Latest news with #R2.8-billion
Daily Maverick
01-08-2025
- Health
- Daily Maverick
Rethinking HIV treatment with tailored solutions for improved patient engagement and outcomes
The health department has R622-million extra to prop up South Africa's HIV treatment programme in the wake of foreign aid cuts. But it's only about a fifth of the total gap. We look at how data can help drive decisions to make the most of this lifebuoy. Just over two weeks ago, Health Minister Aaron Motsoaledi announced that the Treasury had given R622-million of emergency funding to his department to prop up South Africa's HIV treatment programme, with about R590-million for provinces' HIV budgets and R32-million for the chronic medicine distribution system, which allows people to fetch their antiretroviral treatment from pick-up points other than clinics, closer to their homes. This extra budget is just over a fifth of the roughly R2.8-billion funding gap that the health department says the country needed after US President Donald Trump's administration pulled the plug on financial support for HIV in February. (The Pepfar/Aids relief budget for this financial year was just under R8-billion, but the health department calculated that it could fill the void with R2.8-billion if it trimmed extras and ruled out duplicate positions.) So, how to get the best bang for these limited bucks — especially with the health department wanting to get 1.1-million people with HIV on treatment before the end of the year and so reach the United Nations targets for ending Aids as a public health threat by 2030? By getting really serious about giving people more than one way of getting their repeat prescriptions for antiretroviral (ARV) medicine (so-called differentiated service delivery), said Kate Rees, the co-chairperson of the 12th South African Aids Conference to be held later this year, from Kigali last week, where she attended the 13th IAS Conference on HIV Science. At another Kigali session, Lynne Wilkinson, a public health expert working with the health department on public health approaches to help people stay on treatment, said: 'People who interrupt their antiretroviral treatment are increasingly common, but so are people who re-engage, or in other words start their treatment again after having stopped for a short period.' A big part of South Africa's problem in getting 95% of people who know they have HIV on ARVs (the second target of the UN's 95-95-95 set of cascading goals) is that people — sometimes repeatedly — stop and restart treatment. For the UN goals to be reached, South Africa needs to have 95% of people diagnosed with HIV on treatment. Right now, the health department says, we stand at 79%. But the way many health facilities are run makes the system too rigid to accommodate real life stop-and-start behaviour, says Rees. This not only means that extra time and money are spent every time someone seemingly drops out of line and then comes back in, but also makes people unwilling to get back on board because the process is so inconvenient and unwelcoming. Rees and Wilkinson were the co-authors of a study published in the Journal of the International Aids Society in 2024, whose results helped the health department update the steps health workers should follow when someone has missed an appointment for picking up their medicine or getting a health check-up — and could possibly have stopped treatment. 'We often have excellent guidelines in place, built on solid scientific evidence,' says Rees, 'but they're not necessarily implemented well on the ground.' To make sure we track the second 95 of the UN goals accurately, we need a health system that acknowledges people will come late to collect their treatment and sometimes miss appointments. This doesn't necessarily mean they've stopped their treatment; rather that how they take and collect their treatment changes over time. 'The standard ways in which the public health system works mostly doesn't provide the type of support these patients need, as the resources required to provide such support is not available,' says Yogan Pillay, the health department's former deputy director-general for HIV and now the head of HIV delivery at the Gates Foundation. 'But with AI-supported digital health solutions and the high penetration of mobile phones, such support now can — and should — be provided at low cost and without the need to hire additional human resources.' We dived into the numbers to see what the study showed — and what they can teach us about making the system for HIV treatment more flexible. Does late equal stopped? Not necessarily. Data from three health facilities in Johannesburg that the researchers tracked showed that of the 2,342 people who came back to care after missing a clinic appointment for collection medication or a health check, 72% — almost three-quarters — showed up within 28 days of the planned date. In fact, most (65%) weren't more than two weeks late. Of those who showed up at their clinic more than four weeks after they were due, 13% made it within 90 days (12 weeks). Only one in 14 people in the study came back later than this, a period by which the health department would have recorded them as having fallen out of care. (Some incomplete records meant the researchers could not work out by how much 8% of the sample had missed their appointment date.) The data for the study was collected in the second half of 2022, and at the time national guidelines said that a medicine parcel not collected within two weeks of the scheduled appointment had to be sent back to the depot. 