Implementing antiretroviral therapy rollout to strengthen the health care system Dr Olive Shisana Human sciences Research Council

Outline of the Presentation Background Inequities in access to health care Health disparities HIV/AIDS epidemic Impact of HIV/AIDS on the health care system How the roll out of the ARV programme can improve the health care system

ARV rollout & strengthening public health care system The delivery of AIDS treatment and prevention also offers the chance to build up health systems in the poorest countries, providing health benefits for all. "By tackling it decisively we will also be building health systems that can meet the health needs of today and tomorrow. This is an historic opportunity we cannot afford to miss." (WHO) Background

Antiretroviral therapy -Pattern of chronic care, individual patients receive continuous follow-up treatment for the remainder of their lives, rather than the occasional acute interventions that characterize the response to most infectious diseases. -If health systems can be strengthened to accommodate this new pattern the management practices developed for antiretroviral therapy (appointment systems, integrated medical records, drug supply systems, and adherence support) can also be applied to the management of other common, chronic conditions such as diabetes and hypertension. Background, cont’d

Inequities in access to health care “Those with more money are most likely to choose private health care as a first option while those with least money are far less likely to do so. This choice is also linked to belonging to a medical aid scheme. The wealthy sectors of South Africa’s population almost all belong to a scheme, whereas the poorest cannot afford this cover.” HST

Inequities in access to health care “Whites hardly use public hospitals and Africans hardly use private hospitals. With regard to primary care (mainly the use of general practitioners and pharmacists) the picture is slightly different. While again Whites hardly use public primary health care services, this is also true for Indians and to a lesser extent, Coloureds. 41% of Africans do use private services for primary health care.” (HST)

Demographic profile of patients Sex

Demographic profile of patients by age

Percent bed occupancy by type of facility

Mean length of stay in type of facility by HIV/AIDS status

Health disparities

Population Pyramids in two regions of the Eastern Cape

Extent of HIV/AIDS Epidemic in South Africa More than 5 million SA are living with HIV/AIDS Females have a higher HIV prevalence than males Africans have a higher prevalence than other race groups

Locality-type prevalence HIV prevalence in adults (15–49 years) by Locality-type, South Africa

Impact of HIV/AIDS on the health sector Impact on health workers Proportion of HIV+patients in hospitals is high Increase in admissions of HIV/AIDS patients Bed occupancy Length of stay in hospital

HIV Prevalence among health workers HIV+ Health workers in the public health sector

HIV Prevalence among patients HIV+ patients in the public health sector

Health facilities with staff assigned to provide HIV/AIDS care

IMPACT OF HIV/AIDS ON HEALTH WORKERS AND THEIR WORK Nearly 50% were exhausted and stressed because – Inability to prevent the spreading of HIV/AIDS Increase of HIV/AIDS patients I.e. overcrowded facilities HIV/AIDS patients require high level of attention and care Drop in quality of care – race against time and numbers Lack of health services for non-HIV patients

GENERAL ISSUES RELATING TO HEALTH WORKERS’ WORK ENVIRONMENT Increased workload during past year (73,4%) Workload has doubled since a year ago (22,3%) Working longer than officiall hours (39,4%) No job satisfaction (16,3%) Low staff morale (33,8%) Treated for stress-related illnesses during past year (16,2%) and most had to take sick leave (63.9%)

Benefits of ARV Roll Out; Increased financing to improve the health care system Over the next four and a half years, over R750 million is proposed for upgrading systems in the healthcare infrastructure in areas such as drug distribution, patient information systems and monitoring of reaction to the drugs. The cost of implementing the plan was R296 million for the rest of fiscal year 2003/4, growing to nearly R4.5 billion in 2007/8.

Benefits of the ARV Roll out 2003/04 (R millions) New Healthcare Staff: 21 Laboratory Testing: 20* Antiretroviral Drugs: 42 Nutrition: 63 Other Health System Upgrades: 70 Programme Management (National & Provincial): 16 Capital Investment: 30 Research: 34 Total: 296 Note: Includes R20 Million advance payment to NHLS through March '04.

South Africa’s ARV programme 2004/5 New Healthcare Staff: 322 Laboratory Testing: 152 Antiretroviral Drugs: 369 Nutrition: 343 Other Health System Upgrades: 171 Programme Management (National & Provincial): 103 Capital Investment: 75 Research: 55 Total: 1590

South Africa’s ARV programme 2005/06 New Healthcare Staff: 432 Laboratory Testing: 311 Antiretroviral Drugs: 725 Nutrition: 421 Other Health System Upgrades: 184 Programme Management (National & Provincial): 128 Capital Investment: 100 Research: 55 Total: 2358

Benefits of ARV roll out on the health care system 1. Fewer staff would be lost due to illness, absenteeism, low staff morale, low mortality. Length of stay in hospital would decrease, leading to reduction in overcrowding (Lazarus Effect) Improvement in patient management information systems and hence better quality of health care Better treatment for other diseases

Benefits of ARV: Involvement of the Private Sector U.N. Secretary-General Kofi Annan has said, "No company and no government can take on the challenge of AIDS alone. What is needed is a new approach to public health--combining all available resources, public and private, and using all opportunities, local and global." Currently in South Africa the private sector are said to have now put mechanisms in place to give ARVs to workers. Harmony Mines, with support from the South African Department of Health has taken over the Lesedi Project and have begun replication in several South African mining regions. The project established mobile clinic services and a peer educator network to reach women at risk in the vicinity of the Harmony Mines.