evaluation of the policy framework on managing HIV/AIDS in the public
service
8 June 2006
The Public Service Commission (PSC) is pleased to release a report on the
Evaluation of the Policy Framework on Managing HIV and AIDS in the Public
Service today.
Research on the demographic, economic and institutional impact in the
Sub-Saharan region shows that HIV and AIDS have already had a wide scale impact
on the populations of these countries, as well as the ability of their public
services to address such impact. The bulk of the population in Sub-Saharan
countries infected and affected by HIV and AIDS are impoverished rural and
urban populations who do not have access to private healthcare and are very
dependent on public services for their well being. Such public services include
inter alia, health services, social services, labour administration services as
well as development administration services. To ensure effective provision to
the broad populace infected and affected by HIV and AIDS, productive and
effective public services are of vital importance and South Africa is by no
means immune from this.
HIV and AIDS impact on the ability of public services worldwide to function
efficiently. It appears from available evidence that such impacts include,
inter alia the impact on morbidity and mortality rates of public servants of
such organisations and the populations they serve;
*·the impact on staff morale
*·the impact on product and service suppliers to public services
*·the demographic and economic impacts of HIV and AIDS on the service
recipients of public service services
* the impact of HIV and AIDS on the tax base that provides the necessary
funding for Public Service activities.
Should the ability of the public service to provide quality services be
impacted on by high HIV and AIDS prevalence levels among its workers, it could
compromise service delivery to people infected and affected by HIV and AIDS as
well as to the population generally.
One way of strengthening the public service in dealing with the impact of
HIV and AIDS is to ensure that effective HIV and AIDS related health and
counselling infrastructures are in place. The policy framework on managing HIV
and AIDS in the South African public service issued by the Department of Public
Service Administration aims to provide such HIV and AIDS related health and
counselling infrastructures within the public service.
The Public Service Commission deemed it prudent to conduct an evaluation to
determine the extent to which the public service was implementing the policy
framework on managing HIV and AIDS in its workplaces and employee assistance
programmes (EAPs) to provide services to employees living with HIV and AIDS.
The study also sought to identify opportunities and threats regarding HIV and
AIDS in the working environment and best practices to minimize such threats and
to optimise opportunities.
In conducting this evaluation the PSCs objective was to determine the
ability of the current framework to absorb the probable impact of HIV and AIDS
and measures required to address the implications thereof. It should be
emphasised that in no way the research attempted or was focused on quantifying
the prevalence of HIV and AIDS in the public service.
In conducting the research a profile of HIV and AIDS policies programmes and
EAPs was formulated by means of collecting primary data through questionnaires.
Furthermore best practices in departments were evaluated with a view to
formulating guidelines. Finally an assessment was conducted to establish how
effective policies relating to HIV and AIDS have been implemented. The
assessment was conducted both on a quantitative and qualitative basis. The main
findings are as follows:
* Although not all departments have HIV and AIDS committees and not all such
committees are functioning effectively, this aspect seems to have been more
widely implemented than other aspects of the framework such as Voluntary
Counselling and Testing (VCT), infection control and the monitoring and
evaluation of the successes of programmes.
* It was found that although general health promotion programmes have been
introduced in a large number of departments, there is still a lack of
programmes specifically targeting aspects of HIV and AIDS in the workplace,
i.e. programmes aimed at promoting openness, acceptance, care and support for
people living with HIV and AIDS; programmes aimed at reducing HIV and AIDS
related diseases and awareness and training programmes regarding HIV and
AIDS.
* On voluntary counselling and testing, the study revealed that although the
framework for managing HIV and AIDS in the workplace emphasises VCT, a full
introduction of the various aspects of VCT in public service workplaces needs
to be made. It is disturbing to note that neither the counselling nor the
support aspects of VCT appear to be in place in many public service
workplaces.
* The general impression regarding the role and influence of leadership is
that commitment and support of top and middle management is extremely varied.
The views and opinions of respondents regarding the current role of management
in dealing with HIV and AIDS issues include, amongst others, that there is no
serious commitment from senior management to implement HIV and AIDS policies
and although HIV and AIDS policies were drafted, feedback was still being
awaited from senior management on these draft policies. There was however also
very positive comments from some respondents regarding the role their managers
play in managing the potential impact of HIV and AIDS.