'But it's important to distinguish between showing up late and interrupting treatment,' notes Rees. Just because someone was late for their appointment doesn't necessarily mean they stopped taking their medication. Many people in the study said they either still had pills on hand or managed to get some, despite not showing up for their scheduled collection. Pepfar definitions say that a window of up to 28 days (that is, four weeks) can be tolerated for late ARV pick-ups. Pepfar is the US HIV programme that funds projects in countries like South Africa, but most of them were cut in February. Research has also shown that for many people who have been on treatment for a long time already, viral loads (how much HIV they have in their blood) start to pass 1,000 copies/mL — the point at which someone could start being infectious again — about 28 days after treatment has truly stopped. Sending back a parcel of uncollected medicine after just two weeks — as was the case at the time of the study — would therefore add an unnecessary administration load and cost into the system. (Current health department guidelines, updated since the study and in part because of the results, say that a medicine pick-up point can hold on to someone's medicine for four weeks after their scheduled appointment.) Does late equal unwell? Not always. In fact, seven out of 10 people who collected their next batch of medication four weeks or more late had no worrying signs, such as possible symptoms of tuberculosis, high blood pressure, weight loss or a low CD4 cell count, when checked by a health worker. (A low CD4 count means that someone's immune system has become weaker, which is usually a sign of the virus replicating in their body.) Moreover, given the large number of people without worrying health signs in the group for whom data was available, it's possible that many of those in the group with incomplete data were well too. When the researchers looked at the patients' last viral load results on file (some more than 12 months ago at the time of returning to the clinic), 71% had fewer than 1,000 copies/mL in their blood. A viral count of fewer than 1,000 copies/mL tells a health worker that the medicine is keeping most of the virus from replicating. It is usually a sign of someone being diligent about taking their pills and managing their condition well. Yet clinic staff often assume that people who collect their medicine late are not good at taking their pills regularly, and so they get routed to extra counselling about staying on the programme. 'Most people don't need more adherence counselling; they need more convenience,' says Rees. Offering services that aren't necessary because of an inflexible process wastes resources, she says — something a system under pressure can ill afford. Rees says: 'With funding in crisis, we really have to prioritise [where money is spent].' Does late equal indifferent? Rarely. Close to three-quarters of people who turned up four weeks or more after their scheduled medicine collection date said they had missed their appointment because of travelling, work commitments or family obligations. Only about a quarter of the sample missed their appointment because they forgot, misplaced their clinic card or for some other reason that would suggest they weren't managing their condition well. Part of making cost-effective decisions about how to use budgets best is to offer 'differentiated care', meaning that not every patient coming back after a missed appointment is treated the same way, says Rees. Health workers should look at by how much the appointment date was missed, as well as a patient's health status to decide what service they need, she says. Giving people who've been managing their condition well enough medicine to last them six months at a time can go a long way, Wilkinson told Bhekisisa's Health Beat team in July. 'Getting 180 pills in one go reduces the number of clinic visits [only twice a year], which eases the workload on staff. But it also helps patients to stay on their treatment by cutting down on their transport costs and time off work,' Wilkinson said. Zambia, Malawi, Lesotho and Namibia have all rolled out six-month dispensing — and have already reached the UN's target of having 95% of people on medicine at a virally suppressed level. According to the health department, South Africa will start rolling out six-month dispensing in August. 'But not everyone wants this,' said Wilkinson, pointing out that experiences from other countries showed that 50 to 60% of people choose six-monthly pick-ups. It speaks to tailoring service delivery to patients' needs, says Rees, rather than enforcing a one-size-fits-all system when more than one size is needed. Says Rees: 'Facing funding constraints, we really need tailored service delivery to keep the [HIV treatment] programme where it is.' DM
News24
25-07-2025
- Business
- News24
Hawks raid City Power Joburg HQ in R500m corruption investigation
The Hawks have raided City Power's Johannesburg headquarters as part of an investigation into alleged fraud and corruption worth more than R500 million at the municipal entity. News24 has seen the investigation's internal documents, which show that Tshifularo Mashava, the City of Johannesburg-owned company's CEO, is the Hawks' main target in connection with the procurement corruption investigation. On Friday, law enforcement officers seized IT equipment and documents related to alleged tender-related graft, including gross inflation of prices and the payment of contractors for work not done, as detailed in the investigation documents. Mashava has been at the helm of the municipal entity since June 2022. During her tenure, she oversaw what the Auditor-General flagged as financial mismanagement and a collapse of the City's electricity grid, which left City Power with a negative R16.3-billion bank balance as at 30 September 2024. An ongoing News24 investigation titled Power Connections also unearthed that the alleged mismanagement resulted in City Power making a R2.8-billion loss in the 2023/24 financial year ending 30 June 2024.
