- Angolan citizens, representatives of the civil society in Cacuaco district, Luanda, were briefed by the members of the National Assembly (Angolan Parliament) on the Constitution, promulgated on 5 February.
The coordinator of the national commission for Cacuaco, Sérgio Joaquim, informed that the document replaces the Constitutional Law used after the independence of Angola, on 11 November 1975.
The act was attended by MPs, the deputy administrator of the district and the provincial directors of agriculture, rural development, fishing and industry in Luanda, Georgina Tavares and Carlos Botelho, respectively.
To read the article titled, “Civil society clarified on constitution,” click here.Source:All Africa
- More than 10 000 learners have gathered in Cape Town's Grand Parade on Human Rights Day to demand that the government provides libraries for every school in the country.
Equal Education (EE) spokesperson, Yoliswa Dwane, whose organisation spearheaded the school library campaign nationally and coordinated the march, points out that Grand Parade was filled to capacity, adding that, "You couldn't even see a bare patch of ground -- the place was covered with learners in their school uniforms."
Meanwhile, Congress of South African Trade Unions general-secretary, Zwelinzima Vavi, told the learners who had gathered in the Grand Parade before marching on Parliament that inequalities in education provision are still affecting millions. Vavi further said that, "It is absolutely scandalous that only eight percent of public schools have adequate libraries, mostly in privileged former Model C schools."
To read the article titled, “Library campaign for SA schools gains momentum,” click here.Source:Mail&Guardian
- The Department of Home Affairs in Zambia has disclosed that more than eight Zambian NGOs are under investigation for alleged money laundering and other illegal activities.
Minister Lameck Mangani says the government, through the registrar of societies is also scrutinising some NGOs that have drifted from the mandate for which they were established.
Mangani, who states that the Drug Enforcement Commission commenced investigations of the NGOs late last year following concerns on how the funds were being managed, is also urging NGOs to maintain high levels of accountability. Once the investigations are concluded, the erring NGOs will be prosecuted.
To read the article titled, NGOs under probe,” click here.Source:All Africa
- 1. Introduction
The King Code of Governance Principles (the Code) and the King Report on Governance for South Africa were published on 1 September 2009 and became effective on 1 March 2010. Like the first and second reports, this third report is aimed at promoting good corporate governance in South Africa and was compiled by the King Committee under the chairmanship of Professor Mervyn E. King. The King Committee has received both local and international acclaim for its contribution towards corporate governance.
In its first two reports the King Committee did not make any effort to explain its relevance to civil society organisations (CSOs). The King Committee was noticeably more concerned with the governance of commercial companies. CSOs were left in the dark as to the relevance and applicability of the first two codes.
King III has now boldly declared that it applies to ‘all entities regardless of the manner and form of incorporation or establishment and whether in the public, private sectors or nonprofit sectors’.3 The principles contained in the report have purportedly been drafted so that ‘every entity can apply them and, in doing so, achieve good governance‘.4 The accuracy of this statement is questionable.
Although King III is a very important document in the history of corporate governance in South Africa, it must be recognised for what it is: a code suited for commercial entities that may find limited application in CSOs.
This article briefly explores the potential implications of King III on CSOs.
2. The development of the King Codes
In 1992 the King Committee was established with the specific aim of researching and making recommendations into corporate governance in South Africa. The first King report was published in 1994. King I recognised that companies do not act independent from society. For this reason the highest standards of corporate governance were encouraged through enterprise with integrity. This entailed that a wide range of stakeholders’ interests are to be considered as it relates to the fundamental principles of good financial, social, ethical, and environmental practice. The second King Report (King II) was released in 2002. Without deviating from the principles of its predecessor, King II was more focused on introducing the idea of corporate citizenship and the notion of a triple bottom line. The latter involved the exercise of the corporate governance function with due regard to the company‘s actions on people, planet, and profit.
