PORTFOLIO COMMITTEE 20 OCTOBER 2004 MANAGEMENT OF HIV and AIDS IN THE PUBLIC SERVICE

2 PRESENTATION OVERVIEW  What is the potential impact of HIV and AIDS on the Public Service?  How are we responding to this?  What can we do to improve this response?

3 POTENTIAL IMPACT OF HIV and AIDS ON THE PUBLIC SERVICE  Public Service responsible for the delivery of services to the public  Growing epidemic means increased demand for services (Health, Social Services etc)  Public Service is the biggest employer in RSA, and is anticipating facing the following:  Recruitment challenges  Retention problems  Escalating employee benefits costs  Difficulty in meeting the increased demand for services

4 PUBLIC SECTOR RESPONSE  Based on the country’s HIV and AIDS Strategic Plan - Impact and Action Project launched in January 2000  Purpose: to mitigate the impact of HIV and AIDS on the Public Service  3 Phases  Phase I: Impact assessment  Phase II: Policy and legislative review and revision  Phase III: Implementation

5 PHASE I: IMPACT ASSESSMENT  The Public Service consists of around 130 departments employing ±1,1 million employees.  Around 70% of these employees are employed by the provincial departments

6  The impact of HIV and AIDS on various sectors and departments will differ based on the risk profiles of their workforce  All workplaces already having high workloads & over-extended capacity will be particularly vulnerable e.g.  Remote areas & disadvantaged communities  Functions that rely on scarce skills PHASE I: IMPACT ASSESSMENT

7  Policy & legislation review to -  identify key principles upon which workplace programmes should be based  analyze existing legal framework of Public Service to assess the extent to which this supports/contradicts the key principles  Key conclusion: Although legal framework doesn’t expressly violate any of these principles, also doesn’t provide an enabling environment  Hence a policy framework should be developed PHASE II: POLICY REVIEW

8 PHASE II: POLICY DEVELOPMENT  Public Service Regulations, 2001 amended to incorporate minimum standards on HIV and AIDS (Part VI of Chapter 1)  Mandatory guidelines to Heads of Departments on minimum requirements for managing HIV and AIDS in the workplace  Provides a basis for departmental workplace programmes  Now broadening to a comprehensive Health and Wellness focus

9 PHASE II: POLICY DEVELOPMENT  Health Promotion Programmes  Introduce education, awareness and prevention programmes focusing on HIV and AIDS and other STIs to employees, where possible to families.  This programme is preferably to be integrated with broader programmes that promote the health & well- being of employees (e.g. EAP)

10 PHASE II: POLICY DEVELOPMENT  Create mechanisms to encourage openness, acceptance, care and support for HIV-positive employees  Designate a senior manager(e.g HR) skills, seniority and support to champion the implementation of the minimum standards – accountable by means of performance agreement  Allocate adequate human and financial resources and form partnerships

11 PHASE II: POLICY DEVELOPMENT  Establish an HIV and AIDS committee for the dept, with representation of relevant stakeholders  Ensure that the programme includes an effective internal communication strategy

12 PHASE II: POLICY DEVELOPMENT  Occupational exposure  Depts to identify units or employees at high risk of contracting HIV & related life threatening diseases and take reasonable steps to reduce risk  Facilitate access to VCT (HIV & related diseases) and post-exposure prophylaxis  Assist employees to access compensation - Compensation for Occupational Injuries and Disease Act, 1993

13 PHASE II: POLICY DEVELOPMENT  Non-discrimination  Policies and practices not to discriminate against employees on their HIV status or perceived HIV status  Take active steps to promote non-discrimination and protect HIV- positive employees from discrimination

14 PHASE II: POLICY DEVELOPMENT  HIV testing  No pre-employment HIV testing unless Labour Court authorization has been obtained  Departments must promote VCT, and wherever possible, promote access thereto

15 PHASE II: POLICY DEVELOPMENT  Confidentiality  All employees must treat information on an employee’s HIV status as confidential and not disclose this without the employee’s consent  Monitoring and Evaluation  Introduce measures for monitoring policy implementation and evaluating the impact of the programme on employees.

16 PHASE II: POLICY DEVELOPMENT  Good Practice Manual was developed to complement the Regulations and serve as a guide for departments to develop workplace policies and programmes  The regulations indicate what departments have to do and the Manual how

17 PHASE III: IMPLEMENTATION  A three year strategy developed that focuses on supporting departments as they develop and implement their own programmes  Strategic focal areas:  Institution building  Consultation and co-ordination mechanisms  Facilitating Policy Implementation  Monitoring and Evaluation

18 PHASE III: IMPLEMENTATION  Project team employed full-time on the project. - Team lead by a Senior Manager, supported by Project Manager, Employment Practice Specialist, Project Assistant, an administrator and two interns

19 PHASE III: IMPLEMENTATION  Strengthen systems for consultation & co- ordination  Strengthening of the National Interdepartmental Committee on HIV and AIDS (IDC)  Establishing/ Strengthening of Provincial IDCs

20 PHASE III: IMPLEMENTATION  Increase capacity of the Public Service to implement the HIV and AIDS Policy guidelines  Capacity audit commissioned  Develop and distribute well-documented good practices from the Public Service

21 PHASE III: IMPLEMENTATION  Sustain and expand the Communication Strategy - to sensitize departments and individual public servants on their roles and responsibilities & to communicate the policy framework and systems that have been put in place  Website developed for departments to access information and share best practice (

22 PHASE III: IMPLEMENTATION  Guidelines developed on integrated HR planning since DPSA studies have shown that this is a critical weakness in the Public Service - have been made available to departments

23 CHALLENGES  Specific concerns:  Lack of integration of HIV and AIDS policies & programmes into broader wellness initiatives & HR practices  Major problems are being experienced around stigma - hence employees are reluctant to disclose their status & seek help

24 CHALLENGES  Most programmes focus on awareness & prevention, with few focusing on sustaining service delivery – e.g strategies for replacement of skills often inadequate  Taking the programme to where people are is our major concern

25 WAY FORWARD  Broadening our focus from HIV and AIDS to adopt a comprehensive approach of Employee Health and Wellness to enable departments to deal with the challenges the HIV and AIDS epidemic present.  The comprehensive approach should assist in dealing with some of the challenges experienced including stigma and discrimination

26 WAY FORWARD  Assisting departments in strengthening their internal capacity and sustaining their programmes  Develop and implement a monitoring & evaluation framework in consultation with OPSC and relevant structures

27 WAY FORWARD  The Medical Assistance Restructuring Programme will ensure that all employees have access to a reasonable level of health care -includes a comprehensive HIV and AIDS disease management programme  Draft new policy on incapacity management developed and being tested - provides for better health risk management and return-to-work strategies in the face of the HIV and AIDS epidemic