Deputy Minister Sindisiwe Chikunga: Transport Sector HIV and AIDS and TB Forum Workshop opening address

Opening Address by the Deputy of Transport, Ms. Sindisiwe Chikunga (MP) at the Transport Sector HIV and AIDS and TB Forum Workshop

Introduction

Ladies and gentlemen, it is a great honour to be a part of this workshop that brings together important stakeholders operating within the transport sector as well as in the health and wellness sector in order to develop a national strategy for dealing with HIV and AIDS, TB and STIs within the transport sector.

I must begin by acknowledging the great contributions made by most of our partners in helping us fight the impacts of the HIV and AIDS epidemic. We must especially acknowledge the contributions of the International Organization for Migration (the IOM) who have funded this workshop.

We must also commend the commitment of all of those present, more importantly those that have travelled from far to be a part of this workshop. We hope that their travels shall not be in vain, and that these two days of discussion and knowledge sharing shall bear the most positive results towards the resolution of some of the challenges we face in the transport sector regarding these epidemics.

We also wish to acknowledge the efforts of the wellness unit for organising this workshop and also representing us in the quintessential partnerships existing for the sole purpose of ending the actual and opportunistic diseases that define the pandemic.

It is encouraging to note that the Workshop will attempt to reflect on the progress made since the inception of the forum. Such reviews always have the potential of offering critical pathways into progress made by our collective efforts and producing solutions to the kinds of hurdles that still need to be overcome.

These reflections also help us to understand the changes that are happening within the context of our work and reveals not only what the new challenges are, but also what new methodologies are available for the treatment of both old and new challenges within our sphere of work.

We also hope that the workshop will help to strengthen existing partnerships as well as find new ones to add impetus to the vehicle already in motion.

Since its first discovery in the United States in 1924, according to the World Health Organizations, HIV and AIDS was always viewed with scepticism by researchers and commentators and evolved within a context of extreme denialism, prejudice and distrust against victims and causing negative avoidance while completely unaware of the consequences of spread amongst people of the world.

Today, 93 years after the fact, the world is sitting with a pandemic the impacts of which cut across many nations such that we and much younger generations globally have to contend with the consequences of its spread.

South Africa’s bold steps

We must mention that government has taken the issues under discussion here with serious commitment and will and this is proven especially by the space these occupy in the office of the Deputy President, Honourable Cyril Ramaphosa, who is also the Chairperson of South African National AIDS Council (SANAC).

In fact, ladies and gentlemen, this commitment and will is very well spelled out in the founding objectives of SANAC amongst which is included the following statement:

“To advise government on HIV and AIDS, TB and STI policy and strategy and related matters; to mobilise resources domestically and internationally to finance the response to HIV, TB and STIs, including but not limited to estimating expenditure and resource needs; and to ensure the monitoring of progress against the targets set in the NSP”.

What are the Constitutional Imperatives that must guide our deliberations at this workshop?

This commitment by government is based on a number of principles, most important of which is the constitutionally derived principles of human rights of individuals and communities. These principles are founded on the values of human dignity, the achievement of equality and the advancement of human rights and freedoms as stated in the founding provisions of our Constitution.

Esteemed guests, one such overriding right is “the right to life” as enshrined in our Constitution’s Bill of Rights. This amongst other related rights, must for our purposes here always be read with “the right to have access to health care” where the responsibility of the state is to “take reasonable legislative and other measures, within its available resources to achieve the progressive realisation of each of these rights”.

The realisation of these imperatives can only be through collaborative effort across all spheres of society

We are aware that the state on its own cannot win this war on these epidemics unless all of society is brought on board to work together with the state to find sustainable solutions.

We believe that this Forum is such an avenue in which the broadest of stakeholder relations have been structured to strengthen government’s resolve to eradicate the epidemic and its impacts that have both social and economic impacts, some of which are expressed in the growth of child headed families

Furthermore, South Africa is also party to international efforts that have been designed to fight the scourge of this triple of epidemics.

The United Nations Sustainable Development Goals

The United Nations has since 2015 expanded on the original statement of the Sustainable Development Goals and has called for action to specifically bring about an end to the pandemic of AIDS and TB.

Amongst some of the goals conceived is to address the social and structural drivers of HIV, TB and STI infections (goal 4); to ground the response to HIV, TB and STIs in human rights principles and approaches (goal 5); mobilise resources to support the achievement of NSP goals and ensure sustainable responses (goal 7) and strengthen strategic information and research to drive progress towards achievement of NSP goals (goal 8). These are but a few of the goals elucidated in the United Nations programme.

It must be mentioned however, that in its policies and programmes the South African government led by the African National Congress has a long term view that seeks to redress the very causal factors that underpin the spread of these epidemics. This long- term approach is captured in the National Development Plan (NDP) amongst others.

The National Development Plan Vision 2030 and its implications for health, welfare and wellness

In 2012 and thus ahead of the United Nations pronouncements on these epidemics, the African National Congress-led government announced its National Development Plan Vision 2030, in which it seeks to accelerate social and economic development.

In this programme government makes the following recommendations about the perspectives from which we must assess South Africa’s health system and these are:

• Demographics and health – trends in demography, vital statistics and the burden of disease-specific morbidity and mortality.
• Health systems – issues such as health finance, workforce, infrastructure, information, technology and governance.  This provides insight into the capacity of the health system to respond to challenges presented in the first perspective.

• The environmental/social determinant perspective, which involves the social and ecological determinants of health, including climate change and global trends.