Some of the recommended practices of the King II report were incorporated into the Companies Act 71 of 2008 and some have become regulatory prescriptions to companies listed on the Johannesburg Stock Exchange. King III now states that ―Good governance is not something that exists separate from the law and it is inappropriate to unhinge governance from the law. 5 The argument is that with time governance practices eventually becomes the standard against which the board is measured. Should a court have to look at an incident in respect of governance, such standard (governance practices) will be used to measure the conduct of directors. The insinuation is clearly being made that components of King III stand a good chance to attain the standard of law. King III further argues that: ― Corporate governance practices, codes and guidelines therefore lift the bar of what are regarded as appropriate standards of conduct. Consequently, any failure to meet a recognised standard of governance, albeit not legislated, may render a board or individual director liable at law.
There is no doubt that some of the principles contained in King III would eventually become law. This raises the question whether King III lays a proper foundation that could inspire legislation that will govern CSOs.
3. Is King III an appropriate standard for civil society governance?
King III is not legislation. The fact that King III suggests that organisations should ‘apply or explain’ why they are not applying it, creates the illusion that it has the same authority as legislation. Given this insistence that King III applies to all entities, some funders may view it as the standard of governance for all CSOs in South Africa. King III, whether appropriate or inappropriate for CSOs, can in effect play the role of a gatekeeper for donor support.
King III is heavily skewed, in language and meaning, towards the commercial sector. This is highlighted by the fact that the report speaks overwhelmingly to business and commercial enterprises and assumes that trading activities are the sole means of sustaining all entities. King III is seemingly unmindful of the fact that a large number of CSOs in South Africa do not generate their own income through trading activities. It can only be deduced that this assumption is a consequence of a neglected consideration of the nonprofit sector.
King III is heavily associated with the Companies Act. Throughout the Report consistent reference is only made to the Companies Act of 2008 as the Act regulating the establishment of entities in South Africa. Now, one can only deduce that the intention was to speak to the governance of companies that have been and will be registered in terms of the companies’ legislation.
Given these factors alone there is reason to be concerned with the impact that King III may have on the enabling environment of CSOs — in particular on community-based organisations, as the Cinderellas to our sector.
It is claimed that King III was necessary in light of the new Companies Act 71 of 2008 and changes in international governance trends. This poses two very important considerations. First, not all CSOs are established in terms of the Companies Act and King III is seemingly not cognisant of the tens of thousands of voluntary associations that operate in terms of common law in South Africa. Second, an increased expectation of a high level of sophistication has now been imposed by King III on smaller community-based organisations. This seemingly academic approach has placed less emphasis on the local context.
The more sophisticated NGOs would be better placed to keep in step with the latest tunes. That however is not the reality for the majority of community-based organisations, which comprise the overwhelming component of CSOs in South Africa.
The Nonprofit Organisations Act, No. 71 of 1997 (the NPO Act) is one of the key pieces of legislation for the non-profit sector in South Africa. It provides for the establishment of a Nonprofit Directorate which has, amongst others, the function “To ensure that the standard of governance within nonprofit organisations is maintained and improved.”7 It is clear that the King III report was compiled without involvement from the NPO Directorate. This is an important factor, as the NPO Act is in particular aimed at ― creating an environment in which nonprofit organisations can flourish.8
4. The implications of King III for civil society governance
It is not difficult to see how some CSOs would snugly embrace King III and would most probably gain competitive advantage in implementing it. The authors of King III claim that it has been prepared so that ‘every entity can apply them and, in doing so, achieve good governance‘. This is hardly evident from the Report. A number of principles contained in King III cannot realistically be applied to all legal entities. The following are such examples:
- Audit Committees: Principle 3.1 of King III recommends that the board should voluntarily appoint an effective and independent audit committee consisting of at least three members. It further suggests that ‘there should be a basic level of qualification and experience for audit committee membership’.9 This audit committee should collectively have an understanding of a wide range of issues, namely: integrated reporting, internal financial controls, external audit process, corporate law, risk management, sustainability issues, information technology governance, and governance processes within the company.10 This expectation is out of sync with the reality of most community-based organisations in South Africa. In addition, the preparation of audit reports is not a legislative requirement for all companies in terms of the Companies Act of 2008.11
- Internal Audit: Principle 7.1 of King III provides that the board should ensure that there is an effective risk-based internal audit. The Report further suggests that the internal audit function ‘should adhere to the Institute of Internal Auditors’ Standards for the Professional Practice of Internal Auditing and Code of Ethics at a minimum’.12 The implication is that all CSOs should introduce the standards of a professional practice as a minimum requirement into its internal audit function.
