Mahlangu, at the HIV/AIDS Indaba
29 June 2006
Programme Director,
Health MEC Brian Hlongwa,
Executive mayors,
Speakers,
Municipal managers and councillors,
Salga Deputy Chaipersons,
Mayor Khumalo and Mayor Maila,
Nappwa representatives,
TAC representatives,
Dr Liz Floyd,
Aids activists and campaigners,
People of Gauteng,
Labour Movement;
Traditional leaders,
Distinguished guests;
Introduction
A fundamental challenge to every individual and institution in South Africa
today is posed by the onslaught of the HIV and AIDS pandemic and the
devastating impact it has had on the fabric of society. All of us must answer
the question of how we will respond to this challenge. To do so we must build a
clear understanding of the social, cultural, political and economic aspects of
the pandemic.
Since the impact of the pandemic is multi faceted, our response must be
multi sectoral. We must seek to transcend the divisions across sectors between
spheres of government and between government, communities and civil society to
build a common response that addresses the social impact of the disease.
Local government must be a central institution in our common response to the
pandemic. It is the sphere of government closest to communities and has the
capacity to unite the diverse actions of all stakeholders within a shared area
of impact. To play its role effectively, local government must lead in the
establishment of a multi sectoral approach which mainstreams Gauteng is
committed to a multi sectoral approach to HIV/AIDS, spanning a range of
government departments and sincere in its engagement with civil society
organisations.
The reasons for this approach relate to the imperatives of preventing the
spread of HIV, managing and treating AIDS and ameliorating the wider impact of
the pandemic on society as a whole. Prevention rests on changing sexual
behaviours and therefore influencing the social norms that shape these
behaviours and the socioeconomic relations that under-gird them. The health
care aspects of AIDS and other communicable diseases such as tuberculosis (TB)
are complex ad not purely medical. Successful management and treatment require
the support of families and local communities as well as changes in personal
behaviour. Furthermore, the impact of AIDS is largely social and economic. It
is felt in the family, the workplace the community. It alters the demographics
of countries impacts on economic and developmental potential and creates unique
challenges in terms of childcare. The extraordinary scale of the AIDS epidemic
means that everyone will be affected and all potential resources need to be
combined into an efficient and coordinated effort. The more wide ranging our
response is the stronger the leadership and coordinating mechanism that is
required.
A key aspect of our multi sectoral approach is a strong emphasis on building
intergovernmental relations. In the last five years a total of R49,1 million
was disbursed to Gauteng municipalities through Multi-sectoral AIDS Unit (MSAU)
for localisation of HIV/AIDS plans. This is in response to what municipalities
have been allocated in terms of their strategies and programme plans. Amongst
other programmes these funds have enable the employment of HIV/AIDS
co-ordinators in every municipality significantly enhancing our capacity to
fight the epidemic and respond to its consequences.
Working together all three spheres of government have achieved a great deal
in the recent period. While the challenges remain daunting some of the key
successes that we have registered include:
* Political leadership is taking a stronger and more direct role in leading
our campaigns against HIV/AIDS. The leadership displayed by municipal mayors,
especially in respect of mass mobilisation and door-to-door work is a source of
deserved pride the province. In most municipalities responsibility for
co-ordinating the municipality's HIV/AIDS initiatives is placed in either the
mayor or speaker's office.
* All the municipalities have in one way or another embarked on awareness
campaigns notably mass education through World AIDS Day (WAD). 12 000
non-governmental organisations (NGOs) volunteers participated in WAD
door-to-door campaigns. We estimate that during these and similar campaign more
than 2,3 million people have been educated on HIV/AIDS prevention.
* Municipalities have also sought to mobilise ward and community structures
and monitor and evaluate programmes at local and municipal levels. This work
has been done as part of a collaborative effort between civil society and
government to combat HIV/AIDS.
* At provincial level and in all municipalities HIV/AIDS councils have been
established to bring together civil society, government and other stakeholders
in a common programme of action. At provincial level the Premier chairs the
HIV/AIDS council, while executive mayors are chairpersons of AIDS councils in
most municipalities.
* All our municipalities have dedicated HIV/AIDS units and have developed
policies, strategies, workplace plans and programmes. These include
anti-discrimination policies, employee assistance programmes, prevention, care
and treatment, anti-retroviral treatment (ART) and awareness campaigns.
* Many municipalities have begun to integrate HIV/AIDS into their
operational policies and programmes, as well as encourage public participation
on the issues posed by the pandemic.
* According to the South African Cities Network (SACN), in the three metros
in Gauteng ward councillors have provided leadership to communities on these
issues. It is also positive that municipalities have gathered data on areas of
high prevalence and significant impact.
