“The NSP must resist the temptation to be everything to everyone; it cannot – and should not – become the focal point for dealing with all social ills that undermine the response to HIV & AIDS, TB and STIs.”
In a submission on the first draft of the new NSP, SECTION27 argued that the NSP must resist the temptation to be everything to everyone. That submission was important because of the way in which it attempted to define the role of the NSP.
Over the following months it became clear that that submission had identified a key point of contention. While some (SECTION27, TAC and others) were arguing for a streamlined NSP focussing on strategy, other stakeholders argued for a broader NSP that would include many more targets – some of which are very difficult to measure. Every stakeholder seemed to want his/her specific point of interest reflected in the NSP. The worry was that this could make the NSP unwieldy and ultimately harder for wider South African society to rally around.
While keeping the NSP streamlined and focussed was crucial, it was important from the outset to recognise that even if this wasn’t fully achieved, the new NSP would still be an important step forward. The specific SECTION27 submission started: “The new NSP represents a significant advance in South Africa’s response to the epidemics. It marks closure on our history of conflict, recognising the importance of evidence-based underpinnings, the value of meaningful consultation and the centrality of constitutional values and human rights. Importantly, it starts to give expression to recent government commitments regarding HIV/TB integration.”
Many of the interventions identified in the first draft of the new NSP fell outside of an NSP’s appropriate mandate. In our view, it is not for SANAC to coordinate these interventions that are central to the mandates of various government departments.
By definition, an NSP must be focussed; it cannot be the sum of all parts of the country’s response. In addition to providing the basic framework in terms of which all stakeholders – government at all three spheres, business, labour and civil society – are to develop their detailed operational plans, an NSP must also provide the basis upon which it will be assessed and stakeholders held to account. Importantly, it must provide some degree of coordination in relation to identified priorities; it should not seek to replace stakeholders’ plans and programmes.
In particular, it needs to recognise the roles and responsibilities of organs of state, such as the National Planning Commission (NPC), as well as a wide range of line-function departments with primary responsibility over a number of HIV-relevant – but not necessarily HIV-specific – interventions.
The fact that an NSP does not expressly address all HIV-relevant issues does not mean that these issues are unimportant; it is simply to state that it is neither feasible nor appropriate to include every possible intervention under the rubric of an overarching national framework for HIV. That said, there are numerous important policies, programmes and structures – including many that are already in existence – that should be developed and implemented by relevant government departments.
Amongst others, these include the following:
- Health: primary health care revitalisation; national health insurance; enforcement of quality control through an Office of Health Standards Compliance; and a human resources for health strategy;
- Social Development: prevention and treatment of substance abuse; regulation of alcohol use and advertising; and social assistance; and
- Police, Justice & Constitutional Development and Correctional Services: prevention of sexual violence and the successful prosecution and incarceration of offenders; and an efficient and effective criminal justice system that protects the vulnerable.
So how then should the NSP deal with such issues, if at all?
Consider the example of gender-based violence (GBV), in particular rape. In our view, the NSP could focus attention on providing a range of key stakeholders – police officers, correctional services members, prosecutors, health care workers, their respective departments – with a strategic framework that provides the basis for ensuring access to post-exposure prophylaxis (PEP) services. For this to happen the identified stakeholders would also have to work on a broader range of interventions necessary to ensure access; but for the purposes of the NSP, the focus would be much narrower with clearly defined indicators.
The way forward
The final NSP was neither quite as streamlined as what we would have liked it to be, nor was it as broad as we feared it might be. Some stakeholders may feel aggrieved that their specific contributions were not included in the final NSP, but this is inevitable with such wide and extensive consultation. The writing team did an impressive job of taking the many various inputs and still producing a relatively concise final document.
Now that the NSP is out there, it is up to government departments, civil servants, and civil society to make it work. As all these stakeholders do their bit in their particular sphere, we encourage everyone to take a step back from their daily grind to consider how their work fits into this national plan. As argued in the SECTION27 submission, the NSP is not only a long list of targets, but the single strategy around which we can galvanise a renewed push to fight HIV, STIs and TB. If the popular rhetoric about fighting these diseases together is to mean anything, it has to mean aligning all of our efforts with the NSP.