- Remuneration: Principle 2.25 of the Code states that ‘Companies should remunerate directors and executives fairly and responsibly‘.13 The Report further states that ―The Board should promote a culture that supports enterprise and innovation with appropriate short-term and long-term performance-related rewards that are fair and achievable.14 King III has not taken into account that nonprofit boards are, due to the nature of nonprofit organisations, predominantly volunteers and are not getting paid for serving. The payment of nonprofit board members may have detrimental consequences for the nonprofit sector.
- A lack of financial resources
- The availability of proficient board members to ensure compliance with King III.
- The additional financial burden or potential mission drift that may result from having to now also consider matters pertaining to business that do not form part of their main objective
- Many of the recommended practices ignore the fact that CSOs derive income through soliciting funding from a donor. Whether cash-strapped CSOs would be able to mobilise additional resources to implement King III remains to be seen.
King III has introduced a code on governance that largely considers governance practices from a market-based perspective. It has not taken into account that the nonprofit sector does not operate primarily on the premise of supply and demand. The Code accordingly lacks principles on key areas that are central to civil society governance.
King III has not mentioned the issue of resource mobilisation, being a key responsibility of nonprofit boards. It is premised on the assumption that business is a means of sustaining all entities. King III does not take into account that a large part of CSOs have come into existence due to market failure. Accordingly, a number of organisations caring for the poor and needy (who are unable to pay for services) have to rely on donations and fundraising.
King III provides no guidance on how CSO boards should go about recruiting new board members. Recruiting new board members to volunteer their time serving on a CSO board is very different from offering someone a salary to become a director of a commercial company. Nonprofit directors carry similar responsibilities as for-profit directors, but are ordinarily not remunerated. The motivation to serve on the board of a nonprofit is therefore different compared to a for-profit. The commercial director is motivated primarily by financial gain whilst the CSO director will not ordinarily receive financial payment. The recruitment of directors to serve on nonprofit boards is therefore a central component of nonprofit governance – an aspect that King III has simply ignored.
King III does not take into account that different models of CSO governance have evolved over time. King III has, however, impliedly given recognition to the existence of different commercial models. King III does not offer guidance on some of the governance challenges faced with different CSO governance models. In one CSO model, for example—the constituent model—board members are appointed with the mandate of representing a particular constituency on the board. This governance model is widespread in the South African CSO sector and is also being promoted by the South African government. One of the shortfalls of this governance model is that it is not aimed at ensuring individuals with diverse governance skills are represented on the board. King III is unmindful of these unique challenges and offers no guidance on them.
Developments in the marketplace continue to have impacts on the development of legislation affecting the nonprofit sectors across the world. Legislatures often do not take into account the implications of such legislation on nonprofit organisations. The confusion following the applicability of the Sarbanes-Oxley Act to nonprofit organisations in the United States, shortly after its introduction, is an example of this.
CSO accountability should be promoted through laws and codes. The intention of this article is not to argue for lesser standards of governance and accountability of CSOs, but for suitable standards. Governance standards should not be introduced on the assumption that marketplace standards are suitable for CSOs. This form of legislative development is detrimental to the unique character of CSOs and will corrode the values underlying the nonprofit sector.
At least two prominent institutions have blamed weak corporate governance arrangements for the current global financial crisis. The Organisation for Economic Cooperation and Development concluded that: ―...the financial crisis can be to an important extent attributed to failures and weaknesses in corporate governance arrangements. When they were put to the test, corporate governance routines did not serve their purpose to safeguard against excessive risk taking in a number of financial service companies. 5 In a similar vein, the United Nations found that: ―...it is equally urgent to recognize the root causes for the [global economic] crisis and to embark on a profound reform of the global economic governance system.‖16 It is likely that the global financial crisis will result in further legislative and governance reforms. King III illustrates how commercial entities and CSOs can easily be thrown together and measured with one measuring tape. This is clearly inappropriate in the South African context and the consequences of it remain to be seen. A governance code aimed at promoting good governance will overburden and may potentially stifle the growth of CSOs.
