Chapter 4: Progress of the NSP 2007-2011 - cabsa

End of Term Review of the NSP 2007-2011 Final Report 4 November, 2011 Submitted by: Mark Colvin Submitted to: South African National AIDS Council
Acknowledgements
We would like to extend thanks to the following individuals: SANAC Plenary: Deputy President Kgalema Motlante, Plenary Chair; Mark
Heywood, Co-chair; and all Plenary members. SANAC PIC: Co-Chairs, Precious Matsoso and Helen Rees; and all PIC
members. Department of Correctional Services: Kosie Ferreira and Roeleen Booi. Department of Health: Yogan Pillay, Thobile Mbengashe, M. Vusil and
Nhlanhla Ntuli. Department of Labour: EHWP: Sulette Roussouw. Department for Public Service and Administration: Morero Leseka, Sipho
Senabe and Tebogo Monye. Department of Social Development: Connie Kganakga, Johanna De Beer, Malega
Kganakga and Olivia Machusi. Department of Basic Education: Faith Kumalo, Saadhna Panday, Albertina Dano
and Hersheela Narsee. Provincial Government Coordination Structures and Representatives. Gauteng Provincial GovernmentFrancis Akpan Médecins Sans Frontières: Ariane Bauernfeind, Donela Besada, Lynne
Wilkinson and Rebecca Hodes. GIZ: Ingrid Obery and Asta Rau. HEARD-UKZN: Managa Pillay. Irish AID: Tamara Mathebula. Italian Cooperation: Stephen Hendricks (University of Pretoria). SANAC: Zwoitwaho Nevhutalu, Junaid Seedat, Lucie Bar-David, and Tsakani
Mtileni. SIDA: Jackie Sallet. AFSA and Futures Group: Charles Dalton. SANAC/GIZ: Maren Lieberum. SANAC/HLSP: Mariam Sibanda. CHAI: Celicia Serenata. UNAIDS: Miriam Chipimo, Henry Damisoni,Nkhensani Mathabathe and Alasdair
Reid. Soul City: IHDC: S Goldstein. UNFPA: Gerrit Maritz. USAID: Rose Mulumba (Futures Group, Philip Browne, Ian Ralph (Right to
Care), Zodwa Ngobese (MATCH). US CDC: Sara Hersey. Office of the Deputy President's Office: Dr Nono Simelela. All other role players and stakeholders involved with the 2012-2016 NSP and
2007 - 2011 consultation process. Abbreviations/Acronyms AIDS Acquired Immune Deficiency Syndrome ART Antiretroviral treatment/therapy ARV Antiretroviral AZT Azidothymidine CDW Community Development Workers CHH Child-headed households CPT Cotrimoxazole prophylaxis CSO Civil society organisation DHIS District Health Information System DoH Department of Health DSD Department of Social Development HAART Highly active antiretroviral treatment/therapy HCBC Home and community-based care HCP HIV communication programme HCT HIV counselling and testing HIV Human Immunodeficiency Virus HTA High Transmission Area IDC Interdepartmental committee on HIV&AIDS IDU Intravenous drug use/users KYE Know your epidemic KYR Know your response LAC Local AIDS Council LGBT Lesbian, gay, bisexual and transsexual persons M&E Monitoring and Evaluation MARPS Most-at-risk populations MCP Multiple and concurrent sexual partnerships MDR-TB Multi drug-resistant tuberculosis MMC Medical male circumcision MPSA Ministry of Public Service and Administration MSM Men who have sex with men NDoH National Department of Health NGO Non-governmental organisation NPO Not-for profit organisation NSP National Strategic Plan NVP Nevirapine NW North West Province NWDoE North West Province Department of Education NWDoH North West Province Department of Health NWDSD North West Province Department of Social Development NWPAC North West Provincial AIDS Council OVC Orphans and vulnerable children PDPHC Expanded Partnership for the Delivery of Primary Health
Care PEP Post-exposure prophylaxis PIC Programme Implementation Committee of SANAC PLHA People living with HIV/AIDS PMTCT Prevention of mother-to-child transmission PSP Provincial Strategic Plan RHRU Reproductive Health Research Unit SABCOHA South African Business Coalition on HIV & AIDS SANAC South African National AIDS Council
SBCC Social and behaviour change communication
SMT Employee Health and Wellness Management Systems Monitoring Tool
SRH Sexual and reproductive health
STI Sexually transmitted infection
TB Tuberculosis
UNGASS United Nations General Assembly Special Session on HIV/AIDS
XDR-TB Extensively/extreme drug-resistant tuberculosis
Contents
Acknowledgements 2
Abbreviations/Acronyms 4
Contents 6
Executive Summary 8
Background 8
Methods used to review the NSP 2007-2011 8
Review of the NSP 2007-2011 8
Pillar 1: Prevention 8