The NDP goes on to make to make the following point about its vision of 2030 to health and I quote: “The generation of under 20s is largely free of HIV. The quadruple burden of disease has been radically reduced compared to the two previous decades, with an infant mortality rate of less than 20 deaths per thousand live births and an under five mortality rate of less than 30 per thousand. There is been a significant shift in equity, efficiency, effectiveness and quality of health care provision. Universal coverage is available. The risks posed by the social determinants of disease and adverse ecological factors have been reduced significantly”, unquote.

It is concluded in this regard that these aspirations will be achievable if the major problems currently existing in the three perspectives are addressed effectively. It is stated further as part of this vision that to monitor progress health authorities should set mid-term targets towards the 2030 objectives.

Ladies and Gentlemen, in addition to calls for radical reduction of HIV by 2030, the NDP also makes strong calls for the drastic reduction of TB.

The NDP makes several recommendations regarding the attainment of the vision 2030, central among these is the need to address the social determinants affecting health and disease, strengthening the health system, preventing and reducing the disease burdens and promoting health, financing the health system, improving quality by using evidence (thus strengthening research capacity), address human resource issues and implementing effective partnerships in the health sector.

It is also argued that the health sector should engage with partners and departments to ensure that the negative impact of other policies on health outcomes is understood and minimised, while promoting policies that result in positive outcomes.

Furthermore, programme director, the NDP makes the call that the linkages between policies dealing with human settlements, urban planning and urban design, transport, basic services, trade, and rural development amongst others, should be fully assessed and understood and their design should take into account their impact on health.

To prevent and reduce disease burdens, over and above the provision of comprehensive health care, particularly quality primary health care and community outreach, there remains a need to have an integrated focus on three main interventions to reduce the major disease burdens amongst which is should be the prevention and control of epidemic burdens through the deterring and treating of HIV/AIDS, new epidemics and alcohol abuse.

How do we tackle the unintended consequences of socio-economic development?

It can be understood that while social and economic development is critical for South Africa given the triple challenges of poverty, inequality and unemployment in which we are currently trapped, it remains equally vital for us to be vigilant to the unintended consequences that always accompany development.

Certain of our programmes are already taking off quite fast,  bringing  many people into the environment of labour intensive work which naturally attracts large numbers of people.

Huge road, rail, maritime and aviation infrastructure projects clearly place both and women in positions of extreme vulnerability within these environments.

It is thus crucial that the department of transport is fully activated to deal with this consequence. This will mean that programmes that deal with the resolution of these epidemics are made holistic, with widest possible coverage.

It is clear from reading the draft NDP that we will have to expand our focus to look beyond road transportation as important a mode it might be.

A much in-depth examination of the transport sector will show that the different modes provide different contexts and different health threats and each mode should thus be given specific attention.

Impacts on families

Ladies and gentlemen, greater regional cooperation and greater economic development potential across the southern African region and beyond means that our truck drivers will travel a lot across our borders and that similarly we will have greater numbers of drivers from within this region will pass through our borders on long and tiring trips, which will involve more stops and more sleep overs. This carries its own potential for the spread of disease. It also carries the potential for many on treatment to skip treatment, because it cannot be fetched on time.

It is important to view this from the point of view of families that are broken apart by the introduction of the diseases within families, especially poor families where there is a single breadwinner – father or husband or son who gets affected and is forced to leave work for home-based care.

New Governmental Economic Programmes

We have to be aware of large programmes in the form of Operation Phakisa: the oceans economy which is poised to see a huge injection of people at work in infrastructure projects, seafaring and other marine-based works that will have a great influence in the spread of the epidemics. This also means we may see greater expansion of informal port economies and greater interactions between people.

This trend is also bound to see women and men travel for long through seafaring expeditions that will see them not only away for long, but might also be marked by incidents of gender violence especially rape.

The rail sector has through PRASA and TRANSNET embarked on projects of refurbishing of rolling stock and expansion of rail networks that are bound to attract great numbers of working people. Women are vulnerable to sexual violence especially due to the remoteness of their workstations at certain given times over the course of projects.

Equally so most men and women at such projects might be migrant and may thus have left families and wives or husbands behind only to return at certain intervals of the project. At times some of these men or women will have to come back home for good because of illness that due to the remoteness of work stations could not be attended to with regular treatment.

Overcrowding in Public Transport

Growth of the economy and our drive to reduce the number of road users, will see many people move to trains. This will increase overcrowding in many of these trains and produce the potential for TB infections.

The Aviation Sector

Because the aviation sector has taken to our call to transform the sector by including more women in its staff contingent across companies, and also given the lack of aviation medical practitioners that deal with communicable illness it might be difficult for many women to access advice and treatment on their long haul journeys across the world.

On the other hand it is important to note the sheer absence of contraceptives, especially condoms in in our aircrafts. This situation cannot be allowed to continue, because we must treat all public modes of transport equally.

This also applies to all our vessels where all seafarer must be encouraged to use condoms.

The role of Research

These are some of the potential consequences of the radical fast paced social and economic development we foresee. Thus it becomes important that we are able to develop research methodologies and focus that shall be able to clearly define the extent of vulnerabilities of groups and individuals.

We must be clear about the extent of spread of infections and also understand the extent of cause and effect among all groups observed.

Research must also show what the impacts certain public transport  vehicle design will have in the spread of communicable diseases.

Conclusions

It thus remains important programme director, that we are aware of what the different modes of transport are doing, what sizes their projects are in terms of the numbers of people likely to affected and what are the likely health impacts as pointed out in the National Development Plan cited earlier.