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Health care at hospitals hit by public sector strike
The public sector strike in South Africa has entered its 13th day.
President Jacob Zuma is particularly concerned about its impact on health and education, Reuters reports today.
Zuma has told government ministers to negotiate without delay to end the strike by some 1.3 million workers, the news agency reports.
RuDASA chairperson Karl le Roux stated that the intimidation, violence and loss of life that has marred the strike must be condemned.
“We also, however, believe that much of the unnecessary loss of life must be laid at the door of government, which after nearly 10 years has still failed to a minimum services agreement in place for essential services.”
RuDASA urged government and unions to reach a miniumum services agreement urgently once the strike was resolved.
The organisation also promised to work on an agreement for rural health facilities in the next two months.
Government needs to produce a rural friendly human resources plan in the next 18 months, it stated.
RuDASA and MSF (Doctors without Borders) held the 14th Annual Rural Health Conference in Swaziland on the weekend under the theme ‘Inspiration without Borders’.
Integrating HIV and TB care – in line with SA’s newly approved ARV guidelines due to come into effect from April 1 – improves the wellbeing of patients.
MSF, TAC, Cape Town City and the Western Province health department released a report today showing that the integration and decentralisation of care result in “better outcomes”.
What this report also shows is the benefits of partnership. All of them are working together at Khayelitsha at the project, which started in 2001.
Dr Gilles van Cutsem, the project coordinator for MSF Khayelitsha, stated that enrolment on ARVs for TB patients was low prior to integration.
In 2007, only 19 % of patients enrolled on ARVs were referred from TB services and now, since integration, 68% of patients at one clinic on ARVs are on TB treatment.
The rate of notification of drug-resistant TB notification has significantly improved with the launch of a pilot project providing for treatment “in clinics while patients live at home, rather than requiring hospitalisation away from family and friends for at least six months”.
Van Cutsem stated that: “The integration of ARVs within TB services in Khayelitsha (where approximately 70% of all TB patients are HIV positive) was an innovation that improved efficiency and clinical care.
“Previously, patients were referred from TB clinics to distant ARV service points (and vice-versa), resulting in long waiting times and duplication of both clinical and laboratory investigations and medical records.
“It is a matter of one patient with two diseases. There are different meanings of TB/HIV integration, but it is more than treating a patient for HIV and TB under one roof — it is about one clinic, one queue, one folder, one clerk, one nurse and one doctor, for both diseases in one patient.”
“Integration of ARVs in TB clinics is also an incentive for TB patients to take an HIV test: Using an opt-out strategy in 2009, 96% of TB patients in Khayelitsha accepted to be tested for HIV.”
Medecins Sans Frontieres warned this week, again, that declining international donor funds could reverse the dramatic gains made in AIDS treatment, particularly across Africa.
Launching the report ‘Punishing success? Early signs of a retreat from commitment to HIV/AIDS care and treatment’, Dr Tido von Schoen-Angerer said: “We think we are at a very dangerous turning point.”
The director of MSF’s campaign to provide essential medicines, he said: “The donors are getting cold feet about commitment to longterm, chronic disease.”
If the funding of antiretroviral treatment is reversed, lives will be lost.
NO AIDS conference in South Africa would be complete without a protest, an imperative that started with the huge demonstrations at the International AIDS conference in Durban 2000. Activists are the conscience of a conference, reminding delegates how far from their goals – like universal treatment – the world falls.
Today activist treatment groups Medecins Sans Frontieres, ACT-UP Paris and the Treatment Action Camp joined forces at IAS 2009, marching through the conference centre with placards demanding an end to drug stock outs and cheaper second line antiretroviral drugs.
MSF and TAC also demonstrated against the antiretroviral shortages that are harming patients and public health, before the conference even opened on Sunday night.
South Africa needs to double the number of people starting antiretroviral treatment a year to reach its target.
That is: to make sure 80% of those who need the drugs can get them.
In 2007 only about 34% of people needing them were on treatment.
And the countdown is on, with 999 days left to meet this target in the National Strategic Plan for HIV/AIDS 2007-2011.
To achieve this “task shifting” is urgently needed according to Medecins Sans Frontieres, the Reproductive Health and HIV Research Unit, the Treatment Action Campaign and the HIV Clinicians Society of Southern Africa.
“The NSP recommends professional nurses initiate and manage ART for adults and children (now the domain of doctors only); trained lay counsellors to administer HIV rapid tests (now the domain of nurses only), and supervised pharmacy assistants to dispense ARVs (now only pharmacists are allowed to),” the organisations stated today.
They are lobbying for the Health Department, provincial departments annd district managers to issue a directive allowing this task shifting, and for the professional bodies to support this.
“The evidence shows that quality is maintained so what are we waiting for?” asked Dr Francois Venter, president of the HIV Clinicians Society of Southern Africa.
Neighbouring countries have moved on this and the MSF experience in Khayelitsha and Lusikisiki supports this approach.
TAC’s Vickey Lakay declared: “We’ve been here before. In the face of overwhelming evidence to implement an intervention tha tis proven to work, we can no longer be dragging our heels.
“The TAC calls upon leadership from the National Department of Health and cooperation from professional councils and trade unions.”
72 hours. That’s all the time there is to prevent HIV infection after rape and sexual assault. Survivors must be treated as soon as possible with post-exposure prophylaxis (antiretroviral drugs) and definitely within three days.
This is the message from Medecins Sans Frontieres/Doctors Without Doctors, which treated more than 12000 victims of sexual assault in Liberia, Burundi, DRC, South Africa, Colombia and other countries in 2007.
In its Shattered Lives campaign launched online this week, MSF urges that emergency medical care be made available to all people who have been raped.
In South Africa estimates are that a woman is raped every 26 seconds.
Meinie Nicolai, MSF operational director, explains: “Each (victim) tells a story of horror, pain and degradation, often inflicted by the very people who should provide protection, such as fathers, uncles, neighbours, or soldiers. And all of the victims are at risk from serious long-term health consequences as a result of the assault.”
“Men and boys make up a small minority of the people seen by MSF in its sexual violence projects (around 6 per cent in the projects in Khayelitsa, South Africa and Masisi, DRC).”
Near to Khayelitsha survivors of sexual violence can go to the one-stop centre Simelela for treatment and support — and last year more than 1000 new patients were treated at this centre, with 80% of rape survivors assisted within 72 hours.
