End of Term Review of the NSP
2007-2011
Final Report
4 November, 2011
Summary
The purpose of this review of the National Strategic Plan
(NSP) and the Provincial Strategic Plans (PSPs) 2007-2011 is
to contribute to the evidence base to inform the development
of the next round of strategic plans. It consists of an
assessment of the achievements, challenges, missed
opportunities and emerging issues to prioritise in addition to
documenting lessons learnt and good practices.
We are reviewing the 4 different pillars and the priority areas
under each pillar.
1. Pillar 1: Prevention
2. Pillar 2: Treatment, Care an Mitigation
3. Pillar 3: Monitoring, Research and Surveillance
4. Pillar 4: Human Rights and Access to Justice
Review Pillar 1: Prevention
Introduction:
A primary aim of the NSP was to ensure that the large
majority of South Africans who were HIV negative
remained HIV negative. The goal was to reduce the
number of new HIV infections by 50%, with a
particular emphasis on reducing new infections in the
15-24 year old age group.
Although new adult infections (total annual new cases of
HIV infection dropped from 640 000 in 2000 to 390 000
in 2009), the NSP target has likely not been reached.
Estimated number of new infections
among adults 15-49 in South Africa:
1990-2009
Indicator
New HIV
infections
(15-49)
1990
60,000
1995
2000
2005
490,000 640,000 460,000
2009
390,000
While HIV incidence has been declining, there are still large differences
across provinces with three-fourths of South Africa’s new infections clustering
in KwaZulu-Natal, Gauteng, and the Eastern Cape. In contrast, the Northern
Cape has an estimated annual HIV incidence of only 0.7% resulting in an
estimated 3 177 new infections per annum This incidence rate is the lowest
in the country and accounts for 0.9% of South Africa’s total new infections
Estimated annual HIV incidence and
number of new infections in adults
15-49 years old in South Africa’s
provinces (2009)
Percentage of young women and
men aged 15-24 who are HIV
infected
Province
Baseline 2005
Mid-term 2008
Actual 2010/2011
Eastern Cape
12.3%
12.0%
11.7%
Free State
10.4%
9.6%
8.5%
Gauteng
8.9%
7.7%
6.6%
KwaZulu-Natal
13.3%
12.1%
10.6%
Limpopo
6.2%
5.8%
4.9%
Mpumalanga
10.8%
9.9%
8.5%
Northern Cape
3.7%
4.2%
3.8%
North West
10.6%
9.5%
8.3%
Western Cape
3.2%
2.7%
2.3%
It can be concluded that overall, the implementation of HIV
prevention initiatives has reduced infection rates over the
last decade. However, the number of new HIV infections
still remains high exceeding death rates from AIDS (partly
because of the effectiveness of treatment programmes)
leading to an increasing number of HIV positive individuals.
Prevention priority area 1: Reduce
vulnerability to HIV infection and the
impact of AIDS
The MTR stated that the objectives under this component
were “generalized national intervention strategies related to
poverty reduction. It is not practical or realistic to make the
multi-sectoral HIV and AIDS programme accountable for
achieving poverty reduction in the way defined in the NSP”.
Prevention priority area 2: Reduce
sexual transmission of HIV
In South Africa it is estimated that the bulk of HIV
transmission (86%) is through sexual transmission. At
present, the only purely biomedical interventions that are
proven to be effective in preventing the sexual transmission
of HIV are male circumcision, providing HAART (Highly
Active Anti-Retroviral treatment/therapy) to HIV positive
people and post-exposure prophylaxis. For this reason, the
bulk of prevention interventions rely on people making
changes to their behaviours.
1. Mass media, Information,
Education, Communication and
Behaviour Change Programmes.
Exposure to South Africa’s HIV prevention communication
through media campaigns is high, with 80% of those
surveyed knowing at least one of the initiatives, in particular
among the 15-24 year olds age group.
In spite of these initiatives, correct knowledge on the
prevention of sexual transmission of HIV was lower in
2008 than in 2005.
2.
Multiple and Concurrent
Partnership
There is considerable interest and debate on the importance of MCP.
