MINISTER'S REPORT SAYS: "THERE ARE NO GOOD REASONS FOR DELAYING A PHASED
EXPANSION OF PMTCT SERVICES IN ALL PROVINCES."

(PMTCT = Prevention of Mother-to-Child Transmission)

27 February 2002


The Treatment Action Campaign (TAC) welcomes the report on the government's
18 pilot PMTCT sites compiled by the Health Systems Trust (HST).  This
report, commissioned by the Department of Health, confirms in stark facts
much of the experience of women with HIV/AIDS, doctors and nurses,
counsellors and other health care workers associated with TAC.  The
delivery of a comprehensive PMTCT prevention plan using Nevirapine is
necessary, possible, and, it has the potential to transform the
under-funded, under-staffed maternal and child health care services.


Several conclusions stand out in this report:


A PLAN IS NECESSARY

First, the HST found that a measured and phased approach would ensure a
comprehensive sustainable programme. "However it is contingent upon
government to develop a coherent, transparent and credible plan."


TAC demands that the Minister of Health immediately announce the
development of a national plan along the lines suggested by her
researchers. Since at least 1999, TAC has called on government to develop a
PMTCT plan. This call was echoed by civil society and finally, on 14
December 2001, the Pretoria High Court found that "About one thing there
must be no misunderstanding: a countrywide PMTCT prevention programme is an
ineluctable obligation of the State."  The court asked the government to
develop a reasonable plan.


ALLOW DOCTORS TO PRECRIBE OUTSIDE THE PILOT SITES

Second, the report insists that women who know there HIV status must
receive Nevirapine (NVP) immediately. "While a phased and systematic
expansion of comprehensive PMTCT services is being planned, NVP can and
should be provided immediately to all pregnant women who are already known
to be HIV positive, with appropriate counselling and information".


TAC asks the Minister of Health to immediately announce her intention to
allow doctors to prescribe Nevirapine outside pilot projects where women
know their HIV status.  On Friday, 1 March 2002, TAC will ask the Pretoria
High Court to grant immediate interim relief to pregnant women with HIV and
their doctors should the court allow an appeal.  TAC will ask the court to
allow doctors and health care facilities that have the capacity, and, where
women have been counselled and tested to prescribe Nevirapine.  We appeal
to the Minister of Health and all MECs not to oppose TAC in court on this
issue because it will prevent new infections while the appeal proceeds to
the Constitutional Court.


PROVINCES WITH CAPACITY AND INFRASTRUCTURE MUST MOVE

Third, provincial plans and expansions should depend on capacity and
infrastructure. "Given the differences in capacity and infrastructure, it
would be reasonable for provinces to expand the provision of PMTCT services
at different speeds."


TAC calls on the Minister to endorse without qualification the positions of
the Gauteng,  KwaZulu-Natal and Western Cape governments on the roll-out in
their provinces.


POLITICAL AND SENIOR MANAGEMENT COMMITMENT NECESSARY
Last, political and managerial commitment is essential. "With political and
senior management commitment at both national and provincial level, it
should be possible for all provinces to begin implementing PMTCT services
in some new sites by the middle of 2002."


This recommendation can only signal one fact - the researchers believe that
at present there is not sufficient political and managerial support to
allow roll-out. They state their position very carefully but the inference
cannot be denied. Once again, TAC calls on the Minister of Health, all the
MECs, all provincial and local managers at every level to show commitment
to a reasonable plan and its reasonable implementation.


The Minister of Health's record on the development of a PMTCT rollout plan
has not been constructive. We call on her to seize this opportunity,
embrace the findings of this report and to develop a plan. However,
regardless of the position she takes, TAC is prepared to commit its members
and resources to ensure the development of counselling services, community
mobilisation and social support for people with HIV/AIDS.  We will work
with government at local, provincial and national levels to make PMTCT a
success.


ENDS