one ARV site she recently visited, normally staffed by three doctors, about 200 patients were waiting to see just one doctor. "They can only see so many, and they send the rest home," she said.
Sello Mokhalipi, of Treatment Action Campaign (TAC), an AIDS lobby group, confirmed that a critical staff shortage was compounding the drug supply problem. He told IRIN/PlusNews that a number of HIV-positive people could get only one of the three ARVs they needed from their local ARV clinic.
Harrison and Mokhalipi cited mismanagement as the main reason for the renewed crisis, but Jabu Mbalula, a spokesperson for the provincial health department, said in an emailed response to questions from IRIN/PlusNews: "The allocated funds for ARVs for this financial year will most certainly not be enough" to keep pace with the number of new patients needing ARVs. A request for additional funding has been lodged with the national health department.
Mbalula said the waiting list for treatment had been reduced to 705 patients, and waiting times differed "in terms of site, patient load and availability of HR [human resources]".
"Shortage of HR is a challenge," he admitted, but denied that there had been any drug stock-outs. "Low levels of certain drugs were reported, but the province was able to address this."
 I see it getting worse before it gets better, unless we can have massive intervention from the [national health] minister himself |
However, Harrison said a young man had recently died in the back of her car while she was trying to get him medical help, after several months waiting to start ARV treatment, and "We've had reports from all over the province of similar things happening."
Donor-funded NGO programmes that used to assist patients who could not obtain ARVs from the public health sector had reached their limit, she added, and very few patients could afford to buy the drugs from the private sector at a cost of about US$100 a month.
Various NGOs, trade unions and church groups formed the Free State HIV/AIDS Coalition in March to lobby for better services for people living with HIV, but despite numerous requests the group had failed to secure a meeting with the provincial health minister.
The coalition is collecting affidavits from HIV-positive patients who have struggled to get treatment. Coalition chairperson Kabelo Makhetha interviewed three HIV-positive women who recently gave birth at public health facilities.
Only one was offered nevirapine, an ARV that reduces the risk of transmitting the virus to the baby, and none were offered formula milk as an alternative to exclusive breastfeeding, which carries a small HIV transmission risk. One baby who tested positive for HIV had since died.
Harrison had little confidence in the provincial health department's capacity to deal with the crisis. "I see it getting worse before it gets better, unless we can have massive intervention from the [national health] minister himself," she said.
The TAC's Mokhalipi was doubtful. "If the national department of health was really willing to intervene, we wouldn't be experiencing the shortage of staff right now; they should have fixed it right after the moratorium."
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