B Hogan: Regional training seminar on HIV/AIDS for Parliaments of
Southern African Development Community (SADC) and East African Community
(EAC)

13 February 2009

I would like to congratulate the Deputy Speaker of Parliament for the
initiative taken, of holding this extremely important seminar of Parliaments
this year.

It is very sobering, to realise in this day when several provinces are
facing stock-outs and shortages of antiretrovirals (ARVs). The role of
Parliament in situations when that occurs, needs examination. Equally is the
role of government - what is the role of the difference spheres of government -
what do they have to do when these matters happen?

But most importantly, we need to understand what the dynamics are, as well
as what it is that led to this situations, and also what role can Parliament
play in making sure that this does not happen again in future.

Firstly, we have to look at costs of drugs, and that is not an easy thing.
We do have locally manufactured ARV drugs. We are told from certain sources
that we are paying too much and that we should be importing - but what does
that mean for the local pharmaceutical industry? We need to make a policy
decision on that and we have been in discussions with our partner ministries on
that matter.

It is however not only on the costs of ARVs. At the moment, our people are
on the first line of ARVs. That is the first line that was produced to respond
to the ARV crisis. But we are going to have to be moving to the second line,
which is about much more improved drugs with less side-effects. Those are going
to be expensive but will have intellectual property rights attached to them.
This is so that the battles that we had in the first line, are going to be the
battles that we will have in the second line - but the question is what role
will Parliament play in that?

We saw enormous battles that developing countries had to be engaged in to
get the costs of ARVs reduced, and the whole question of intellectual property
rights over that managed.

We are going to get into the second round of that and it is going to be
interesting to see how we use the Trade-Related Aspects of Intellectual
Property Rights (TRIPS), to be able to significantly negotiate our way through
these very difficult waters.

But costs are not just related to the individual cost of each tablet of each
package. Costs are also related to the procurement procedures that we engage in
government. It also relates to the way we manage our stocks, i.e. how long do
we wait until we order for the new supply. What is the procurement policy - is
it clean; are we procuring from the best possible sources.

And without wanting to invade or undermine the executive authority, I do
think that it is very important for Parliaments to acquaint themselves with the
niceties and the details of these issues. Not just simply because you have to
exercise oversight, but because we have a pandemic in this country, an illness
and a disease that is ravaging our country on a scale that no other disease has
ever ravaged this country.

And the provision of ARVs therefore has been a beckon of light for so many
people. It has given families their breadwinners back. These issues are not
just budgetary issues - whether we can or cannot afford. These are the issues
that we need to be engaged in, and not just taking simplistic views of saying
"Government must deliver". We need rather to understand the constraints and
difficulties, but also the commitment of government to deliver - and we have
delivered and will continue to deliver. We therefore need to understand the
procurement processes.

We also need to understand the role of donors. We failed as a country, on
the last round of the Global Fund when we applied for additional funding. That
was a terrible setback. But out there, are large numbers of donors, and let me
say that the Americans have been absolutely superb in our present crisis.

President's Emergency Plan for AIDS Relief (PEPFAR) has just come to our
assistance in a way that no other donor was able to do. Within a matter of
couple of weeks, they were able to identify a source of supply, were able to
get approval and within a couple of days we are going to be able to roll-out
ARVs particularly to the Free State, to the actual supply depots there. But we
must apologise to health workers and patients who presented themselves to those
facilities, who were turned away because we could not initiate them onto
ARVs.

This is a sobering moment in our history in relation to ARVs. When provinces
start to exceed their budgeted targets, when they oversupply, when they bring
more people onto the programme than they had anticipated, and they do not have
a budget going forward, what is a policy decision and how do they manage that
process and how do we then go forward. This has been a very salient and
learning experience for all of us in the health sector.