1 Peter S.A. Hendricks was admitted as an attorney in 1999 in the Cape High Court of South Africa. He has numerous skills and wide experience in nonprofit law and governance. His law firm PSA Hendricks & Associates has a focus on service and support to nonprofit and commercial entities with a social mission.
2 Ricardo G. Wyngaard has provided legal advice, training, and assistance to the nonprofit sector since 2000. He has participated in a number of legislative reform and research initiatives on nonprofit legislation and is currently running a solo law practice focusing on nonprofit law and governance (www.nonprofitlawyer.co.za).
3 The King Committee, (2009) King Report on Governance for South Africa, Institute of Directors, p. 17
5 Ibid, p.7
6 Ibid, p. 8
7 Section 5b(ii) of Nonprofit Organisations Act, No. 71 of 1997
8 Section 2 (a) of the Nonprofit Organisation Act, No. 71 of 1997
9 The King Committee, (2009) King Report on Governance for South Africa, Institute of Directors, p. 57
11 The draft regulations of the Companies Act of 2008 are more in line with a threshold approached adopted by the California's Nonprofit Integrity Act of 2004 which requires charities with gross revenue of $2 million or more to appoint an audit committee, which amount excludes grants received from government.
12 The King Committee, (2009) King Report on Governance for South Africa, Institute of Directors, p. 93
13 Ibid, p. 48
15 The Corporate Governance Lessons from the Financial Crisis, Organisation for Economic Co-operation and Development, 2009
16 The Global Economic Crisis: Systemic Failures and Multilateral Remedies, United Nation
- This article first appeared in the International Journal of Not-For-Profit Law, volume 12, Number 2 February 2010. It is republished here with the permission of the authors; Peter S.A. Hendricks, PSA Hendricks & Associates and Ricardo G. Wyngaard, Ricardo Wyngaard Attorneys .
- In the past few months earthquakes in Haiti and Chile have caused unprecedented devastation and suffering to the two countries and their people.
In response to the earthquake that struck Haiti on 12 January 2010, the international community has already raised millions of dollars in support of emergency relief and reconstruction efforts. However, much more needs to be done over a sustained period of time to support Haitians and the rebuilding of their country. Under the banner of the “Africa for Haiti” campaign, a number of African civil society organisations are combining their efforts in mobilising support for Haiti. The aim is to raise US$20 million in support of specific reconstruction initiatives which will be identified in partnership with Haitian civil society organisations.
It is hoped that this campaign will provide Africans from all walks of life an opportunity to demonstrate their collective solidarity and support for the people of Haiti, thereby uniting Africans in compassion and giving.
To make a donation, visit your nearest Standard Bank branch and make a donation using the following bank account:
Account Name: The African Monitor - Haiti Campaign
Account Type: Money Market Call Account
Branch: Adderly Street, Cape Town
Branch code: 020009
Swift Code SBZAZAJJ
If in South Africa, you can also make a donation by sending an SMS to 38159 (R10.00).
You can also make an online donation by visiting the “Africa for Haiti” website.
Since 2006 SANGONeT is a member of TechSoup Global, a network of NGOs in various parts of the world committed to assisting local NGOs in obtaining donations of essential technology products, information and services. SANGONeT's SANGOTeCH technology donation programme forms part of this initiative.
After the earthquake that struck Chile on 27 February 2010, many areas in the country still have no communication. In response to this situation, the TechSoup partner in Chile, the Centre for Digital Inclusion (CDI), is restoring connectivity to Chilean NGOs through the CDI Mobile Telecentre - connecting individuals to loved ones and connecting NGOs to resources helping them get back on their feet.
Each US$1 000 raised enable the CDI Mobile Telecentre to visit another city, let residents of that city contact their friends and families and work with a local NGO to rebuild its technology infrastructure.
For more information about CDI's work and to make an online donation, click here.
SANGONeT would like to encourage all our readers, users and stakeholders to support these two important civil society initiatives.
- The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) is expected to make a presentation at the National AIDS Council (NAC) on findings of an assessment of access to health services by the lesbian, gay, bisexual and trans-gendered community as well as a study on men who have sex with men (MSM) in May this year.
