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In the state of the nation address the President highlighted a number of challenges for us. I wish to deal with some of these and indicate both progress as well as the immediate challenges ahead.

HIV/AIDS

Quite clearly HIV/AIDS continues to be the major challenge facing us. Also important in our perspective is for us to remember the point made by the President that where Poverty & disease is rife HIV/AIDS thrives with even greater brutality. So our approaches to be comprehensive must grasp this reality. HIV/AIDS is a major developmental challenge both in terms of its contribution to economic under performance as well as its viciousness in areas characterised by under development. What then have we tried to do:

Following a major review of our HIV/AIDS campaign in 1997 we concluded that key ingredients for success were visible and sustained political leadership and mobilisation of different formations in our society.

The Interministerial Committee on AIDS (IMC) committee was thus formed chaired by then Deputy President Mbeki - a practice that continued in this present administration under the guidance of Deputy President Zuma.

As you are all aware, Cabinet recently undertook a restructuring of the way it does business. This also included a review of all the cabinet committees including the IMC. This however will not in anyway reduce the attention that cabinet will dedicate to this important subject.

In October 1998, we also launched the partnership against HIV/AIDS as a challenge for all of us to act in unity in the different sectors to which we belong.

We have taken this further with the launch/establishment of the South African AIDS Council (SANAC) in January 2000 - under the chairmanship of the Deputy President.

The SANAC consists of representatives from different sectors. Government is approaching this initiative with an open mind. We do not have experience in this country on this and the lessons from countries such as Uganda are that the form and nature of such institutions evolves over time responding as they should to changing and evolving situations.

Government therefore holds the view that during its 2 year span, this council will learn and subsequently inform the composition and the functioning of its successor.

It was also important for us, that we make a start as a matter of urgency without bogging ourselves on prolonged discussions on such matters as legal status in particular. These will be addressed as we deal with our primary task - viz the containment of this epidemic.

As many of you know, the SANAC had its first meeting on Tuesday February 1 2000. I have been encouraged by the seriousness with which all the members tackled their task. The meeting was vibrant and I am certain that by establishing sectoral task teams the representatives of the sectors will root the work of SANAC throughout our country. This also includes to responsibility of the government Ministers sitting in the Council to ensure that all government departments act in a co-ordinated manner.

A key decision of that meeting was the agreement on the establishment of 5 technical task teams. These are:

I) Prevention
II) Care, treatment and support
III) Research
IV) Human Rights and legal issues
V) Social mobilisation

These technical task teams will be constituted soon. In addition to these, each sector is to establish sectoral task teams that will cover all the identified areas. Each sectoral team will then report progress to the SANAC through the sectoral representative in the Council. Through this mechanism we believe there will be greater involvement of the sectors in the work of the Council.

The next meeting of SANAC is scheduled for 26 February, 2000.

The success of this initiative is key to a sustained social mobilisation against HIV/AIDS.

In addition to this above initiative, in our MINMEC of the 3rd February 2000, my colleagues the nine provincial MECs for Health and myself agreed on a number of key decisions.

We agreed to roll out a programme of Voluntary Counselling and Testing. This decision was preceded by an investigation on the availability currently of testing sites as well as Counselling Services. We need of course to do a lot to consolidate what exists but we believe we are ready to make a start.

We have also concluded that to sustain a programme of counselling, use has to be made also of lay counsellors. In this regard we deliberated and endorsed a proposal detailing minimum standards to be adhered to in any training of these counsellors. We shall be proceeding with the training and in certain instances retraining of existing counsellors.

We also reflected and endorsed a recent initiative on the greater use of Rapid HIV testing in the health sector. This would enable pre test Counselling, obtaining results and post test Counselling to be done in one visit thereby reducing default rates and the anxiety associated with long periods of waiting for results.

We caution however in relation to these rapid tests against individual use outside the context of available counselling services.

We also believe that various sectors of our society like NGOs and Churches have and important role to play to ensure a successful VCT initiative.

It is our view that knowledge of one`s HIV status is important to facilitate appropriate behaviour.

Another key decision taken in our recent MINMEC was the approval of Guidelines for the adequate treatment of opportunistic infections. We believe this will contribute significantly to improving the quality of life of those infected. We need to all remember that proper treatment of these infections leads to productive lives in the interests of the individuals, families and communities.

You will recall that in his address to the NCOP, the President instructed us to investigate concerns around the toxicity of the antiretrovirals. We have commenced with this task. We asked the Medicines Control Council (MCC) to make available to us information that would assist in determining the risk benefit assessments of the use of the antiretrovirals for different indications. The initial reports we got were not to our satisfaction. I have now recently received the latest report from the MCC which I am studying.

Another challenge we face in the months and years ahead is the extent to which we shall be able to deal with the many children orphaned due to AIDS as well as provision of care and support. In this regard, last week I had the opportunity to listen to some presentations from a group of NGOs who have been doing some work for the department on alternative settings for care of those with AIDS.

We shall be dedicating a significant part of our discussions in our next MINMEC in March to this topic. So too shall we be working with other government departments particularly Welfare.

QUALITY OF CARE

During his state of the Nation address, the President also reaffirmed our common commitment to a caring and a humane society. Over the past few years, we have done a lot to improve access to hither to marginalised communities. In my previous briefings I detailed these achievements to you. Needless to say, we are proud of these achievements and we believe they form a solid foundation and a launching pad for our further advance. But we are not saying the job is complete. Far from it. But we believe in addition to continuing to improve access, time has come for us to deal with the problems of quality throughout the health system.

This will be a comprehensive attack on all the dimensions of quality and include such interventions as:

I) Peer review systems and clinical Audits
II) Establishment of complaints mechanisms
III) Continuing Professional development and recertification

This work will constitute our strategic focus over the next few years. That is why in November 1999 we launched the Patients Rights Charter as an intervention to highlight this focus. Together with the Batho Pele initiative, we believe this will contribute to the restoration of the humanity of all South Africans especially the most vulnerable, - the poor, women and the rural.

We need a restoration of the caring and compassionate ethos that has characterised our health professions. We need to emulate those health workers who work under extremely difficult conditions at times in service of their country and people.

But to succeed in these initiatives, we need all our people to reclaim their right to dignity and own our institutions which are after all their own.