Thank you very much, Chairperson. I would like to thank the question from the hon Matsemela. We are finalising the draft PMTCT - prevention of mother-to-child transmission - policy guidelines which are in line with the expectations of the National Strategic Plan for South Africa 2007-2011. May I also take this opportunity to say to this House that even when I was ill I was part of the formulation of that strategy, very actively so. We are currently finalising the policy guidelines which guide implementers on how to administer dual therapy. A stakeholders' meeting to review the final draft of the guidelines with HIV and Aids experts, obstetricians and paediatricians is planned for 11 September 2007.
As I said, we would have gone a long way if indeed we had been allowed to do what we had thought was correct, and that was the establishment of 18 sites in the country - one rural and one urban in each province - in order to ensure the efficacy and effectiveness of monotherapy. Of course, as you know, the Constitutional Court has ruled that we should roll out the monotherapy and this is why it is taking us some time because now we are doing the work that we should have done a long time ago. I'm sure we are learning lessons from this. Thank you.
Thank you, Chairperson. Thank you, Minister. Thank you for being an integral component of the struggle that has effected a fundamental change in our society, and thank also for a precise answer. Therefore, hon Minister, would you kindly share with the House what challenges are envisaged by the department with regard to the implementation of dual therapy, and what contingency measures are in place to counter any adverse side effects? Thank you.
Thank you very much, Chairperson. Thank you very much for the follow-up question. Also, thank you very for acknowledging the role that most of us played in the liberation of our country. May I say that if I were to choose that same path, and thank God it's not going to happen again, I would have travelled the same path again because of my convictions about the liberation of the people of this country to ensure that they indeed access quality health care which they were deprived of in the past.
The challenges, hon member, are that AZT is a long-term therapy - from 28 days gestation to delivery - and women must therefore be properly counselled to ensure adherence, and followed up to monitor any side-effects or problems with the drug, whereas a single dose of nevirapine was a once- off regimen.
That is why I say we regret today that we didn't do those things that we were supposed to do in order to ensure that we didn't lose time in implementing dual and triple therapy. Therefore, the training of health care workers at PMTCT sites will need in-service training to prepare them for implementation, including protocols, follow-ups and referrals of women, monitoring and data management and strengthening of all our follow-ups of the mother-baby pair. This is very important so that we can determine whether what we are doing is effective or not, and not just efficacy only. Thank you very much.
Thank you, Chairperson. Professor Nigel Rollins, the head of the Centre for Maternal and Child Health at the University of KwaZulu- Natal recently told Health-e that the delay in introducing dual therapy is a shame. In KwaZulu-Natal alone, 20 000 to 30 000 children are being infected with HIV each year. Minister, could you give us a definite date on which this will be introduced in South Africa? Could the Minister explain to the House why the Western Cape has implemented dual therapy in public hospitals without the permission of Cabinet, and why the other eight provinces still have to wait for Cabinet approval before implementation?
I don't know about shame. What I know is that this department is committed to ensuring quality and safe health care for our people. This is why we are doing what we are doing, which I have just articulated - in-service training for the providers. We think this is absolutely critical for the women of this country, not just to jump because we are afraid of shame. Shame will not solve problems. I think what will solve our problems is to do things correctly, calculatingly and with a little bit of concern in particular for the women of this country. So, I don't know anything about shame. I only know the issue of providing quality health care to the people of our country.
Now, the question you are asking about the Western Cape, I think you must ask the Western Cape why it did it and therefore ask them to give you the results with regard to efficacy and effectiveness. They haven't given me those reports. Thank you.
Chair, hon Minister, we appear to be debating around the fringes of Aids management. In the meantime, while people are admiring the changes to the National Action Plan and to Sanac - the SA National Aids Council - the changes are mainly on paper and, admittedly, there is better communication amongst all the role-players who are going to deal with HIV.
However, many people doubt whether those changes will be able to come about until the structure of health services is changed. And that will require greater efficiency, less duplication, more decentralisation and more accountability - the very things that the Deputy Minister of Health was fired for pointing out to the hon Minister and the government. Do you not believe that an urgent summit or some urgent action should be taken to look at the entire health services so that these debates that we have are about fundamental issues, and not about fringe issues like mono or dual therapy?
Chairperson, I thought the hon member was a member of the Portfolio Committee on Health and therefore she should be aware of what the department is doing. I just want to take her back a little bit: If she looked at the ANC health plan before 1994, which we developed in anticipation of our democracy, it really deals with these issues. If you look at the National Health Act, it deals with these issues - and we didn't just end there. Since she is a member of the Portfolio Committee on Health - I hope you attend all the meetings - she would know that as from 2001, contrary to what is being said out there, this department has been working on these issues. So, I don't know what you want me to say here. If you have another political agenda in the manner in which you phrased your question, I am not going to be party to it and I am not going to engage on those issues. Thank you.
Measures to ensure sufficient human resources to effectively implement Children's Act
293. Mrs T J Tshivhase (ANC) asked the Minister of Social Development:
What measures have been taken to ensure that sufficient human resources are in place to effectively implement the Children's Act, Act 38 of 2005?