* In terms of care and treatment the province has exceeded its targets. Home
based care services are available in all municipalities.
Voluntary counselling and testing (VCT) sites have increased from 10 in 2001
to 202 in 2003. The Prevention of Mother to Child Transmission (PMTCT)
programme has 117 functional sites in 83 clinics that provide antenatal care
where more than 87 500 women attended. A total of 150 000 women have accessed
PMTCT since 2001.
In general the people and government of our province are moving towards
coordinated, multi sectoral response. This means that local government has had
to take the lead in building partnerships in a manner that mobilises all local
resources and community based initiatives towards common objectives.
A key element of our programme must be to build and strengthen the
partnerships we have begun to establish at provincial level including through
initiative such as the Workplace AIDS Indaba and the Traditional Health
Practitioner Summit, held earlier this year. Partnerships with wider civil
society, business and the international community have proved fruitful in many
parts of the country. These partnerships can help leverage support in various
areas including HIV/AIDS education, counselling, treatment and care, feeding
schemes and so on. Faith-based organisations (FBOs) are a particularly
important sector which can augment local government services with additional
support and services. All faiths are now involved in education and awareness
raising activities, and training for FBOs now includes the African Independent
Churches (AIC).
Ekurhuleni and Johannesburg have established ward level relationships
between themselves and HIV/AIDS service organisations. These partnerships serve
to ensure that where access to municipal services is limited, partner
organisations can intervene to augment service to the community. Informal
communitiesâ initiatives started by a small group of dedicated individuals who
respond to particular needs are an important source of strengthening our
response to the epidemic. Another critical aspect of this work is the
participation of people living with AIDS in all our activities, both directly
and through their organisations.
Municipalities generally have established ward forums to promote public
participation in municipal affairs, including on HIV/AIDS issues. Some
municipalities like the West Rand District Municipality have reported training
of people living with HIV/AIDS and provision of support to them.
4. Key challenges facing local government
Although municipalities have made significant progress in their responses to
HIV/AIDS, a number of shortcomings and challenges have been identified.
The first is the lack of capacity in local government structures partly due
to the new needs of local government which go beyond the traditional role of
municipalities.
Secondly, there has been a lack of strategic planning around HIV/AIDS. Local
government's ability to deal with this has been hampered by financial and
technical constraints. Despite these stumbling blocks it is still the role of
local government to deal with and plan intervention programmes for HIV/AIDS as
they are the sphere of government closest to the public and its communities
(SACN, 2004: 7). This means that they are best placed to develop bottom up and
integrated approaches.
Issues of HIV/AIDS, gender and poverty alleviation programmes have not been
properly responded to due to overly technocratic, sector led development.
Planning and implementation have dealt with and focused on symptoms and not the
underlying causes of the issue at hand. Community consultations need to take
place practically and properly. Lastly, there has been limited consideration
for institutional transformation and organisational development in the local
government sphere. Related to these problems is that frequently there is
limited understanding of HIV/AIDS as a development and governance issue among
planners, together with sector specific implications of HIV/AIDS and the
perspectives of municipalities' planning and implementation practices. A fully
multi sectoral response is often retarded by an overly health sector oriented
programme, which fails to take account of the social and economic complexity of
the disease and its implications.
One of the challenges faced by local government is their inability to secure
donor funding to respond to the HIV/AIDS epidemic. Most of the donor funding
goes to provincial and national spheres of government and seldom get channelled
to local level where implementation is crucial. As we move forward this as an
issue needs to be addressed to allow local government to access funds. However,
local government would also have to improve on its capacity to manager
finances, so that channelling money to local government is not seen as
risky.
Improving intergovernmental relations as part of the programme to mainstream
HIV/AIDS interventions also remains a significant challenge facing
municipalities. The building of networks between departments and external
stakeholders will be vital if mainstreaming is to be successful. This means in
particular that we need to overcome the mentality of competition between
government agencies where the success of one is regarded as the failure of the
other. The challenge of HIV/AIDS is so large that any success at any level
needs to be welcomed and supported by all of us. It also means overcome the
hierarchical approach sometimes adopted in dealings across spheres of
government. Each sphere has a unique and important role to play and a 'big
brother' approach can serve to undermine the contribution and challenges faces
by each of us. In many respects the provincial spheres of government have not
been adequately able to act in support of local government. There has also been
an uneven willingness of sector departments to respond to municipalities with
regards to their planning and implementation activities and/or to participate
meaningfully.
