keynote address jay naidoo chairman, dbsa november 2008
TRANSCRIPT
Keynote AddressJay Naidoo
Chairman, DBSA
November 2008
From Sabcoha’s Intent
Mission:SABCOHA seeks to mitigate the impact of HIV/AIDS on sustained profitability and economic growth by:
- Establishing and building sustainable partnerships with key stakeholders- Mobilising all business sectors in implementing effective HIV &AIDS initiatives- Being a trusted conduit for business of relevant information on HIV & AIDS- Piloting projects on behalf of business that can be used to drive effective action and assist in the achievement of the other objectives
Have I got a job for you!
More than one in ten South Africans already infected
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1990
1995
2000
10.34%
2005
11.58%
2008
2010
1985
11.73%
HIV Negative
HIV Positive
2015
Source: current ‘best knowledge’ as captured in ASSA models
South African population:Current model assumptions
• SSA: 2% of world population• SSA: 33% of global HIV prevalence
• SA: 1 in 9 South Africans have HIV• SA: 1 in 6 adults (15-49) have HIV
The ‘healthcare Tsunami’
1990 1995 2000 2005 2010 2015
1,500,000
1,000,000
500,000
0
People infected6,000,000
5,500,000
5,000,000
4,500,000
4,000,000
3,500,000
3,000,000
2,500,000
2,000,000
Current peopleOn ARV’s: 450,000 adults, 50,000 children
Coming to a town near you in the next 5-8 years: 5,5m people
Source: Current projections from the ASSA models
They can die
They can swamp the healthcare system
They can get ARV’s
Our outcomes are poor, and are declining...
38
35
45
33
40
51
44
79
69
76
India
EU
Afghanistan
Botswana
Lesotho
UAE
Swaziland
SA
Sierra Leone
Angola
Life expectancy at birth Infant Mortality (per 1,000)
5
6
9
20
27
61
69
76
124Botswana
India
SA
Namibia
China
Brazil
Chile
UK
NL
Maternal Mortality
16
13
31
260
300
250
230
6
8
16
110
210
230
300
400
450
Iraq
SA
India
2000
NL
UK
Chile
2005
Brazil
Namibia
China
Source: Unicef; WHO Maternal Mortality Report, 2007, StatsSA; Monitor Analysis
Maybe it’s easier to think about this in less abstract terms
• If you’re selling to consumers, chances are, 15-20% of your current customers are going to be dead within the next 5-8 years if we do nothing
• If you have people working for you, capture their experience. You never know
• Of course, their children might also be affected...
• And what made you believe you are safe?
The Ubuntu Clinic is an Example of a Successful Partnership Programme that Operates to Achieve Superior Health Outcomes Within the Current System
Ubuntu Clinic (Site B)Khayelitsha
Overall Objective
Integration of HIV & TB Services– 50% co-infection rate
Partners – The City of Cape Town Health Services, – The Department of Health of the Provincial
Government of the Western Cape (PGWC) – The Infectious Diseases and Epidemiology
Unit of the School of Public Health, University of Cape Town (UCT)
– The Epidemiology Unit of the Institute of Tropical Medicine of Antwerp (Belgium)
– Treatment Action Campaign (TAC); – TB Care– Lifeline– Médecins Sans Frontières (MSF)
Objectives of the Programme
Increase VCT amongst TB clients as an entry point to HIV care
Diagnosing TB disease earlier in HIV-infected persons Facilitating an integrated approach to the
management of co-infected persons, creating a “one stop” service
Increasing service efficiency through more rational staff deployment and increased competence in the management of co-infected patients
Improving cure rates for both co-infected and TB patients through a more patient-centered approach to adherence
Benefiting from the experience of the TB programme to standardize the approach and the monitoring of ARV patients
Successes: Achieved a Mother-to-child transmission rate of 4.7%, the lowest in the Western Cape 97% HIV counselling rate for TB patients up from 50% in 2002
Source: Report on the Integration of TB and HIV Services in Ubuntu clinic (Site B), Khayelitsha, City of Cape Town Health Services, Medicins Sans Frontieres, Infectious Disease and Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town
CASE EXAMPLE
The Lusikisiki Challenge:
Lusikisiki has an Example of a Community Supported Programme that Improves Outcomes Despite a Profound Lack of Resources
Decentralized HIV/AIDS CareThe Lusikisiki Model
Objective:
Descriptionof theProgramme
Partners
Lusikisiki has a population of 150 000 serviced by 1 hospital & 12 clinics
Health worker shortages are a major bottleneck to ARV rollout esp. in rural areas
Primary Health Care versus hospital approach– Task transfer
Including nurse instead of doctor initiation of ARV
– Community support Training of peer educators Establishing community groups etc. 2 200 patients were enrolled in 2006
– 95% coverage
3129
0
25
50
National Lusikisiki
HIV Prevalence at Antenatal Care (2006)
Percentage
5
77
National Average
Lusikisiki
329
Euro27**0
350
50
Doctors* per 100,000 population (2006)
Introduce ARVs into a remote Primary Healthcare Clinic
Number Médecins Sans Frontières (MSF) The Infectious Diseases and Epidemiology Unit of
the School of Public Health, University of Cape Town (UCT)
Note: *Article describes doctors as physicians, **Euro27 is an average of the 27 European Countries, Source: Implementing Antiretroviral Therapy in Rural Communities: The Lusikisiki Model of Decentralized HIV/AIDS Care, the Journal of Infectious Diseases, Eurostats; World Health Report 2006