Pillar 2: Treatment, care and mitigation 12
Conclusion: Summary of highlights and challenges with resulting
recommendations 15
Conclusion 15
Achievement Highlights of the NSP 2007-2011 15
Key Challenges of the NSP 2007-2011 16
Recommendations 18
Review Background 19
Review Objectives 19
Methods used to review the NSP 2007-2011 19
Desktop Review 19
Provincial Reviews 19
Strengths and Limitations of the Provincial Review Process 20
Strengths 20
Limitations 21
Review of Government Sector 21
Overview of the NSP 2007-2011 23
The Policy Environment 24
Management, Coordination and Institutional Arrangements - National to Local
25
Background 25
The Integrated Support Team review of health overspending and macro-
assessment of the public health system in South Africa 25
The South African National AIDS Council 26
The Provincial AIDS Councils 28
District and Local AIDS Councils 30
Ward Based Community Competency Programmes 31
Outcomes of Community Dialogues 31
Government Response 33
The Department of Public Service and Administration's Systems Monitoring
Tool Report 34
Department of Social Development 37
The Department of Basic Education 42
Department of Correctional Services (DCS) 46
Review Pillar 1: Prevention 49
Introduction 49
Prevention priority area 1: Reduce vulnerability to HIV infection and the
impact of AIDS 51
Prevention priority area 2: Reduce sexual transmission of HIV 51
Multiple and Concurrent Partnerships 54
Age of Sexual Debut 55
Medical Male Circumcision 57
Provincial Perspectives 57
Condom Distribution and Usage 58
Key Populations 61
Key points about the NSP 2007-2011 in relation to Key Populations 62
Long Distance Truck Drivers 63
Prevention priority area 3: Prevention of Mother to Child Transmission
(PMTCT) 64
Introduction 64
Provincial Perspectives 65
Prevention priority area 4: Minimize the risk of HIV transmission through
blood and blood products 68
Review Pillar 2: Treatment, care and mitigation 69
Introduction 69
Treatment, care and mitigation priority area 1: Increase coverage to
voluntary testing and promote regular HIV testing 69
HIV Counselling and Testing 69
Treatment, care and mitigation priority area 2: Enable people living with
HIV to lead healthy and productive lives 72
Treatment, care and mitigation priority area 4: Mitigate the impacts of
HIV and AIDS and create an enabling social environment for care treatment
and support 77
Review Pillar 3: Monitoring, research and surveillance 79
Introduction 79
Provincial Perspectives 80
Monitoring, research and surveillance priority area 1: Implement the
monitoring and evaluation framework of the NSP 82
Monitoring, research and surveillance priority area 2: Support the
development of prevention technologies 83
Monitoring, research and surveillance priority area 4: Conduct policy
research 83
Monitoring, research and surveillance priority area 5: Conduct regular
surveillance 84
Review Pillar 4: Human Rights and Access to Justice 85
Introduction 85
Provincial Perspectives 86
Stigma Reduction 87
Reducing vulnerability to sexual and gender based violence 88
References 90
Appendix 1: Recent Policy Initiatives in South Africa 95
Appendix 2: 96
Appendix 3: Proposal for a Standardised Structure for Provincial Reviews
97
Appendix 4: List of Key Indicators for the Provincial Reviews 101
Appendix 5: Strengths and Limitations of the Provincial Review Process
104
Strengths 104
Limitations 104
Appendix 6. Table from page 6 of the SANAC strategic review (Dalton, 2010)
107
Executive Summary Background 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. Methods used to review the NSP 2007-2011 The Terms of Reference for this review required an assessment of NSP
implementation by consolidating the following:
1. A desk review on NSP implementation at national level.
2. The 9 provincial reviews of the NSP/PSPs 2007-2011.
3. Analysing data from programme and governance review tools.
4. Incorporating data from the community dialogues. Sourcing information for the review has been a challenge (please refer to
specific challenges relating to M&E). We specifically thank each Province
for preparation and submission of their own reviews and the following
Departments for their detailed information provision: NDOH; NDSD; NDCS;
NDBE. The document has been broadly discussed through SANAC structu