Perhaps part of the problem is the lack of common definition of
mainstreaming (SACN, 2004: 20). Without a clear understanding between all
stakeholders mainstreaming could easily become a rhetorical notion, devoid of
programmatic dimensions.
The absence of local information on HIV/AIDS prevalence rates and statistics
and how these will have an influence on development priorities will also need
to be addressed as a key constraint on our work in fighting the pandemic.
5. Way forward
We must build on the foundation laid over the past five years that
municipalities and it is therefore important to develop detailed plans for the
next five years. Such plans can provide a focus for better co-ordination both
at the intergovernmental level and between all spheres of government and
partners.
Amongst the critical factors that would define a successful programmatic
response to the pandemic are:
* A multi sectoral and intergovernmental approach to our work.
* A concerted and conscious education programme to drive change in sexual
behaviours including influencing social norms that shape behaviour.
* The empowerment of vulnerable groups such as women. This has to recognise
that AIDS is not simply a health issues it is a social, economic and political
issue.
* Leadership at the highest political level should continue to be present
and visible in the fight against HIV/AIDS. In particular, mayors and
councillors must take the lead.
* All potential resources need to be combined into an efficient coordinated
effort. The more wide ranging the response, the stronger the leadership and
coordination mechanism is required.
More specifically, the elements of our programme over the next few years
would have to include the following important areas which will form the basis
of our debate at the indaba on which basis we will develop a framework for our
programme going forward.
Improving multi sectoral intervention and co-ordination
One of the main challenges in the fight against the AIDS epidemic is the
shortcomings about co-ordination between different role players. Local
government would have to find ways to strengthen its ability and capacity to
act as facilitator to form and establish current and future partnerships.
This has to be coupled with a more strategic management of the existing
expertise at local level in order to make better impact. In addition, all
stakeholders would have to agree on their individual roles vis a vis the multi
sectoral AIDS response. Lastly, co-ordination and integration of planning and
action between local and provincial government would be crucial in making this
multi sectoral approach successful.
Strengthening HIV/AIDS councils and units
All Gauteng municipalities have established HIV/AIDS units and have
developed policies, strategies, workplace plans and programmes. However, some
of these units have no dedicated staff assigned to functional areas and tend to
lack on funding. As such, there are still gaps in the capacity of
municipalities to coordinate responses as many are understaffed perhaps with
the exception of the metros. In many cases, HIV/AIDS programmes are add ons to
existing responsibilities of assigned staff within the units. Furthermore,
policies and strategies are not adequately integrated into decision making and
budgeting processes. Perhaps one of the tasks of the Indaba is to review the
role and clarify the HIV/AIDS councils, including the constitution of the
councils.
Funding of non-governmental organisations (NGOs)
It has been acknowledged and accepted that NGOs and organisations of civil
society can play a major role in the fight against AIDS. There is a need for
municipalities to fund organisations of civil society in order to support the
work they do and we therefore need to develop a framework for such funding.
This would help to ensure that throughout the province we develop a common
approach, even if the details and modalities may differ from region to region.
In addition, municipalities may need to be equipped on how to manage and
administer NGO funding. This process has to be standardised.
Mobilising communities
Community and social mobilisation gets people to take action to address HIV
prevention, AIDS care and social support in their personal lives, families,
local communities or workplaces. It is driven by activism, volunteerism and a
sense of social responsibility. For any programme to work successfully from the
planning to the implementation phase, it is important that those who will be
affected by the programme are involved in the process from the start. It also
has to be recognised that community responses are crucial in fighting HIV/AIDS.
They are immediate, direct, flexible and are driven by community members.
Responses are directed at local needs, reflect local forms of organising and
acting and make use of available resources. Local government would have to
ensure that real community participation takes place.
It is important to reflect on the successes that municipalities have
achieved on the door-to-door education campaigns. These campaigns have reached
a large number of people and there impact has been significant.
Enhancing HIV/AIDS workplace programme
The extent of the impact of AIDS on local government employees is already
significant. It is therefore suggested that a starting point for local
government would be to define its response to HIV/AIDS in the municipal
workforce within the context of transformation, including quantifying the
impact this would make on local government's ability to continue to provide
services. The extent to which the workplace programme is meeting the needs of
the municipal staff would need to be reviewed to allow improvement. Alongside
this review a sharing of best practices across municipalities and provincial
government would also be valuable.
Research, monitoring and evaluation
Ongoing research work by all stakeholders including institutions of higher
learning in partnership with local government would be required if government
is to succeed in improving our understanding of the issues involved and how it
responds. A conscious effort would have to be made to identify priority areas
for local government research on HIV/AIDS. In addition, monitoring and
evaluation systems would have to play a crucial role in assessing progress and
impact of programmes including the development of benchmarks and indicators for
success.