BONELA says this decision was made by former president Festus Mogae, at the NAC last week, following a query by BONELA as the presentation initially scheduled for May last year, was cancelled at the last minute, without consultation.
BONELA director, Uyapo Ndadi, points out that, "As an organisation, we are excited that our leaders are now more progressive and open towards issues of sexual minorities which is reflective of sound democratic principles.”
To read the article titled, “BONELA to present findings of access to health by 'gays',” click here.Source:All Africa
- Zimbabwe Lawyers for Human Rights (ZLHR) and the Zimbabwe Human Rights Association (ZimRights) have warned of worsening human rights abuse at the hands of Zimbabwe’s state security agents. The warning follows an escalation in the number of threats, intimidation and harassment against its members.
ZimRights director, Okay Machisa, explained how he and other members of the ZimRights board last week received a series of threatening text messages and phone calls, warning them against conducting constitutional outreach programmes.
One of the threatening email that Machisa received two weeks ago from a person claiming to be Dzapasi Mumunda, read, "You enjoy flying in and out of the country demonising your country, why don't you go and stay there? They monitor, soon you will all stay out."
To read the article titled, “Civil society warns of worsening rights abuse,” click here.Source:All Africa
- The World Bank has defended its proposed R29 billion loan to Eskom amid growing criticism from environmental groups and NGOs.
The NGOs, Climate Justice Now, groundWork and the Federation for a Sustainable Environment, have criticised the loan, supported by the National Union of Metalworkers of South Africa and the South African Council of Churches.
They say if it is approved, the poor will bear the burden of Eskom debt.
Meanwhile, Eskom finance director, Paul O’Flaherty, says the company had already factored the World Bank loan into the funding plan it submitted to National Energy Regulator of South Africa (NERSA) as part of its application for tariff increases.
To read the article titled, “World Bank defends loan to Eskom,” click here.Source:Business Day
- The South African Institute of Race Relations (SAIRR) says the demand for free education by students at higher education institutions is justifiable considering the high number of students who dropped out because they could not afford higher education.
SAIRR deputy CEO, Frans Cronje, says the students’ protests raised questions about how the government prioritised its programmes.
Cronje points out that, “The country has a high number of students (30 -40 percent) who drop out every year, partly because they cannot afford fees, and the government is spending billions of rands on less prioritised things.”
To read the article titled, “Institute backs free varsity call,” click here.Source:Business Day
- HIV, tuberculosis (TB) and malaria continue to be the leading causes of mortality and morbidity in Sub-Saharan Africa. The region remains home to 62 percent of global HIV infections and 72 percent of global AIDS mortality - mainly amongst women and children. It is estimated that there are 33.4 million people living with HIV. Most of them continue to face illness and death if they are unable to access treatment.
South Africa remains the epicenter of the epidemic. The country has 28 percent of the global population of people with dual HIV/AIDS and TB infections. It has a maturing HIV epidemic, mainly driven by heterosexual sex, multiple concurrent sexual partnerships, intergenerational sex and mother-to-child (vertical) transmission. HIV prevention strategies are not succeeding in cutting the number of new HIV infections – largely because they are unfocused, lack resources, and lack full and ongoing political commitment.
In South Africa and across Sub-Saharan Africa there are visible signs that we will not meet the targets of achieving universal access to treatment by the end of 2010. Universal access targets were agreed to by G8 members and, subsequently, heads of states and governments at the 2005 United Nations (UN) World Summit. The main reason why we are not meeting the targets is due to a lack of committed national and international leadership to prevent and treat HIV.
The Treatment Action Campaign (TAC) believes that civil society must remain vigilant and monitor the implementation of HIV and AIDS plans across the region.
Global Political Commitment – But Will It Last?
In 2001 we started to see world leaders and African governments committing to fight AIDS/TB and malaria in developing countries. The UNGASS Declaration of Commitment in 2001 was a landmark in global commitment to HIV. The declaration was followed in 2002 and 2003 respectively with the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US President’s Emergency Plan for AIDS Relief (PEPFAR).
The result is that today five million people that would have died without access to treatment are receiving antiretroviral treatment (ART). 4.5 million orphans have received medical services, education and community care and 790 000 HIV-positive pregnant women have received PMTCT treatment.