CASE EXAMPLE
The Bushbuckridge Project:
Funding:
Private Sector / NGO Partnerships Appear to be Able to Increase Access to Healthcare Beyond the Immediate Employees and Their Families
Anglo Coal and Virgin Unite A corporate partnership to serve BushbuckridgeObjective:
Partners:
Bushbuckridge has a population of 70,000 Lack of access to healthcare is a major problem
– Only one government mobile clinic service the area The program intends to:
– Stimulate the local economy– Build capacity for entrepreneurship– Tackle the HIV / AIDS related stigma– Create a working model for rural AIDS treatment in South
Africa
To develop a local community health centre to provide free HIV treatment, TB and general medical services of high standard to service not only employees but also their families as well as the community
Médecins Sans Frontières (MSF) The Infectious Diseases and Epidemiology Unit of
the School of Public Health, University of Cape Town (UCT);
Source: AIDS and the Private Sector : The case of South Africa, Overseas Development Institute
The Bushbuckridge HIV / AIDS Challenge:
– Anglo Coal– Virgin Unite– President Bush’s Emergency Plan for AIDS Relief,
(PEPFAR)– National Union of Mineworkers
2011
0
25
National Bushbuckridge
HIV Prevalence 2007
Percentage
R50 Million has been pooled for the health centre project:– Anglo Coal has donated R5 million every year for
five years– President Bush’s Emergency Plan for AIDS Relief
supports operational costs
CASE EXAMPLE
The MBSA Siyakhana Project:
Funding:
Lessons Learnt by Employer Lead Initiatives are being Translated into Community-Wide Programmes
Mercedes-Benz South AfricaHIV & AIDS Workplace Programme
Objective:
Partners:
The Siyakhana project offers HIV / AIDS workplace support and programmes for small businesses in Buffalo City Municipality in the Eastern Cape
The programme deliberately extends beyond MBSA’s own supplier and dealer network, to:
– Address the development challenges posed by AIDS– Demonstrate ongoing commitment to corporate
responsibility The programme is developed based on MBSA’s experience
with HIV & AIDS workplace intervention programmes The aim is to have 67 companies signed-up by 2009
– 17 companies are already involved (2007)
Source: AIDS and the Private Sector : The case of South Africa, Overseas Development Institute, Mercedes-Benz South Africa
– Mercedes-Benz South Africa– Local Chamber of Commerce– Buffalo City Municipality– National Union of Metalworkers
Extend quality prevention, treatment, care and support to employees, their dependants and the community for HIV / AIDS conditions
Reflect the corporation's commitment to Corporate Social Responsibility
Progressively manage the increasing financial and human resource impacts associated with HIV & AIDS
MBSA provides 55% of the funding for the project Companies are expected to pay a nominal annual fee:
– Companies less than 50 employees pay R6,000 annually
– Larger companies pay R8,000 a year
CASE EXAMPLE
So, what’s needed?
So, what’s needed?
Infrastructure needed
• Logistics, facilities upgrades, .....• Training Infrastructure • Networks: telecoms, transport
• Management practice• Measurement as a basis for action• Help ensure performance
• Easiest one in the book • “Conditional Grant”: pay and teach• Target spending
So, what’s needed?
Marketing?
• Marketing is the art and science of changing behaviour • When done well
– ... It is based on identified segments...– ... With clearly identified behavioral change objectives ....– ... With a strategy as to how that comes about
• It results in brands, in “truths”, in dissemination of knowledge• If there’s anything we need right now, it’s a change in some behaviours
– Around unsafe sex– Around getting tested– Around getting into ARV programs– Around staying the course on ARV programs– Around getting into AnteNatal programs early, etc
• So, how can we deploy the technology of marketing curb HIV & Aids?
So, what’s needed?
Innovation – nothing new!
So, what’s needed?
Thought Leadership: enlightened self-interest meets humanity
• The challenges faced by the health services represent a profoundly strategic challenge ...
• .... Which ultimately challenges all of us, since it talks about our families, our colleagues, our customers, and our friends ...
• ... Which is of a size and a significance to put to the test, the best we can throw at it ....
• ... Which will force us to collaborate across firms, private/public sector, with Unions and a mobilised civil society – and anyone else who cares enough to help ....
• Seems we’re at our own point of choice: we can hang together, or hang separately
And here’s the profound part- building the rainbow nation
• this is not just about HIV
• or TB
• or Malaria
• or malnutrition
• or crime
• or or or or or or
It takes a village.... ?
• 1 in 5 of our children suffers from long-term malnutrition: they are stunted• 1 in 3 of our children has chronic vitamin A deficiency that will shorten their life• 1 in 8 of our children are underweight for their age • 2% of our children suffer from kwashiorkor or marasmus: severe malnutrition of protein or energy: they will die. 2% means 200,000 children under the age of 10
In our village?