Indigent burial
We are already experiencing very high numbers of death due to AIDS and
mortality rates are directly correlated with levels of poverty, necessitating
an approach to the cost of burial which ensures that the poor are afforded the
dignity that is the constitutional right of all South Africans. Thus, indigent
burial policy or at least guidelines would have to be discussed by local
government to ensure that there is some policy clarity on this matter.
Assessing and countering AIDS' impact on municipal services
Municipalities' understanding of their role in addressing the social and
economic consequences of HIV/AIDS in communities and at the workplace is
important. For instance, housing and other basic services have more than one
role to play when it comes to intervention purposes. If provided properly they
can provide a cushion to affected households and infected individuals. Most
importantly, local government needs to recognise the efforts made by other
external stakeholders. Their participation and contribution in the fight
against HIV/AIDS is crucial and needed. Community initiatives must not be seen
as an alternative to local government in terms of aid and service delivery
rather, they should be seen as a complement.
Expanding Joint Children's Services, community and Home-Based Care
Programmes which aim to foster care and support in the home or at the level
of the community can be important levers in building a multi sectoral approach.
Various sector departments need to work with municipalities in up scaling these
programmes, which include the Joint Children's Services Programme and Home
Based Care programmes. Given the provincial government's commitment to the
programme of Bana Pele and the significant impact of HIV/AIDS on children,
including through the emergence of large numbers of child headed households; a
co-ordinated and inter-sectoral approach is required. Home-based care should be
viewed as one of the several options available to local and provincial
authorities in response to HIV/AIDS. Without their involvement excess burden
will fall upon the shoulders of families already overburdened by poverty,
unemployment, ill health etc. For home-based care to be effective it needs
constant support and input from the public health, welfare and education
system.
Integrated Development Planning (IDP) processes
The IDP offers a platform for engagement across all government spheres and
other stakeholders in the future development of the specific area. It is also
an ideal platform on which community members can voice their concerns, either
affecting them directly or indirectly. Programmes aimed at HIV/AIDS
intervention should form part of IDPs, where institutional arrangements and
development are specified through the engagement between development
role-players and stakeholders.
Although these interventions strategies should be informed by broad national
or provincial strategies, the definition of support intervention will need to
occur on a case by case basis, to align with the particular area context.
However, for this to succeed local government would have to develop its own
capacity, and that of community leaders, for proper situational analysis of HIV
and AIDS, in order to create a basis for proper planning and intervening
strategies. The role of community development workers (CDWs).
The Gauteng Provincial Government (GPG) has put mechanisms in place to
ensure that the community has better access to the services provided by
municipalities, namely the deployment of CDWs.
The primary role of CDWs is to bridge the gap between the services delivered
by government and the people's access to these services. CDWs are linked to the
ward committees in the areas where they are deployed to help increase and
encourage public participation and participatory democracy. They help ward
committees to ensure that there is an increase in people taking part in the
issues that have an effect on them. Government would have to define the role of
CDWs in relation to AIDS. In addition, support to CDWs would be required if
they are expected to play some role with regard to this problem.
Conclusion
On this basis, key challenges facing local government and how local
government can possibly respond to these challenges were highlighted. We hope
that the final outcome of this summit would assist in setting the local
government agenda on HIV/AIDS for the next five years.
Experience of the last five years has shown that initiatives and
intervention programmes are not without challenges. The problem of capacity,
largely attributable to the old apartheid system of unequal distribution of
resources has become a major stumbling block among most local government
structures. The processes of transformation, restructuring and amalgamation
have been necessary to strike balance and create the necessary capacity within
the local government structures.
The report has also indicated that financial and technical constraints are
commonplace in many local government structures and many are still unable to
secure donor funding to respond to the problem of HIV/AIDS.
In terms of policy and strategy, despite various challenges such as lack of
capacity and a clear strategic plan the province views the HIV/AIDS problem in
a serious light. This is demonstrated by the integration of HIV/AIDS programmes
in its strategic priorities for 2005 to 2009.
The role of communities especially participation in various government
initiatives is equally important. It is highlighted in the report that
communities have the responsibility to address prevention, care and social
support I their personal lives, families, local communities and workplaces. To
this end, community responses are crucial in fighting HIV/AIDS.
Let me thank the official from the Department who have worked tirelessly in
preparing for this summit.
I thank you!
Issued by: Department of Local Government, Gauteng Provincial
Government
29 June 2006
Source: Gauteng Provincial Government (http://www.gpg.gov.za/)
