at the opening ceremony of the Annual Pepfar Implementerâs meeting,
Durban
12 June 2006
Programme Director
Honourable Ministers and MECs here present
Executive Director of UNAIDS, Dr Peter Piot
Distinguished guests from multilateral partners
Distinguished participants
My greetings to you all
It gives me a great pleasure to participate at the opening of this meeting
aimed at sharing lessons and good practice in the response to HIV and
AIDS.
The indication from the programme is that a wide range of issues, emerging out
of programmes supported by the United States Presidential Emergency Plan for
Aids Relief will be discussed and good practice will be shared. These projects
are mainly from President's Emergency Plan for Aids Relief (Pepfar) focus
countries including South Africa.
This meeting comes at an appropriate time as we have just come back from the
United Nations (UN) high level meeting which reviewed global progress in
response to HIV and AIDS. At this meeting, we expressed our commitment to work
towards access to primary healthcare, including HIV and AIDS prevention, care
and treatment.
United Nations Programme on HIV/AIDS (UNAIDS) estimates that between 20 and
23 billion United State (US) dollars is needed annually to support efforts
towards universal access by 2010 particularly in low and middle income
countries. This global resource gap is an excellent advocacy tool; however we
also need to determine the national resource gap in our various countries.
In our view, each country needs to conduct an in-country resource gap
analysis and mobilise resources for adequate financing of such a gap. Our view
is that countries should bear part of the responsibility to close this funding
gap by allocating in an incremental manner, domestic funds in their own budgets
to implement a comprehensive response to HIV and AIDS. Of course, the extent of
this domestic funding will depend on the amount of national resources available
in each country.
In this regard, we need to convene a Pepfar meeting as South Africans soon
after this meeting, to take stock of our activities and determine how we move
forward as a country, which Pepfar must fund.
Long-term sustainability and predictability can be assured if low and
middle-income countries progressively increase domestic investment to the
health sector, including adequate financing of sectors responsible for other
social determinants of health such as water, sanitation and education.
We therefore need to also direct the flow of resources towards these sectors
and the strengthening of the health and social system. In South African, our
comprehensive HIV and AIDS plan is 90% funded through government fiscus.
Budget allocation has tripled over the last four years from just over R1
billion in 2002 to R3,5 billion in 2005. However, the reality is that even with
investment of domestic funds, many low and middle-income countries would still
need new and additional resources to support the implementation of their
national response plans.
This is where the support of donors and development partners becomes
important. It is important that long-standing commitments such as debt relief,
fair global trade environment and the pledge by the Organisation for Economic
Co-operation and Development (OECD) Member States to commit 0.7% of gross
national income for official development assistance be fulfilled.
We also need to take into account distortions created by external funding,
especially when this is not aligned to national priorities.
Multilateral institutions and international partners should commit to
working with national coordinating authorities to align their support to
national strategies, policies, funding cycles and plans. Vertical financing is
not sustainable. Sustainability lies in the extent to which countries can build
and maintain health systems.
It is only when founders support the efforts to build well functioning
health systems that we can truly speak of sustainability. Also the
conditionality attached to external funding are a cause for concern. In our
view, conditionality should only be limited to fiduciary requirements and be in
line with the country strategic plan.
Formal arrangements on the involvement of the United States government on
HIV and AIDS programmes in South Africa started with the finalisation of our
five-year strategic framework on HIV and AIDS and Sexual Transmitted Infections
(STIs) in 2000. At that time, most of the activities covered related to
technical and financial support for the central office in Pretoria.
Indeed much was achieved that was relevant for the period.
This collaboration was further extended with the introduction of
programmes.
In 2003, there was the announcement of Pepfar, which included South Africa
amongst several focus countries for this programme.
The announcement was followed by discussions on a number of issues including
lack of clarity on the criteria for selecting these focus countries. The other
issue was direct access by âprincipal partnersâ to Pepfar funding which posed a
serious co-ordination and harmonisation challenge.
I am glad that there is a session in this meeting that will discuss the
issue of co-ordination and harmonisation. In the spirit of the much talked
about âThree Onesâ and the recommendations of the Global Task Team, our view is
that external funding must be coordinated through government systems.
In this way, issues of gap identification, priority setting, policy
alignment and monitoring and evaluation can be managed more efficiently to
achieve better outcomes. Our view is that HIV and AIDS is a developmental
challenge that requires long-term responses.
We were pleased to hear Dr Peter Piot in his closing remarks to the UN
high-level meeting, refer to HIV and AIDS as a long-term developmental crisis
not just an immediate emergency and calling for a response that is embedded on
social change. This is a position that South Africa has always advocated for
locally and internationally.
I understand that currently about 65% of Pepfar funding to South Africa is
for treatment, care and support. The UN high-level meeting has acknowledged
that prevention should be the mainstay of the response to HIV and AIDS.
Therefore, we would like to see a larger proportion of resources allocated
to prevention interventions contained in response plans of focus countries
including abstinence, being faithful and condom use. We hope that this meeting
will also begin to share some light on the future of Pepfar as we are into the
second half of this five-year initiative.
Discussions on this issue will assist in ensuring certainty in the future of
programmes supported by Pepfar and assist focus countries to plan
accordingly.
Programme director let me conclude by extending our warm welcome to all the
participants at this meeting to our country, South Africa and wish you well in
your deliberations for the next three days.
We hope that this meeting will assist in shaping our initiatives towards
supporting the commitments we made at the UN high-level meeting in New York
more than a week ago.
In conclusion, this meeting must consider the following messages and
questions:
1. Is Pepfar assisting in reducing HIV infections?
2. What is the impact of Pepfar over and above the country projects?
3. What is Pepfarâs contribution to the global trend fight by WHO, UNAIDS
4. Who owns the data that is collected from all the countries?
5. What institutional capacity is Pepfar building in the countries?
Issued by: Department of Health
12 June 2006
Source: Department of Health (http://www.doh.gov.za)
