At the beginning of 2015 the role that the Treatment Action Campaign (TAC) needs to play in South Africa’s fledgling democracy is clearer than ever. As in many spheres of our public service, the healthcare system is breaking down. Vacancy rates are unacceptably high, morale is low, clinics and hospitals regularly run out of medicines and equipment, ambulances take hours to arrive, if they arrive at all - and at the end it is our brothers and sisters, children and parents, friends, families, and comrades who suffer.
Rather than just tyre-burning anger and pickets, South Africa needs a sophisticated, evidence, and human rights-based response to the governance failure that is leading to the breakdown of our public service. While other progressive, membership-based organisations will respond to this breakdown in areas such as education and sanitation, TAC will continue to focus on the healthcare sector.
We will continue to empower our members and our communities by learning about our rights and about the science and treatment of HIV and TB. We will continue to build active branches in poor communities throughout South Africa. We will continue to let our work be informed by the experience of our members.
As a collective guided by democratically-elected leaders, we will take on mismanagement and corruption in the public sector. We will engage at a clinic, a district, a provincial and a national level. We will continue to seek constructive engagement with government at all levels. However, if constructive engagement fails to bring the change our people have a right to, then we will not stand back from criticising government, campaigning against specific policies or corrupt individuals, and if all else fails, go to court.
We will continue to guard our independence. We will not align ourselves with any political party. We will engage with political parties as required - but our primary obligation will always remain to our members. We will not take money from the South African government or from pharmaceutical companies. We will seek to decrease our dependence on large international donors. While we still need these donors - we will seek to fund our work through greater donations from the public.
While our core work will remain to build and empower active and informed communities, TAC’s National Council has mandated the following five key campaign areas for 2015 and beyond. These are strategically chosen and are the result of extended political discussion and analysis within the organisation. We believe that success in these campaigns will have knock-on effects on governance more widely.
- Keeping the AIDS response on track: Monitoring and advocacy to ensure effective implementation of the National Strategic Plan (NSP) on HIV/AIDS and TB.
The significant gains we have made against AIDS in recent years remain precarious. The collapse of most provincial healthcare systems is threatening to unravel our AIDS response. It also appears that positive initiatives like the HIV Counselling and Testing (HCT) campaign is losing momentum. Rather than an ‘end to AIDS’, we may well be heading to an extended epidemic far into the 21st century.
The key document that guides South Africa’s AIDS response is the National Strategic Plan on HIV, STIs and TB 2012 -2016. We will continue to monitor and to advocate for the effective implementation of this plan. We will publish our findings in the NSP Review - a joint publication with SECTION27.
As the current NSP draws to an end, we will consult widely in our communities and advocate for an even better NSP to follow the current one. We will not shy away from asking whether the South African National AIDS Council (SANAC) is still fit for purpose and whether it needs to be restructured. We are the people affected by the HIV epidemic and it is up to us to drive the response.
- Fix collapsing provincial healthcare systems:
In recent years we have witnessed the collapse of healthcare systems in the Free State, the Eastern Cape, and Mpumalanga. Even wealthy provinces like Gauteng are struggling to get their house in order. However good the policy direction provided by the Minister of Health may be, it is of little value if provinces do not implement it. We will not accept a situation where underperforming provincial leadership remain untouchable because of political reasons. We will do what we can to force accountability in such situations.
In the Free State we will continue to seek the dismissal of MEC for Health, Dr Benny Malakoane. Malakoane is appearing in court again on 13 February 2015 on charges of corruption. A further charge of corruption that TAC has brought against him is still being investigated by the police. In the Eastern Cape and Mpumalanga,
we will continue our efforts to work constructively with the current provincial leadership. We will continue to engage on cross-cutting issues like medicine stockouts and we will remain an active member of the Stop Stockouts Project (SSP) which has in recent weeks had constructive meetings with the national department of health as well as several provincial departments.
- Fixing South Africa’s patent laws to improve access to medicines:
South Africa’s patent laws are the most lenient and most favourable to the pharmaceutical industry on the planet. We do not examine the substance of patent applications to check if they deserve to be granted and, even if we did, the criteria for patentability in South Africa is so lax that essentially the same medicine could be patented multiple times. As a result, many medicines are much more expensive in South Africa compared to other countries, including in some cases to high-income countries.
We will continue to campaign for the finalisation of the Draft National IP Policy published in September 2013. It is our hope that this policy will set South Africa on a more sensible course that makes full use of the flexibilities available to us under international law that protect health. If countries like Argentina, India, Brazil, Thailand, and even the United States can utilise these flexibilities, there can be no excuse for South Africa not to do so.
Once the policy is finalised we will continue to advocate for amendments to our intellectual property laws. We will do so in reference to the Constitution - which unambiguously states that the state has an obligation to make reasonable legislative changes in order to progressively realise the right to access healthcare services.
- Stop TB campaign: declare drug-resistant tuberculosis (DR-TB) a public health emergency, stop new TB infections in prisons. Take DR-TB treatment to the people.
The overwhelming majority of delegates at the 2014 South African TB conference agreed that drug-resistant TB should be declared a public health emergency in South Africa. The current response to DR-TB falls exceedingly short of what is needed to Stop TB. A key 2011 national policy that outlines how treatment should be taken closer to where people live remains unimplemented in most provinces. As a result, many patients do not get diagnosed or drop out of care after diagnosis.
Those who stay in treatment often have to travel hundreds of kilometres to treatment facilities. We will continue to monitor the situation on the ground and we will engage provincial leaders on their failure to implement this policy.
We will also continue to engage with the problem of TB in prisons. In this regard there are a number of very important upcoming court cases of which we will share more details at a later stage.
- Prioritise woman’s health rights: reducing cervical cancer and monitoring the rollout of the HPV vaccine for young girls.
While we welcome the provision of HPV vaccination in schools, we are concerned about how the programme is being implemented - especially regarding informed consent. We will monitor the implementation of the programme in a number of provinces and use our findings to inform our advocacy in this area.
We will also continue to advocate for the provision of condoms and comprehensive sex and sexuality education in schools. We believe that it is morally unacceptable not to provide sexually active teenagers with access to the tools they need to prevent pregnancy and HIV infection.
Toward a National Congress
Funding permitting, 2015 is also the year in which TAC will have its next National Congress. TAC has a National Congress every five years where branch representatives from across the country come together to elect the organisation’s leadership and to decide on key policy priorities.
We thank all the friends and comrades who supported our fundraising campaign at the end of 2014. We are now in a position where we can continue our work for the 2015/2016 financial year. We will continue our fundraising efforts throughout 2015. Like many civil society organisations, we are grappling with how to ensure sustainable funding for our work. At the same time, we are exploring how we can make our operations leaner and fit for purpose.
Friends and comrades, the struggle ahead of us is long. Mismanagement, corruption and cadre deployment has hollowed out our public service. Poor governance, especially at provincial and district level means that many people do not have access to the healthcare services they have a constitutional right to. Along with other progressive organisations we will fight the decline of our public service. We will hold leaders to account and use the power of our Constitution to force positive change. Once we struggled for an end to apartheid and a new democracy, now we are struggling to keep that democracy alive.
We invite you to walk with us in this struggle.
- Anele Yawa is a general secretary at the Treatment Action Campaign. This article first appeared in the TAC Electronic Newsletter.