These tangible gains make all the more worrying an apparent change of heart by the most powerful governments of the world, who are contemplating reduced funding for HIV, and creating artificial contrasts between funding health systems and funding AIDS. It is essential that civil society and governments in developing countries unite to challenge cuts in AIDS funding. We also call on our partner organisations in developed countries to highlight the price that we will pay with our lives for their government’s austerity measures.
Can Political Will in SA Translate Into Action?
In South Africa, we began to see a turning of the tide in the country’s HIV and AIDS response last year. AIDS denialism was buried. The new political leadership, led by Deputy President Kgalema Motlanthe, the new Minister of Health, Dr Aaron Motsoaledi, and occasionally President Jacob Zuma, has shown commitment to tackling the epidemic. This was reinforced by the appointment of Dr Nono Simelela to lead the South African National AIDS Council (SANAC) secretariat, which TAC welcomed.
At last, after years of civil society advocacy, South Africa has a strong policy for the treatment and prevention of HIV. This policy aims to treat 80 percent of people who require treatment and to reduce new infections by 50 percent by 2011. The country is currently updating its treatment and prevention guidelines to take advantage of scientific evidence showing that there are more effective methods to reduce mortality and prevent new infections.
HIV and AIDS must be tackled side by side with strategies to strengthen all aspects of the health system. The government has also developed a 10-point plan to provide strategic leadership and create cohesion amongst stakeholders for better health outcomes through: the implementation of National Health Insurance (NHI) and by overhauling the health care system to improve the management and quality of health services. Priorities include: addressing human resource shortages; improving development and management; revitalising of infrastructure; accelerating the implementation of the HIV and AIDS and Sexually Transmitted Infections National Strategic Plan (2007-2011); building focus on TB and other communicable diseases; and reviewing the drug policy to strengthen research and development.
The recent budget put money behind most of these priorities.
However, the big question is whether funds allocated for health will be sustained, and whether this government truly has the political will to root out corruption and inefficiency in the health system.
Linked to this is the question as to whether the private health sector will recognise its constitutional duty to fully and extensively support the national effort around HIV prevention and treatment - with financial resources, health personnel and infrastructure.
Challenges and Priorities for 2010
1. Scale and Up and Sustain Access to Treatment
South Africa currently has the biggest antiretroviral (ARV) programme in the world. But still less than half of the people in need are able to access treatment. We recognise that government is trying to address these challenges and we welcome the removal of the long accreditation process to ART clinics, often delaying access to treatment.
We need to address the substantial implementation challenges at provincial and district level. These challenges include: removing all waiting lists; integrating HIV/AIDS and TB services; decentralisation of care in order to increase access closer to communities; ending drug stock-outs and monitoring availability of essential drugs.
We need to implement effective strategies to improve treatment adherence – both for the health of patients and to reduce drug resistance and the need for second and third line ART. We need to provide ART regimens with better side effect profiles. We need fixed-dose combinations. We need more social support. We need better education about HIV. We need a more welcoming health system that is sensitive to issues of mental health.
On World AIDS Day 2009, President Zuma announced a number of updates to South Africa’s treatment guidelines. From 1 April 2010 pregnant women and people who are co-infected with TB and HIV must be provided with ART at a CD4 count of 350 and all infants who test positive should be treated with ART immediately.
Government must address financial and human resource shortages to ensure the timeous implementation of these changes.
2. Make HIV Prevention Work
South Africa has a maturing HIV epidemic, mainly driven by heterosexual sex and mother to child (vertical) transmission. One in three women between the ages of 25-29 is living with HIV (32.7 percent). We need to dispel the myths such as: ‘prevention is easier than treatment’, or ‘we must have treatment over prevention’ - we need both.
Preventing new infections and AIDS-related deaths amongst young women in South Africa is crucial. Some of the main drivers of our epidemic are early sexual debut, gender-based violence and gender inequality, intergenerational sex, multiple concurrent sexual partnerships and a lack of knowledge about HIV and HIV status. We need to address the lack of access to: prevention of mother-to-child (vertical) transmission programmes, voluntary medical male circumcision, sexual reproductive health services, and male and female condoms.