Daily Maverick
09-06-2025
- Politics
- Daily Maverick
Mr Lesufi, you have 72 hours to put this motion into… motion
ActionSA is crowing about proposals the Gauteng government will definitely, certainly, assuredly get to, soon. It's rather touching – the trust ActionSA has in the power of the Gauteng provincial legislature. The other day, ActionSA's website trumpeted a great victory. The minority party motioned two motions, one to do with traffic lights and the other to do with provincial oversight. And both motions were unanimously adopted! Hooray. Unanimity surely does not happen very often in our legislatures, whether provincial, national or any other kind. The piece on the ActionSA website, signed by Funzi Ngobeni, the party's provincial chairperson in Gauteng, states eloquently: 'The first motion, introduced by Emma More MPL, calls on the Gauteng provincial government to urgently address the persistent failures of traffic light infrastructure. The impact of malfunctioning traffic lights on road safety, productivity and the economy is staggering. Every 37 minutes wasted in traffic costs commuters approximately R28,000 annually.' Wow. R28,000! Divide that by 37 (why didn't they do that?) and you get R756.75 wasted every minute. Why does R756.75 per minute feel like more than R28,000 every 37 minutes? Is it simply because I, for one, though I'm one of many, am terribly bad at maths, or is it because that odd number – 37 – confuses the mind in some special way that only prime numbers can? Whatever the case, I can imagine there would have been some questions about the enormity, or failing that, the enormousness, of R28,000, especially in a province where, the Auditor-General informed us recently, the huge Johannesburg metro dispenses R2.8-billion in 'unauthorised expenditure' every year. That's an unauthorised R100,000 (if my calculations are correct) for every 37 minutes you've spent waiting at a broken traffic light. Personally, if I'd waited 37 minutes at a traffic light that was clearly nonfunctional, I'd surely have to check myself into the nearest mental health facility to see whether I really am a true Joburger. Most of us don't even wait 37 milliseconds. But let us not get distracted by personal matters. Rather, let us reconsider those numbers. R2.8-billion in unauthorised expenditure every year? Calculated differently, that's R100-million for every ANC member of the Gauteng provincial legislature. Yes, there are indeed 28 ANC members of the provincial legislature, and I'm beginning to feel a conspiracy theory of the Da Vinci Code kind coming on… What's it with all the 2s and 8s? Next there'll be a link to the 28s gang! Still, the numbers, fascinating though they are, are not my main point here. Nor is the fact that the ActionSA motions were 'unanimously adopted' – the second one, about giving MPLs more oversight, too. Are all the parties in the Gauteng legislature in a coalition? That would certainly solve some problems. Anyway, that unanimity is pleasing. The last time any South African legislative body was unanimously in support of anything was when it was declared that smoking was bad for you and should be legislated out of existence. What I find so touching is the faith ActionSA has in the Gauteng legislature of which it is so vibrant a part. Motion your motion, get it unanimously approved and… what? Are all the bodies and persons responsible for traffic lights now going to knuckle down and soon all the traffic lights in Gauteng will be moving serenely through their cycle of green, red and orange without interruption? You will note they didn't put a time frame on it. No, they didn't commit the strategic error of the ANC's Gauteng premier, His Highness Panyaza Lesufi, when he said in his State of the Province Address, I think it was, that all potholes would be fixed within 72 hours. That is, if I understand the premier correctly (yes, I know it's difficult), no more than 72 hours would elapse between the reporting of that pothole that's just opened up in your street and its successful closure – sorry, 'resolution', by pothole officials. A strategic error, I say, because I've been keeping an eye on most of the 47 potholes within a kilometre of my house and they're still there – whereas it's certainly more than 72 hours since the premier made that promise in his speech. Perhaps some time has to elapse before that promise becomes an instruction to the relevant civil servants, and then perhaps a mandatory period has to elapse before any action is taken? Perhaps Lesufi forgot to add 'And this will become law in a year's time,' or something like that? Timelines for instructions from above to be heard and acted upon by those below seem variable, but I'm sure if it doesn't happen, Lesufi can blame his coalition partners, or perhaps just the Democratic Alliance (DA), whose members are well-known subverters of any good idea the ANC comes up with. I mean, the DA has been complaining since the aforementioned State of the Province Address (or Sopa, which means 'candyfloss' in seven of South Africa's 12 official languages) that all the thousands of kitskonstabels (instant constables) hired by Lesufi to help curb crime in the province haven't helped. Not to mention the helicopters. There are helicopters? Lesufi bought helicopters for the kitskonstabels? And we thought it was only BMWs. Let's not go down that road, or at least not today. It is a road with too many potholes. And maybe that R28,000 wasted every 37 minutes pales next to some of the other numbers thrown up by the Auditor-General. Johannesburg, she said, had awarded more than R987-million to contractors 'with close ties to employees or councillors' of the city. That's what a journalist of the yellow press variety would call a pretty 'dodgy tender'. Okay, R987-million is a large amount of money and should probably be looked into – though the relevant officer of the city was already fingered in a dodgy tender case but has been cleared of Special Investigating Unit charges by a mysterious inner ANC process. Still, R987-million is a lot less than R2.8-billion. This is surely an incontrovertible fact, even to those expensive lawyers hired by the ANC to compose internal reports that the mayor can leave in his bottom drawer for a few decades. At least the Honourable Premier of Gauteng, Mr Lesufi, didn't object when the ActionSA motion calling for more oversight by MPLs was passed unanimously – so, by the 28 ANC members too. They obviously endorse the idea that, in Ngobeni's words, the 'motion responds directly to the executive's pattern of disregarding legitimate oversight interventions such as its failure to place the Emfuleni Municipality under mandatory administration despite sustained collapse'. 'Sustained collapse' may be oxymoronic, but never mind. ActionSA goes on, in a distinctly firm tone of voice: 'The unanimous support for these motions sends a clear message: accountability, transparency and basic service delivery are non-negotiable. 'We commend all political parties that voted in support [that's everyone, then], and we call on the Gauteng executive [that's Lesufi] to immediately act on the resolutions of the house.' Did you hear that, Mr Lesufi? You have 72 hours. DM Shaun de Waal is a writer and editor. This story first appeared in our weekly Daily Maverick 168 newspaper, which is available countrywide for R35.