The (NCS 2009) National Communication Survey reported that, overall, the
rate of partner acquisition was three times higher in men than in women, and
highest in men aged 20-24 years . The rate was highest among those who
have no partner, and those who are in their early twenties. African men and
women seemed more likely to acquire a new partner than non-Africans. Men
and women living in tribal areas were the least likely to acquire a new
partner.
Comparing multiple partner data across the five national surveys, there is
some indication of an increase over time in the proportion of 16-55 year old
men who reported MSPs in the past 12 months. HIV prevalence was higher
in respondents reporting more sexual partners.
There is little data available on concurrency in South Africa although there is
a growing interest in research in this area. For this reason, we present below
data from the provinces on multiple partnerships only.
3.
Percentage of women and men
15 - 49 who have had sexual
intercourse with more than one
partner in the last 12 months
Province
Eastern Cape
Free State
Gauteng
KwaZulu Natal
Limpopo
Mpumalanga
North West
Northern Cape
2005
8.1%
5.4%
11.3%
10.6%
9.5%
7.2%
11.4%
7.5%
2008
13.1%
14.6%
8.6%
10.2%
10.8%
9.4%
12.9%
8.8%
4.
Provincial perspectives
For more information about the provincial perspectives
of the Eastern Cape, Gauteng, KwaZulu Natal and North
West, see p 52 and p 54 of the manual.
5.
Age of sexual debut
There has been a long term trend towards earlier sexual debut
amongst youth. For men and women born before 1950, median
age at first sex was 20 years and for those born in the 1980s; it
was 18 years. Young Africans report higher levels of sexual
experience than coloured, Indian and white youth.
The Cape Area Panel Study (WC) found that girls in lower
income households tended to have earlier sexual debut, and
that community poverty rates were associated with early sexual
debut and higher rates of unprotected sex.
In the Africa Centre study area (KZN), the most important and
highly significant factor protecting females against first sex
before the 17th birthday, was school attendance.
6.
Percentage of young men and
women who have had sexual
intercourse before age 15 (Age at
first sexual debut)
Province
Eastern Cape
Free State
Gauteng
KwaZulu Natal
Limpopo
Mpumalanga
North West
Northern Cape
Western Cape
National
2005
6.7%
7.8%
10.9%
4.5%
10.1%
10.1%
4.6%
12.7%
10.4%
8.4%
2008
7.8%
9.6%
7.8%
4.9%
11.2%
15.0%
7.3%
8.5%
9.3%
8.5%
7.
Medical Male Circumcision
Since the development of the NSP 2007-2011, new evidence has
emerged that male circumcision can reduce HIV transmission in men
by up to 60% and in South Africa local researchers found the risk of
HIV transmission in circumcised men was reduced by 76% with no
significant increase in sexual risk-taking behaviour.
In 2010, South Africa instituted an aggressive roll-out of a national
Medical Male Circumcision (MMC) program with the goal of reaching
80% of HIV negative men aged 15-49 (approximately 4.3 million
men) by 2015. As of June 2011, almost 238 000 circumcisions had
been conducted. The guidance from the UN recommends at least 5
million circumcisions would be required in South Africa as a
prevention strategy to impact on new HIV infections.
KZN has made the most progress of all the provinces in regards
to circumcision.
8.
Condom Distribution and Usage
 The distribution of male condoms increased from 308.5 million in 2007,
to 495 million in 2010 (a 60% increase). However, this translates to an
individual level of only 14.5 condoms per adult male per year (15-49) in
2010 against 12.7 per adult male in 2008. The number of female condoms
distributed free has increased from 3.6 million in 2007 to 5 million in 2010 (a
39% increase). However, there are still widespread complaints that female
condoms are not as readily available as they should be.
 Condom use in South Africa has continued to increase with the
percentage reporting the use of condoms in the most recent sexual
encounter increasing from 35% (2005) to 62% (2008) with the highest rates
amongst younger age groups. Increased condom use among the youth may
have contributed to the recent decline in HIV incidence in this age group.
People above 50 and married people are least likely to report condom use.
 PLHIV who knew that they were HIV-positive were significantly more likely
to use a condom than PLHIV who did not know their HIV status.
9.
