Yogan Pillay National Department of Health, South Africa July 24, 2014 The HIV programme & implications for health systems strengthening in South Africa Yogan Pillay National Department of Health, South Africa July 24, 2014

HIV and ART in South Africa 6.4 million people living with HIV and AIDS (total population 54 million) Prevalence amongst pregnant women: 29% Prevalence in the general population: 12.2% Incidence: 1.07% (0.71% in males; 1.46% in females) 50% of maternal mortality and under 5 mortality associated with HIV 2.5 million on ART ART Coverage: 80% of women, 65% of children and men

PROGRESS Significant domestic investment in the treatment programme Investment case done since 2008/09; currently TB/HIV investment case being completed (used to convince Treasury to fund the programme) 20 million tested in 20 months (campaign); currently 8 million tested annually Treatment at PHC level (NIMART) and integrated with TB Large numbers on treatment (initiation at CD 4>200)

Progress contd >90% of pregnant women tested and >80% on treatment MTCT: <2.6% at 6 weeks Fixed dose combination since April 2013 (1.2m on FDCs); drug cost declines Courier service for stable patients piloted First ever independent integrated TB, HIV and PMTCT programme review conducted in Sept/Oct 2013

HIV/AIDS deaths cut by >50% since 2006

Life expectancy is increasing

Key factors in HIV response success Political leadership & domestic funding Strategic information for steering the response Design of programmes that fit the epidemic Delivering effective services Enabling and sharing innovations

HIV spending in South Africa

Strategic information for decision-making Joint Review of HIV, TB and PMTCT Programmes in South Africa Main Report April 2014

Political leadership Deputy President chairs the South African National AIDS Council (with civil society rep as co-chair) President Zuma address World AIDS Day in 2009 and announced new treatment guidelines President Zuma and Deputy President Mothlanthe launch HIV, STI and TB Strategy Plan, 2012-2016 President Zuma launches national HCT Campaign to test 15 m South Africans in 15 months President Zuma tests and announces his HIV status publicly

Design programmes that fit the epidemic National Strategic Plan for HIV/AIDS, STIs and TB 2012-2016 Nine provincial strategic plans Costed implementation plans Reprogramming of national grants to align with these plans One national proposal for grant renewal, national investment strategy

Delivering effective services Well managed health services (at all levels) Drug procurement & delivery/availability Task shifting Reducing laboratory costs Involvement of civil society and private sector Strengthening integration Links to social safety nets

Integrated, independent programme reviews Five yearly individual programme reviews (HIV and TB) 2013: joint review to review level of integrated service delivery – TB, HIV and PMTCT (led by WHO) 2014: using lessons from the 2013 joint review – midterm review of the maternal, newborn, child and women’s health and nutrition strategy (led by UNICEF) Currently programming the recommendations from these reviews (most relate to the need for health systems strengthening) Must create the conditions and evidence for use in reflecting on successes and challenges in programme implementation

Progress towards the Millennium Development Goals (SAMJ, Vol 104, No 3 (2014) Progress towards the Millennium Development Goals in SA Y Pillay, P Barron Successfully controlling malaria in South Africa L Blumberg, J Frean, D Moonasar, South African Malaria Elimination Committee Effectiveness of pneumococcal conjugate vaccine and rotavirus vaccine introduction into the South African public immunisation programme S A Madhi, L Bamford, N Ngcobo Laboratory information system data demonstrate successful implementation of the prevention of mother-to-child transmission programme in South Africa G G Sherman, R R Lilian, S Bhardwaj, S Candy, P Barron Elimination of mother-to-child transmission of HIV in South Africa: Rapid scale-up using quality improvement S Bhardwaj, P Barron, Y Pillay, L Treger-Slavin, P Robinson, A Goga, G Sherman Tuberculosis control in South Africa: Successes, challenges and recommendations G J Churchyard, L D Mametja, L Mvusi, N Ndjeka, A C Hesseling, A Reid, S Babatunde, Y Pillay A brief history of South Africa's response to AIDS N P Simelela, W D F Venter

Challenges (lets also learn from challenges and what does not work) Joint planning across the social sector to take into account the social determinants of health Increasing inputs and involvement of communities Improving quality of care at the same time as we expand coverage rapidly Moving from pilots and demonstration projects (largely development partner funded) to review and to scale How to keep front line health providers motivated The list is endless....... Hence the need to learn from each other......

I THANK YOU FOR YOUR ATTENTION