South Africa Faces Obstacles in Implementing New Nationwide Antiretroviral Program

Toronto's Globe and Mail today reports on some of the obstacles South Africa faces in implementing a national antiretroviral program by Oct. 1, including a potential lack of funds in the Department of Health (MacGregor, Globe and Mail, 8/15). The South African government on Aug. 8 called for the Ministry of Health to develop a national program to provide antiretroviral medications to residents with HIV/AIDS. The announcement came after a special meeting of the cabinet to consider a Joint Health and Treasury Task Team cost report on providing HIV/AIDS drugs to the public. According to the cabinet, "Policy and funding commitments made in the last two years leave South Africa well placed to offer a comprehensive package of prevention and care in the health sector" (Kaiser Daily HIV/AIDS Report, 8/11). However, some experts doubt that the department will develop a plan by the suggested date, and some AIDS advocates say that it is unlikely that a nationwide plan will be in place before the 2008 deadline, according to the Globe and Mail. The price of the drugs and a lack of funding and health workers pose challenges to the department, the Globe and Mail reports. Funding earmarked for HIV/AIDS for fiscal year 2003-2004 is about $1 billion and is set to reach $1.35 billion in the next two years. According to the cost report released last week, a full care and treatment package for half of the 120,000 people who would be eligible for the plan could cost as much as $1.8 billion annually.

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"The real hard work starts now," Zackie Achmat, chair of South Africa's Treatment Action Campaign, said, adding, "South Africa has some of the best health care infrastructure in the developing world, but our public services are overburdened. Antiretroviral provision based on universal access will require a clear plan, training of health workers and further decreases in medicine and diagnostic prices." Achmat said that although the cabinet's original announcement of the plan was the "first genuine ray of hope in four years ... no one in South Africa will condone any foot-dragging or the invention of new obstacles." Eric Goemare, head of Medecins Sans Frontieres in South Africa, said that he worries that the health department may "dela[y] universal treatment for years" by requesting the creation of pilot sites as it did before introducing nevirapine to prevent mother-to-child transmission of HIV, according to the Globe and Mail (Toronto Globe and Mail, 8/15).

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