Provincial Perspectives. Table:
Percent of young men and women
15-24 and 25-49 reporting the use of
a condom with their last sexual
partner at last sex
Province
Eastern Cape
Free State
Gauteng
KwaZulu Natal
Limpopo
Mpumalanga
North West
Northern Cape
Western Cape
National
2005
35.8%
30.7%
37.7%
36.3%
44.7%
36.1%
37.3%
19.1%
22.5%
35.4%
2008
70.0%
46.8%
57.6%
66.2%
68.0%
70.2%
62.0%
52.6%
49.0%
62.4%
10. Table: Number of male and female
condoms distributed annually in the
provinces by the public sector
Province
Male Condoms
Female Condoms
Mid-term 2008
Actual
Mid-term 2008
Actual
2010/2011
2010/2011
Eastern Cape
22,661,055
28,962,143
1,285,225
1,070,270
Free State
8,001,206
9,405,099
140,614
216,736
Gauteng
30,273,069
35,225,331
855,002
797,221
KwaZulu-Natal
25,934,049
27,606,619
59,884
853,353
Limpopo
20,836,360
21,792,958
149,532
217,370
Mpumalanga
14,640,739
22,316,318
219,419
634,998
North West
2,346,096
3,578,820
28,519
112,764
Northern Cape
7,787,477
9,251,642
201,660
156,366
Western Cape
74,455,988
87,287,145
796,237
1,079,606
11. Key Populations
Globally, men who have sex with men (MSM), transgender people (TG),
sex workers (SW), injecting drug users (IDU), prisoners, and migrant
populations have been shown to be at disproportionate risk for HIV
infection. In South Africa an estimated 9.2% of all new HIV infections are
related to MSM and 19.8% are related to commercial sex work.
Because they are often marginalized by society and greatly affected by
discrimination and stigma, these groups have become some of the most atrisk populations for HIV infection. These groups are collectively labelled “key
populations”.
HIV prevalence within these populations tends to be higher in areas where
same-sex behaviours, drug use and sex work are criminalized, and where
appropriate actions addressing their specific health needs are absent. High
levels of prejudice and moral loading has been shown to create barriers to
accessing prevention, treatment, care and support – increasing vulnerability
to HIV.
For:
1.
2.
3.
“Evidence that Key Populations are at higher
vulnerability to HIV infection”, and
“Key points about the NSP 2007-2011 in relation
to Key Populations”, and
“A minimum service package for all key population
groups should include...”
see the manual on pages 61 and 62.
Question:
Why are key populations at higher
vulnerability to HIV infection?
12. Long Distance Truck Drivers
Long distance truck drivers, particularly in the early stages
of the HIV epidemic, were considered important in the
spread of HIV and to have particular prevention and
treatment needs. In response to this, a variety of
programmes aimed at this sub-population have been
developed.


For info on provinces about long distance truck
drivers in the Eastern Cape, Free State and
Limpopo, see p 63 in the manual.
Also note the section about farm workers on page
64 of the manual
Prevention priority area 3: Prevention
of Mother to Child Transmission
(PMTCT)

Prevention of mother-to-child transmission (PMTCT)
programs play a significant role in averting peri-natal infections
in South Africa. Without antiretroviral treatment (ART), about 1
out of every 3 babies born to HIV-infected women will be
infected. With ART, transmission can be reduced to less than
5%, the South Africa PMTCT goal, with an effective PMTCT
programme.

Since 2008, South Africa has rapidly scaled-up its
PMTCT and Early Infant Diagnosis (EID) programmes. By
2010, PMTCT was offered at 98% of health facilities. As a result
of the scale up of PMTCT in South Africa, by 2010,
transmission from mother to child at 6 weeks was reduced
to 3.5 percent
Table: Number of infants born to HIV
infected mothers who are HIV-infected
Province
Eastern Cape
Free State
Gauteng
KwaZulu-Natal
Limpopo
Mpumalanga
Northern Cape
North West
Western Cape
Mid-term 2008
1,658
231
3,278
3,610
369
553
25
1,482
404 (3.6%)
Actual 2010/2011
1,534
829
3,464
5,304
3,764
1,414
212
1,398
388 (3.2%)
Prevention priority area 4: Minimize
the risk of HIV transmission through
blood to blood products
South Africa continues to achieve 100% targets for blood being
screened in a quality assured manner. Across the almost
19,000 blood banks operated by NBTS that screened over
775,000 blood units in 2010, HIV transmission through blood
has been virtually eliminated and the safety of blood products in
South Africa is on par with international standards (UNGASS
report, 2010).