It must be noted that prevention messaging starts with our leadership in the South African National AIDS Council (SANAC). As our country’s leader, our President needs to protect us and his family from the scourge of HIV. His behaviour, or that of other political leaders, must not send mixed messages to the public.
We need to scale up evidence-based prevention interventions if we want to meet the NSP target to cut new infections by half by 2011.
TAC believes that prevention strategies must prioritise:
- Scaling up prevention of mother-to-child (vertical) transmission programmes by increasing access to and uptake of HIV counseling and testing, especially before 14 weeks of pregnancy, and proper implementation of the new revised PMTCT protocol and consistent monitoring and evaluation of the programme.
- Scaling up services that empower young women and girls to negotiate in their relationships. This includes economic empowerment of women so that they are not dependent on partners that put them at risk of HIV infection. Further, prevention tools that are women owned are very limited. South Africa distributes less than six million female condoms per year and there are currently no other women owned prevention measures. Part of the NSP’s aims is to support research development of new prevention tools that will help reduce women’s vulnerability to HIV.
- Scale up the implementation of voluntary male medical circumcision by implementing pilot sites in KwaZulu-Natal, Eastern Cape and Western Cape. The Global Fund and PEPFAR are committed to funding this intervention which has the potential to greatly reduce new infections both in men and women.
South Africa is aiming to scale up treatment and prevention services through its revised guidelines. Scaling up services demands: addressing the human resource capacity constraints and the introduction of task shifting, increasing financial resources and implementing needs-based budgeting, and securing affordable essential drug prices.
The 2010 ART tender must be for the drugs that are to be included in the new first line regimen. It must promote adherence by prioritising fixed dose combinations and co-packages.
Ignoring TAC’s advice in the last tender led to South Africa paying avoidably high prices for drugs - making local and international pharmaceutical companies rich. The new tender process is a very good opportunity for South Africa to fight for lower prices for ART. The UNITAID patent pool is a new opportunity that all drug companies should make use of to ensure a sustainable and sufficient supply of life saving drugs.
If it is devised and implemented properly, the proposed government plan to reform health funding and delivery through a system of National Health Insurance (NHI) could ensure equity in health care provision. The private health system must be regulated to control costs and to require it to share the costs of expanding human and financial resources to the poor. South Africa’s universal health plan should keep the promise of the Constitution that says ‘everyone’ should have access to health care services – a right that should not be based on their income. But ‘everyone’ must include all people in South Africa. TAC will fight any plan to turn our backs on the health needs of refugees and undocumented migrants. To be able to introduce NHI, South Africa will have to tackle current human resource capacity problems, management challenges and systematic problems.
4. Let SANAC Lead with Action
This year must be a year of action because we have to report on our universal access to treatment targets by the end of 2010. Secondly, we need to implement the recommendations that came out of the NSP mid-term review to ensure we are on track.
SANAC must be turned into an efficient and cost effective statutory body. Each sector and government ministry should demonstrate accountability, transparency and action.
A priority must be to strengthen the provincial, district and local AIDS Councils to implement our targets locally. Establishing functioning AIDS Councils should be made part of the performance agreements of the president, premiers and mayors, and be assessed by SANAC.
Every person in South Africa should take part in the HIV testing and counseling campaign - this has to start with the highest office in the country. This must be a multi-sectoral response that involves provincial, district and local AIDS Councils, in order to ensure that it reaches the most rural areas. We say that by the end of 2011 every South African should know their HIV status!
As a matter of urgency, treatment guidelines must be finalised and distributed to all districts to prepare them for scaling up their treatment and prevention programmes.
HIV prevalence and incidence remains unacceptably high in South Africa. We are only left with a year to meet the goals of the NSP, which includes reducing new infections by 50 percent and providing appropriate treatment, care and support to 80 percent of HIV positive people by 2011.
The role of civil society in monitoring, advocating for and promoting health system reform has not diminished – and TAC will continue to be instrumental in strengthening the voice of civil society in this regard.
- This article was first published in the Treatment Action Campaign’s Electronic Newsletter, 19 February 2010 and it is republished here with the permission from the TAC, a NGO working to ensure that every person living with HIV has access to quality comprehensive prevention and treatment services to live a healthy life.