Communication strategies for HIV and AIDS programmes are generally in place
but they differ within departments in their effectiveness and approach. In
terms of communicating the aims and objectives of the HIV and AIDS policies, as
well as the public serviceâs approach to HIV and AIDS, there is room for
improvement. The views and opinions expressed regarding communication
strategies of HIV and AIDS include, amongst others, that-
* there seems to be an information overload regarding HIV and AIDS
* many HIV and AIDS policies are drafted by management but are not
communicated or circulated to all public officials
* management sometimes drafts HIV and AIDS policies while not involving all
relevant stakeholders
* public officials complain that they do not have time to read all the
policies
* policies are often too complex, they are not written in a manner which
makes it easy for the average public servant to comprehend.
Departments varied greatly in budget allocation and the provision of
resources. Those with budgets specifically allocated towards HIV and AIDS
management were consistently more successful in their provision of services to
deal with HIV and AIDS. It is clear that there is a direct link between budget
and leadership support. All departments that identified their heads of
department or senior management members as contributing to the success of the
policies also indicated that they had appropriate funding available. The main
challenges that were identified are obtaining adequate budgets and maintaining
and increasing these budgets.
Very few departments had specific programmes in place to combat the stigma
surrounding HIV and AIDS and very few departments reported occurrences of
disclosures. Departments reported having systems in place to ensure the
confidentiality of respondents and few reported incidents of discrimination.
Probably the main obstacle hampering the utilisation of HIV and AIDS programmes
is the stigma and fear surrounding it. Even where comprehensive HIV and AIDS
programmes are in place, public officials are hesitant or afraid of making use
of the available facilities because of fear that this will cast a shadow of
suspicion over them as being either HIV positive or clearly at risk
thereof.
Condom distribution and awareness campaigns are undoubtedly the most
effectively implemented parts of the HIV and AIDS policy. Almost every single
department makes condoms available to their public officials. The main obstacle
in the path of condom distribution is not availability, but rather usage. The
only way for the co-ordinators to measure the usage of condoms is to check the
containers to see whether condoms are taken. Employee respondents indicated
that taking condoms from the containers did not adequately reflect the actual
usage thereof. The following example was given to motivate this view; âIt was
alleged that condoms provided by departments are taken in large quantities from
the distribution boxes and then sold on the streets. This could not be
verified.â
Awareness and education are very actively promoted. Generally HIV and AIDS
related printed media and literature were abundant within departments. The
benefits of awareness campaigns should not be underestimated. Respondents
referred to a dramatic change in their perception of both the disease and
people living with HIV and AIDS due to the fact that they have become better
informed through campaigns. Furthermore, the provision of VCTs varied
significantly. Some departments managed to organise on site VCT sessions on an
almost quarterly basis, while others simply arranged with an external facility
to provide VCTs on a daily basis. Some departments have never organised any
event where public officials could participate in VCTs.
With regard to the provision of post exposure prophylaxis, the minimum
standards for the management of HIV and AIDS (Department of Public Service and
Administration (DPSA), 2002) stipulate that a head of department shall identify
units within the department that due to the nature of their work are at high
risk of contracting HIV and other related diseases and take reasonable steps to
reduce the risk of occupational exposure to HIV and such diseases. It further
requires that a head of department shall take all reasonable steps to
facilitate timely access to voluntary counselling and testing and post exposure
prophylaxis (PEP) in line with prevailing guidelines and protocols for public
officials who have been exposed to HIV as a result of an occupational incident.
Very few departments indicated any satisfactory knowledge with regard to PEP.
Public officials were mostly unaware of the existence of such treatments.
Monitoring, evaluation and reporting remains one of the most neglected
aspects of the HIV and AIDS policy, with very few departments having proper
systems in place to monitor the impact of HIV and AIDS on the workplace. There
is no uniform system to monitor the implementation of the policy. According to
respondents, monitoring and evaluation consist of two distinct elements namely
monitoring the implementation of the policy and monitoring the actual
utilisation of the programmes and subsequent impact. Respondents identified a
need for a basic evaluation system that would enable them to effectively report
on the status of the policy.
Very few HIV and AIDS co-ordinators in departments are senior managers and
in general many of the co-ordinators lack the experience to successfully create
or implement the policies. The main issues that were identified relating to HIV
and AIDS co-ordinators and committees were seniority and authority, experience,
knowledge and training and workload. It has been found that certain senior
managers avoided the responsibilities and workload associated with managing HIV
and AIDS by simply appointing junior members to address the issues. This was
identified as one of the main stumbling blocks to the effective implementation
of policies because the junior public officials lacked knowledge and experience
to create an effective strategy and action plan within a reasonable time.