Review Pillar 2: Treatment, care and
mitigation
Introduction:
The second aim of NSP 2007-2011 was to reduce the
impact of HIV and AIDS on individuals, families,
communities and society by expanding access to
appropriate treatment, care and support to 80% of all
HIV-positive people and their families by 2011.
Priority area 1: Increase coverage to
voluntary testing and promote regular
HIV testing
HIV Counselling and Testing
Coverage of HIV counselling and testing (HCT) increased substantially
from 2005 to 2010. In 2008/09, 96% of public health facilities in the
country offered voluntary HIV counselling and testing (HCT) with a target
of 100%, and 24.7% of adults had been tested and received their results
in the past 12 months with a target of 11%.
In April 2010, South Africa launched a national HCT campaign with the
goal of promoting HIV counselling and testing and urging all South
Africans to know their HIV status and be screened for TB.
As of June 2011, almost 11 million people had been tested for HIV as
part of the HCT Campaign. In addition, South Africa is currently scalingup its Provider Initiated Counselling and Testing (PICT) model to extend
access to HCT at health facilities.
Provincial Table: Number of people
tested for HIV (excluding antenatal)
including provision of results
Province
Eastern Cape
Free State
Gauteng
KwaZulu-Natal
Limpopo
Mpumalanga
Northern Cape
North West
Western Cape
Mid-term 2008
316,523
130,539
403,383
658,022
324,175
176,102
53,708
176,878
325,992
Actual 2010/2011
743,925
294,921
727,614
1,392,978
728,350
390,871
91,371
464,241
653,093
Priority area 2: Enable people living
with HIV to lead healthy and
productive lives
Roll-out of antiretroviral therapy continues to be successful, with 1.4
million persons started on antiretroviral therapy and approximately 1.1
million currently on treatment. Treatment initiation rates have reached
30,000 per month. A revision of the treatment guidelines in 2009 has
increased the threshold for ART treatment in pregnant women and patients
co-infected with TB and HIV to CD4+ count 350, and the provision of safer
and effective antiretroviral therapy regimens for adults and children. The
number of people living with HIV receiving nutritional support (734,900)
surpassed the NSP targets for 2008/09 (500,000)
Overall mortality rates have demonstrated a gradual reduction, reflecting the
increase in treatment access.
Table: South Africa projected AIDS
related deaths
National ANC Sentinel HIV and Syphilis Prevalence Report. National Department of Health,
2010,
Total
annual
AIDS
deaths
Adult
AIDS
deaths
(15+)
AIDS
Deaths (014)
2008
2009
Spectrum
Assa
Spectrum
Assa
330 000
235 000
314 000
200 000
2010
Assa
188 828
297 000
208 000
284 000
179 000
167 894
33 000
27 000
30 000
21 00
20 934
Provincial Table: Percentage of adults
and children with HIV known to be on
treatment 12 months after initiation of
antiretroviral therapy.
Province
Eastern Cape
Free State
Gauteng
KwaZulu-Natal
Limpopo
Mpumalanga
Northern Cape
North West
Western Cape
Adults
2010
89.2%
86.9%
96.9%
88.2%
100.0%
95.8%
97.6%
96.8%
83.6%
Children
2010
91.5%
55.9%
99.3%
89.0%
100.0%
79.9%
49.8%
100.0%
81.9%
Priority area 4: Mitigate the impacts of
HIV and AIDS and create an enabling
social environment for care treatment
and support
The Department of Health provides nutritional support to people living with
HIV and AIDS mainly through the provinces. By 2008/9 a total of 734 409
people living with HIV, AIDS and TB were provided with nutritional
supplements which exceeded the target of 500 000.
Difficulties accessing grants is one of the main reasons why some OVCs go
without financial assistance. Problems include legislative barriers requiring
a guardian to receive and manage monetary assistance from government,
and elaborate documentation which children are often unable to provide.
Review Pillar 3: Monitoring, research
and surveillance
Introduction:
The MTR listed the following main conclusions on the monitoring, research and
surveillance component of the NSP 2007- 2011 and little has changed since then:
1.
