The mess in Mpumalanga
Mpumalanga is one of the provinces where South Africa’s plan to fight HIV and TB has been most poorly implemented. Now, after years of dysfunctional provincial and district AIDS councils, there may just be some light at the end of the tunnel.
Mpumalanga’s Provincial AIDS Council (PAC) was launched in November 2009, almost three years after the National Strategic Plan on HIV, STIs and TB (2007- 2011). It might have taken even longer, had it not been for pressure exerted by civil society organisations including the Treatment Action Campaign (TAC) in Mpumalanga.
“After the official launch of the … PAC it was still a difficult task to convene … meetings. [They] were not properly coordinated and were poorly constituted,” says Thandi Maluka, an Advocacy Communication Coordinator at TAC Gert Sibande.
Once formed, the PAC appears to have done little meaningful work. According to Maluka the Provincial Strategic Plan (PSP) 2007-2011 was drawn up by the PAC mainly for compliance purposes. The drafting process concluded in 2010 a year before the end of the plan itself. “The PSP was never implemented due to its lateness”, Maluka recalls.
Late 2011 saw the launch of the 2012-2016 National Strategic Plan for HIV, STIs and TB (NSP). This time the Mpumalanga PAC rose to the challenge and began developing a new PSP. It also reviewed the previous plan, concluding that poor coordination had lead to its failure.
The PAC then realised that they were not in fact meant to draw up a PSP, but instead a provincial operational plan (POP) aligned to the principles of the NSP. With input from stakeholders the POP was duly drawn up and identified the following priorities for Mpumalanga:
• Increase HIV awareness especially among high-risk populations such as young people and farm labourers.
• Intensify case finding and follow-up for HIV, STIs and TB.
• Expand HIV Counselling and Testing (HCT) campaigns.
• Use combination prevention strategies to maximise HIV and TB prevention.
• Maintain the health and wellbeing of all Mpumalanga residents.
• Promote the core values of the South African constitution to reduce stigma and discrimination.
• Strengthen the PAC, district AIDS councils (DACs) and local AIDS councils (LACs) to encourage participation from all sectors of Mpumalanga communities.
The National Association on AIDS Spending was called in to assist with costing the POP. However, not all stakeholders have taken part in the costing. It has therefore become more of a desktop exercise by the consultant involved than a fully inclusive process.
An external consultant has also been drafted in to help finalise the monitoring and evaluation (M&E) framework and to enable districts to align their own M&E plans to the provincial plan.
The development of the provincial operational plan should be inclusive, targeting all stakeholders. It is also a knowledge-building activity that can help to sensitise political leadership, civil society, managers and health practitioners to the needs of our communities.
Lack of leadership
Poor implementation of the PSP was partly due to a lack of political will from Premier Mabuza, who delegated his responsibilities as Chair of the PAC to the MEC of Health. The message implicit in this action has had a trickle-down effect as a result of which few district and local AIDS councils were formed to carry forward the implementation of the PSP. TAC and other civil society groups have repeatedly called for Mabuza to chair the PAC, but without success.
To effectively implement the NSP at a local level it is essential for the PAC to support district AIDS councils. DACs should also participate in the PAC. However, so far only two of the three districts in Mpumalanga – Gert Sibande and Ehlanzeni – are active in the PAC.
In most provinces DACs are chaired by district mayors. However in the absence of a directive from the Mpumalanga Premier’s office making this a requirement, it doesn’t always happen. This contributes to the dysfunctional HIV response in the province. In addition, district mayors cannot hold municipal mayors accountable for LACs and many ward councillors do not chair clinic committees as they should.
The revolving door of political appointees in some districts further contributes to the lethargy in DACs and LACs. In Gert Sibande, for example, the DAC is currently chaired by the third mayor in a year. This lack of continuity has stalled progress on HIV and TB issues.
Furthermore, civil society groups represented on the PAC are relatively fragmented, and government departments often send different representatives to each meeting, most of whom have limited decision-making powers.
[box]On 8 August 2012, TAC, SECTION27, COSATU and the South African Council of Churches convened a meeting with civil society partners involved in HIV/AIDS work in Mpumalanga. They aim to create a united civil society coalition to collectively advocate for effective AIDS councils in Mpumalanga.[/box]Simonia Mashangoane is a researcher with TAC. Thandi Maluka and Patrick Mdletshe, both TAC leaders, also contributed to this article.