Looking at the risk profile of public service departments with regard to HIV
and AIDS, an average of 40 percent of public service worker respondents in this
study were identified in the high risk category with regard to HIV and AIDS.
This percentage was arrived at through an analysis of the responses of 1680
participants during the survey reflecting on their perceptions and reported
attitudes towards HIV and AIDS. This necessitates a broad based implementation
of HIV and AIDS policies and programmes and a strengthening of EAPs in order to
minimise the risk of HIV and AIDS to the public service.
Except for the fact that a wider variety of programmes must be introduced to
address the situation of employees living with HIV and AIDS, this study shows
that the HIV and AIDS policies which form the backbone of such programmes also
need to be strengthened. The objectives of HIV and AIDS policies need to be
clearly defined, purposefully communicated to public officials and should be
easy to understand. The individuals responsible for the implementation of HIV
and AIDS policies need to be clearly identified and public officials should
participate in the formulation of HIV and AIDS policies. HIV and AIDS policies
should provide step by step guidance for implementation and disciplinary action
should be taken in cases where there is non-compliance with such policies.
From the analysis conducted for the study, the following recommendations
were made:
a) It is recommended that a Minimum Standard Action Plan (MSAP) should be
developed with regard to HIV and AIDS in the public service. The MSAP should
clearly and in no uncertain terms define the rights of the public officials and
the duties of the Department in terms of the policy and programmes that it must
deliver.
b) Whenever practical there should be centralised preferably off site
wellness centres dedicated to the provision of wellness services for public
servants. Such wellness centres should incorporate comprehensive EAP and HIV
and AIDS programmes.
c) There needs to be effective and committed leadership responsible for the
implementation of HIV and AIDS policies and programmes. It is recommended that
HIV and AIDS policy implementation should be made part of the performance
agreements of senior managers to ensure the commitment of such managers to
implementation.
d) Effective internal communication is of vital importance in ensuring the
success implementation of HIV and AIDS policies and programmes. It is also
important for ensuring the promotion of public officialsâ knowledge and
awareness about HIV and AIDS, as well as about their rights and duties in the
face of HIV and AIDS and the duties of the Department in conducting disease
management.
e) Resources should be allocated to ensure the effective implementation of
HIV and AIDS policies and programmes. The availability of sufficient financial
resources has been shown to be directly connected to leadership commitment and
support in addressing HIV and AIDS in the workplace.
f) Departments should create awareness and intensify education campaigns
aimed specifically at altering perceptions, instituting disciplinary action
against public officials and managers who discriminate against people living
with HIV and AIDS and ensure SMS support for people living with HIV and
AIDS.
g) Departments should effectively utilise counsellors and other support
systems, particularly with regard to the emotional support needed by people
living with HIV and AIDS through guidance and assistance.
i) Effective monitoring and evaluation systems need to be developed to
ensure that HIV and AIDS policies and programmes are implemented and effective
in addressing the management thereof in the workplace. Most critically
monitoring and evaluation systems will assist in identifying problems and
successes of HIV and AIDS policies and programmes.
j) The promotion of effective and informed usage of condoms is imperative as
a first line of defence against the impact of HIV and AIDS in the workplace. It
is recommended that condoms should be readily available in the working
environment.
k) The continuous provision of knowledge, education and awareness programmes
regarding the risks of contracting and spreading HIV and AIDS needs to be
included in the MSAP requirements. Educational programmes and material should
be co-ordinated on a national level to ensure a uniform message.
l) Access to voluntary counselling and testing should be encouraged and
ensured by SMS members.
m) It is important to inform public officials where PEPs can be obtained. A
list of facilities should be made available on a website or other general
communication media.
In conclusion
Focusing as it does on one of the most challenging threats to the public
service and its ability to sustain continuous and effective service delivery to
strengthen our democracy, the PSC considers this a critically important report.
Therefore some of the recommendations made may be regarded as far reaching and
may even have financial implications. These financial implications can and
should be obviated through greater collaboration and co-operation between
departments. Given the potential impact of HIV and AIDS on the public service,
these recommendations should be given the serious consideration that it
deserves.
Specifically to note in the report is the need for the public service to
stand united in its management of the impact of HIV and AIDS. The combined
resources and commitment of public service departments in engaging with this
critical challenge will ensure that the public service becomes an example for
other employers to follow.
For more information please contact:
Humphrey Ramafoko
Cell: 082 782 1730
Issued by: Public Service Commission
8 June 2006
