JOINT CALL FOR EC GOVERNMENT TO PROVIDE NEVIRAPINE IN PUBLIC HEALTH FACILITIES For Immediate Release - 30 January 2002 The Treatment Action Campaign (TAC) and the Public Service Accountability Monitor (PSAM) call on the Eastern Cape Premier to follow the example of his Kwa-Zulu Natal counterpart and provide the anti-retroviral drug, nevirapine, to HIV-positive pregnant mothers in the province. This joint call is made after careful consideration of the resources available to the Department of Health in the province. Research published by the Eastern Cape Department of Health, in the journal Epidemiological Notes, recognises that over 20% of women attending antenatal clinics in the province tested HIV positive in 2000. As a result it is estimated that in excess of 10 500 babies are born HIV positive in the Eastern Cape each year. TAC/PSAM believe that on the strength of the pilot studies conducted in Kwa-Zulu Natal, which delivered a 100% success rate, the lives of these infants could have been saved through the provision of nevirapine to pregnant mothers in the Eastern Cape. Despite recognising the devastating spread of the HIV/AIDS epidemic in the province the Eastern Cape administration has chosen to remain with the two pilot sites proposed by national government. Over the past 2 years the province has maintained that the establishment of a provincial programme to prevent mother to child transmission of HIV would be costly beyond what the Eastern Cape government can afford (Premier Makhenkesi Stofile, Speech on 'The challenge of HIV/AIDS in Eastern Cape', 1/12/2000). A study conducted by national government, however, demonstrates that the implementation of a public nevirapine programme would achieve an overall saving of government funds. It established that it is cheaper to prevent mother-to-child transmission than to treat infected infants for the opportunistic diseases that they will contract as a result of their immune deficiency (TAC vs. RSA, p.17). In opposition to the provincial government's stance TAC/PSAM believe that the Eastern Cape has the sufficient resources to provide a comprehensive programme of administering nevirapine. The following evidence testifies to this fact: Operational infrastructure * According to Dr Thobekile Mjekevu, the Head of the Department of Health, the Eastern cape has 716 clinics and 95.2 percent of these currently provide antenatal services (TAC vs. RSA, p.30). These 680 clinics could form the infrastructural basis for the administration of nevirapine. * Although many of these clinics lack the necessary physical infrastructure like running water, electricity and telephone lines, the Eastern Cape reported an underspending of its capital expenditure over 70 percent in 2000 (Business Day, 2/11/2001). * Evidence shows that 94% of women in South Africa use public health antenatal services and 84.4% of them give birth in public hospitals. 93.3% of South Africa's public hospitals are capable of providing first child immunizations. In addition, 56.2% of fixed clinics in the country already offer HIV testing and 83% of these clinics already provide HIV counseling. This shows the extensive capacity of provincial public health services in South Africa to provide comprehensive treatment to prevent mother to child transmission of HIV. In addition to the 680 clinics presently capable of administering nevirapine, and providing patient counseling, the Eastern Cape has 93 hospitals, 67 of these being district hospitals, 8 regional hospitals and 18 specialised hospitals, which could be used for this purpose. It is clear that if there were a commitment to providing essential healthcare to prevent the mother to child transmission (MTCT) of HIV this would be possible by using existing resources and infrastructure. Financial costs * The HIV/AIDS budget for the financial year 2000/2001 was R33 m of which R 31.9-million was not spent and had to be returned to the Treasury (Auditor-General's Report on the 2000/2001 Financial Statements). * The Eastern Cape Department of Health's HIV/AIDS directorate only managed to finalise its HIV/AIDS NGO funding for the financial year 2001/2002 this month (January 2002). This means that NGO funding was only allocated one month before it was supposed to be spent. * According to the Department of Health's own estimates it will cost R56.9 million to implement a comprehensive programme to prevent MTCT in the province, R24.3 million of this will fund counseling with R15.8 million for infant feeding .The Department claims that it cannot afford this amount. * In the light of financial mismanagement within the Department of Health during 2000/2001, reported by the Auditor General's office, it is the firm belief of TAC/PSAM that the department could comfortably afford to finance a comprehensive nevirapine MTCT programme. The Auditor General has pointed out that personnel expenditure of R2,3 billion by the department could not be fully substantiated; no supporting documents could be produced to back up R142 million of capital expenditure and the department's R3 billion in current expenditure; there were also insufficient controls in place to ensure that the department collected its own revenue. There is a current lack of political will to deal with HIV/AIDS epidemic, and specifically the issue of preventing the MTCT of HIV, within the Eastern Cape department of Health. This is made clear by the fact that there is not a single programme devoted to dealing with HIV/AIDS in the department's strategic plan for the period 1999 - 2003. The fact that the Western Cape and Kwa-Zulu Natal provinces both plan to implement a comprehensive MTCT programme by using their existing infrastructure demonstrates that such a programme is possible. TAC/PSAM call on the Eastern Cape Premier and Department of Health to revisit their current policy and strategic plan and start implementing a comprehensive MTCT programme with immediate effect. Issued by Xolisa Vitsha, Researcher, Public Service Accountability Monitor (PSAM), Rhodes University, Grahamstown, Tel: 046 603 8358 Ncumisa Nongogo, Treatment Action Campaign (TAC) National Executive, East London, Tel: 043 722 1711