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Progress and peril when saving people's lives

Christina Scott

Four years after antiretroviral drugs were introduced into the scenic Western Cape, the wildly successful programme is bursting at the seams.
A thousand new HIV positive people join the province's AIDS drug rollout every month, said Dr Keith Cloete. 

A total of 16,000 patients, nearly three-quarters of them female, are currently receiving the drugs at sites ranging from Paarl and Plettenberg Bay to Beaufort West and Vredendal.

''The real problem is a big scale-up in a primary care setting,'' the Western
Cape health department official told the audience at the third South African AIDS conference in Durban. ''It's going to be a challenge to maintain the verysteep increase in patients.''

Ways to cope with the pressures of success include targeting clinics rather than hospitals, relying on nurses with doctors as a back-up, and increasing physical space of over-crowded venues, he said. A simple, regular, monitoring system meant that managers could immediately identify issues and reward staff at best-performing/busy clinics.

Several provinces highlighted skills shortages as major impediments. Dr Dingie van Rensburg of the University of the Free State asked if South
Africa's rollout was over-ambitious given the migration of nurses and
pharmacists to the better-paid private sector and the shortage of staff – even pharmacy assistants - in the rural regions and small towns.

''The adding of posts does not mean the adding of bodies to fill the posts,'' he noted dryly.

Van Rensburg, from the Centre for Health Systems Research and Development, said progress in providing AIDS drugs came ''at the cost of weakening'' other medical facilities and programmes. 

In northern KwaZulu-Natal, wedged between Mozambique, Swaziland and the Indian Ocean, close to half the healthcare posts were also vacant, another speaker said.

But despite this, the poverty-stricken and unemployed residents of rural
Umkhanyakude had one of the most successful antiretroviral rollouts in the
country, according to Brandon Bennett of the Institute for Healthcare
Improvement. Due to political and personal leadership, the region was reaching 80 percent of people who needed antiretrovirals, surpassing the twenty percent common elsewhere in the country.

Margot Uys of the Medical Research Council used the example of Richmond hospital in the KwaZulu-Natal midlands to show how ''the burden of HIV prevention and care is largely channelled to tuberculosis programmes.''
The Johannesburg-based project manager showed how combining both TB and HIV could contribute to ''a significant decrease in deaths.'' The programme, including a roving clinic, has been so successful that it has now expanded to Bergville in the Drakensberg, semi-desert cattle and sheep farming areas alongside the Botswana border, and rural districts around the Sun City holiday resort.

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