There is not one multisectoral, M&E system to collate, aggregate, analyse
and report on the national response.
2.
The NSP has too many, non-prioritised and in some cases, un-measurable,
indicators.
3.
Without a national NSP implementation plan in place, there has been a
missed opportunity to break targets down by priority area and province.
4.
Regular, public reports on the NSP progress do not exist.
5.
Monitoring, evaluation and research tends to be an under-capacitated and
underappreciated area.
Note the following priority areas:
(page 82-84 in the manual)
1.
Priority area 1: Implement the monitoring and evaluation framework
of the NSP
2.
Priority area 2: Support the development of prevention
technologies
3.
Priority area 4: Conduct policy research
4.
Priority area 5: Conduct regular surveillance
Review Pillar 4: Human Rights and
Access to Justice
Introduction:
South Africa has a very progressive constitution, as well as laws and other
regulations that provide for the security of human rights and protects
individuals against discrimination. These specifically include provisions for
vulnerable populations such as women, young people, MSM, prison inmates
and migrant populations. However, implementation of some of these policies
has been poor, and policies do remain that promote stigmatization and
discrimination, such as the continued criminalisation of sex work which
creates barriers for HIV prevention and treatment.
(continue)
a.
Stigma Reduction – Provincial
A Stigma Mitigation Framework was developed as a collaborative effort
between the National Department of Health and the USAID funded Health
Policy Initiative. This framework constitutes a guideline for the design and
implementation of stigma reduction interventions for chronic infectious
diseases including HIV, AIDS and TB.
A gender based violence assessment report for South Africa was also
produced by the United States Government. This document amongst other
things makes an assessment of gender based violence programmes and
priorities in the country.
Review Pillar 4: (cont)
b.
Reducing vulnerability to sexual and
gender based violence
A review of women, girls, and gender equality in Southern and Eastern Africa,
South Africa scored high in relation to the inclusion of gender-based rights in
National Strategic Plans for HIV and AIDS. However, the report also indicates
several areas for improvement.
Overview of the NSP 2007-2011
a. Policy Environment
The KYR and other reviews have pointed out that simply having policies
in place does not constitute an effective programme; it is implementation
that is the key issue.
The KYR report concurred with the MTR in identifying the main gap as
being the lack of a national, unified prevention strategy that is
adequately resourced and that flows down operationally and
programmatically to provinces and districts.
(Continue)
Other gaps in the policy environment identified by the KYR report
included:
1.
The lack of male engagement in prevention of mother-to-child
transmission (PMTCT).
2.
The need for better communication of the post-exposure
prophylaxis (PEP) guidelines.
3.
The need to ensure cultural sensitivity in the development of a
National Male Circumcision Policy.
4.
The need to better target special populations including out-ofschool youth, people with disabilities, mobile and migrant
populations, commercial sex workers, and men who have sex
with men (MSM).
5.
The need for policies on female condom distribution, serodiscordant couples, and on regulating the provision of health
services across international and regional borders.
(Continue)
For more information on:
Management, Coordination and Institutional Arrangements – National to local,
The South African National Aids Council
The Provincial Aids Councils *
The Provincial Aids Councils
District and Local Aids Councils
Ward Based Community Competency Programmes
Outcomes of Community dialogues
Government Response
Department of Public Service and Administration’s Systems monitoring Tool
Report
10. Department of Social Development *
11. Department of Basic Education
12. Department of Correctional Services
1.
2.
3.
4.
5.
6.
7.
8.
9.
See pages 25 - 48 of the manual
* We would like to underline the following
Strategies for Orphans and Vulnerable
Children
The number of children who require alternative care in the form of foster care
and residential care has grown tremendously due to the increase in the
number of orphans in the country, as a result of HIV and AIDS. The number
of children in foster care rose from 378 748 to 445 306 during the reporting
period.
Lets look at the Prevalence of Orphan hood in South Africa (Surveillance
System Report on Maternal Orphans, 2010)
Table: Number of mothers dying and children
ever born to them by year
*2010 figures only include information up to end of September 2010
Year
2003
2004
2005
2006
2007
2008
2009
2010
Total
Number of mothers dying
65,628
77,371
84,079
88,784
88,450
88,300
82,754
51,132
626,498
Number of orphans
101,736
122,995
138,069
149,341
152,624
156,174
147,352
90,963
1,059,254
• Of the 1,059,254 maternal orphans created in South Africa between 2003 and end
of Sept 2010, a quarter (25%, 269,150) is from the province of KwaZulu-Natal.