So, with regard to donor co-ordination as well, we are a country that is
proud of the health infrastructure. We are not a general developing country
which has to depend heavily on donors to provide a lot of our health care
services and we are proud of that. But we must also realise that we simply do
not have the resources to roll-out a health care delivery system on a scale
that we wish, under the scale of burden of disease that we are carrying at the
moment.

Therefore, donor co-ordination becomes a major priority. We need to know
those donors, what they need, what lead times they require, and what they can
offer us so that we can move swiftly and efficiently with our partners. In
South African National AIDS Council (SANAC) for example, in the Resource
Mobilisation Committee, we are setting in the resources, to be able to do that
as best as possible. Madame Deputy Speaker, let me say also that let us not
just isolate this issue to HIV and AIDS alone - it is tuberculosis (TB) as
well. TB is a twin and it walks the same path along with HIV and AIDS, and
therefore Parliament really needs to be looking at what is happening with our
TB programmes.

The debate at hand is: "What do Parliaments do to assist with the treatment
of HIV and AIDS?" As a person who has long sat on these benches, this is
something very dear to my heart, and that is the oversight of Parliament.

I want to say that we cannot see the National Parliament in isolation of the
Provincial Legislatures - health is a concurrent function. We do have the
National Council of Provinces (NCOP) who plays an invaluable role in bringing
in the provincial perspective.

Let me just share an experience - that when we were in the Public Accounts
Committees back in 1994, one of the first initiatives we undertook was to
establish an Association of Public Accounts Committees that have met every year
since then for 15 years.

This association was an association of the National Public Accounts
Committee and the provincial ones, and we would have a national get-together
every year, to assess where we were and what were the common issues facing us
as legislatures exercising oversight.

Health service delivery is primarily in the provinces. The national
Department of Health (NDoH) is a department that primarily sets standards, and
is responsible for quality assurance and it is therefore not really at the
coal-face of health service delivery.

If we are going to have proper oversight, we need to be co-ordinating, and I
must say that it would be wonderful if it could be done in the way that Public
Accounts Committees do it - on a non-Party basis, with our provincial
counterparts, to see what effective oversight is.

National Legislature and in particular the National Parliamentary Committee
on Health can play an invaluable role when we are looking at the Doha
agreements, on the TRIPS, and on those kinds of international things that can
facilitate our access to ARVs and other measures to support our fight against
HIV and AIDS.

It is at the provincial level, that we really need that oversight, but we
also need to support our provincial counterparts, who often come under an
incredible pressure. They therefore need our collective support.

Let me also just say that from this House, every Member of Parliament (MP)
has access to a constituency office. We need to set early warning systems
around drug supply and procurement, and one of our best early warning systems
is if each and every Member of Parliament is in contact with what is happening
in their clinics and in their hospitals, they could be an important port of
call for every Parliamentarian, for every healthcare worker or for every
patient.

We do not need to have non-governmental organisations (NGOs) and health care
workers calling on us to alert us on the problems that they are experiencing in
the provinces. The constituency offices should be an important port of call for
every health care worker and every patient, to be able to say that people are
coming to our offices and we do not have drugs - not only ARVs but also drugs
for Diabetes, Hypertension and others.

We would therefore want to appeal as the Departments of Health, that
individual Members of Parliament should take it upon themselves, to keep very
close to what is happening in Health.

There are therefore many important roles. There is also a suggestion that
there should be a specific committee on HIV/AIDS and TB - I will endorse that.
There are other ways also, such as to establish a sub-committee of health in
Parliament, that could look at those issues - but this is up to Parliament to
decide.

A national conversation is going to have to take place around the challenges
that we face, such as financial, human resources etc.

Everyone has the right to protest and embark on legal litigation, but we
need to say that we need to face these problems together.

We therefore appreciate as the national department, this initiative and we
congratulate Parliament, and we hope that in the next Parliament, we will have
a very active and vigilant Parliament relating to health issues and HIV and
AIDS in particular.

Thank you.

Issued by: Department of Health
13 February 2009
Source: Department of Health (http://www.doh.gov.za)