• The Eastern Cape and Gauteng are showing the second and the third largest
distributions with 168,957 and 168,542 respectively.
• The two Provinces with the lowest number of maternal orphans created between
2003 and end of September 2010 are Northern Cape and Western Cape Province
at 29,342 (3%) and 44,565 (4%) respectively
Table: Number of orphans receiving grants
by grants province
Province
EC
FS
GP
KZN
LP
MP
NW
NC
WC
Total
Total
100,288
53,284
71,878
191,689
74,743
57,701
51,189
15,244
17,850
633,866
%
15.8
8.4
11.3
30.2
11.8
9.1
8.1
2.4
2.8
100
Care
Dependen
cy Grant
1,145
388
743
3,045
764
611
886
405
244
8,231
Child
Support
Grant
50,764
28,484
38,384
113,434
37,283
40,996
28,563
7,893
9,685
355,486
Foster
Care
Grant
48,379
24,412
32,751
75,210
36,696
16,094
21,740
6,946
7,921
270,149
A list of provinces which have Provincial Strategic
Plans 2007-2011, Operational Plans and M&E
Frameworks in place.
Province
PSP developed
PSP approved
Operational Plans
M&E Framework
Eastern Cape
Yes
Yes
Nothing that linked
directly back to the
PSP
Yes but not
monitored or
tracked
Free State
Yes
Approved by
Technical Working
Committee; not by
Premier
Major interventions
in PSP were costed
Yes
Gauteng
Yes (2009 – 2014)
Yes
Annual business
plans
M&E system in
place.
KwaZulu-Natal
Limpopo
Mpumalanga
Yes
Yes
Yes
Yes
No
Yes but not
implemented
No
No
No
Yes
No
yes but not
implemented
North West
Northern Cape
Yes
*
No
Will have to find out
No
Western Cape
Yes
Yes
Yes
5 year targets set
Scale up of the HIV and AIDS Life Skills
Education Programme
2000-2004:
Implementation in
the General
Education and
Training Band:
Grades 4-6
Focus on
learners & on
prevention
2005: Extension to
Foundation Phase
(Grades R-3) &
Further Education
and Training Band
(Grades 10-12)
2008-2009: Focus on
learners & educators
2010: Implementation
in 25 850 schools,
involving 12 260 099
learners and 418 109
educators
2010: Alignment
with latest trends
and NSP
reporting
Achievement Highlights of the NSP
2007 - 2011
1.
2.
3.
4.
5.
6.
7.
HIV incidence continues to decline, particularly in younger age groups.
There was renewed engagement and high-level political leadership for
the HIV response as well as growing cooperation between the
Presidency, the Department of Health, NGOs and all sectors of civil
society in SANAC structures.
Provincial, District and Ward AIDS Councils have been established
across the country.
There is some progress in restructuring SANAC.
Strong policies were developed to support the HIV and AIDS response
Research has shown that MTCT nationally has been reduced to 3.5%
by 6 weeks of age.
The national HCT policy was approved by the NHC and the HCT
Campaign was launched in April 2010 and by August 2011, 14 million
HIV tests had been conducted.
Achievement Highlights of the NSP
2007 – 2011 (cont)
8.
9.
10.
11.
12.
13.
A national Medical Male Circumcision program was launched and as
of June 2011, 237 812 circumcisions had been conducted.
The revision of the ART treatment guidelines and the
implementation of NIMART increased the access to treatment and
there are now more than 1.1 million people on ART with new
policies likely to extend access even further in coming years.
There was a significant reduction in ARV tender prices.
The number of people living with HIV receiving nutritional support
(734,900) surpassed the NSP targets for 2008/09 (500,000).
There has been a big growth in the CBO sector and in CBOs that
provide home-based care in particular.
South African researchers extended the evidence base with a
number of high profile studies
Statistical Highlights
Category
Indicator
2007
2010
Epidemiology
National HIV incidence (daily)
1.3%
1.2% (2009)
Epidemiology
Estimated total new HIV infections
460 000
(2005)
390 000
(2009)
Prevention response
National condom distribution
308.5 million
495 million
Prevention response
35.4% (2005)
62.4%
Prevention response
Men and women 15-29 using condom at
last sex
Medical Male Circumcision (MMC)
No programme
237 812 (June 2011)
Prevention response
DoH facilities offering PMTCT
Prevention response
Babies PCR tested at 6 weeks
60.4% (2008)
83.9%
Prevention response
Babies tested at 18 months
17.5% (2008)
17.8%
Prevention response
Babies on co-trimoxazole at 6 weeks
2.4%
65.8%
Treatment response
People on HAART
Treatment response
Prisoners on HAART
2 323
8 091
Impact
AIDS-related deaths (ASSA estimate)
235 000
188 828
Impact
Mothers dying
88 450
51 132
Impact
No of orphans
152 624
90 963
Impact
No. of child headed households
12 219
38 306
Impact mitigation
Child support grants
8 200 000
9 569 602
98%
1.1 million
Key Challenges of the NSP 2007 - 2011
1.
2.
3.
4.
5.
6.
7.
Little progress has been made in restructuring SANAC.
The SANAC Secretariat has been critically understaffed with most
posts vacant and this has compromised the ability of SANAC to deliver
on its mandate.
Most SANAC civil society sectors have no funding, no coordinator or
staff and are run by professionals over and above their day to day job
responsibilities.
Coordination of the public sector, private sector and non-government
sectors remains underdeveloped.
Synergy between the national strategy and implementation at province,
district, and ward and facility level was not consistently applied between
2007 and 2011.
Although the NSP was intended to be multisectoral, in practice it was
very “health” orientated.
TB and STI integration were not well defined in the 2007-2011 NSP and
little progress has been made in STI integration.
8.
9.
10.
11.
12.
13.
14.
Most reporting against the NSP targets was dominated by the health
sector, and this masked the amount of activity by other government
departments and non-state organisations.
The absence of an overarching, prevention communication strategy
to accompany the NSP.
There was no costing or budgeting of human rights and access to
social justice component in the 2007-2011 NSP.
There was no clearly defined M&E framework or costing of the
research, monitoring and evaluation component in the 2007-2011
NSP.
No shared repository of research outputs exists.
The extent of input, coverage, effectiveness and impact of HIV,
AIDS, STI and TB programmes financed by development partners
could not be established.
Although the implementation of the NSP is based largely on nurses,
the NSP did not articulate the engagement of the HPC and in
particular the Nursing Council in terms of pre-service training and
nursing regulations that would allow such programmes as NIMART
and the changing scope of the professional nurse within the primary
health care system.
Recommendations
1.
2.
3.
4.
5.
6.
7.
8.
There is a need for a national, unified prevention strategy that is
adequately resourced and that flows down operationally and
programmatically to provinces, districts and sub-districts.
The SANAC governance and structural weaknesses require the
introduction of a broad and effective accountability framework.
The roles and functions of the PACs, DACs and LACs need to be
clearly defined.
All government departments need to be consulted and involved in the
development and then implementation of the NSP.
The NSP should be centred in the broader development plan of
government and that should be clearly articulated in the NSP.
There is a need for regular sector consultations on the NSP.
The NSP should clearly articulate the involvement of People Living with
HIV and People affected by TB. There is also a need for united action
from the PLHIV sectors.
There needs to be a formal review and evaluation of the recent HCT
campaign to better understand the impact of the initiative.
(continue)
9.
10.
11.
12.
13.
14.
15.
The NSP 2012 – 2016 must have a clear M&E framework from the
beginning with clear recommendations on data flow.
There is need for greater investment by SAG in the research agenda
There is need for a program for the development of young researchers
especially those from previously disadvantage backgrounds.
The NSP 2012 – 2016 needs a section on the financing of the NSP.
There should be a national consultation on Community Care Givers
with the view of integrating this program into the broader health and
development agenda.
The NSP 2012 – 2016 need to better target special populations
including out-of-school youth, people with disabilities, mobile and
migrant populations, commercial sex workers, and men who have sex
with men (MSM).
The issue of human rights and HIV needs to be better articulated in the
next NSP.
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