HOW CAN THE BUSINESS RESPONSE SHAPE THE FUTURE FOR SOUTH AFRICA Prof Wiseman Nkuhlu

2. HOW CAN THE BUSINESS RESPONSE SHAPE THE FUTURE FOR SOUTH AFRICA Prof Wiseman Nkuhlu

3. 1. INTRODUCTION • HIV/AIDS remains the biggest socio-economic challenge world-wide; • Sub-Sahara Africa is the worst affected region – accounting for 68% of infected adults in the world; • Realising the threat posed by the epidemic, the African leadership identified the fight against HIV/AIDS as one of the top priorities of the New Partnership for Africa’s Development (NEPAD) IN 2001;

4. HIV/AIDS is the biggest socio-economic challenge facing South Africa; • At the Global Conference in Mexico (August 2008) the international community re-affirmed its commitment to provide universal access to HIV/AIDS prevention, treatment, care and support by the year 2010

5. 2. SOUTH AFRICA LAGGING BEHIND THE REST OF THE WORLD. • The rest of the world is taming the AIDS monster; • HIV incidence rates are slowing down globally; • Yes, in Sub-Saharan African countries as well, but not in South Africa; • Mandatory testing at health care points has been introduced in Botswana and Uganda and the result is improved levels of treatment access due to people knowing their status

6. Access to treatment is growing; however, the concern is that new HIV infections significantly outpace the numbers of those starting on ART by a ratio of 5 to 2; • South Africa has 5,6 million people living with HIV/AIDS, 510 000 new infections per annum and 1 000 000 who are AIDS sick and of whom only 500 000 are on ART.

7. 3. THE CLARION CALL TO BUSINESS • The magnitude of the challenge and its economic impact is such that it can not be left only to Government to resolve; • Once again, business is called upon to respond to a major threat to the economy and the future of South Africa; • The threat requires visionary and courageous leadership. The kind of leadership that business produced in the late 1970s following the Soweto uprising;

8. And throughout the 1980s leading to its role in CODESA and the establishment of the Business Trust; • The threat is HIV/AIDS which kills 370 000 young South Africans per year; • HIV/AIDS remains the greatest threat to South Africa and as long as it is not effectively addressed, the economic gains of the last few years will not be sustainable; • The country will plunge into what the Live the Future Model calls, the Winter of Discontent;

9. To move to the Summer for All People of the Live the Future Model scenario, we need a strong commitment by business leadership to champion and support the fight against HIV/AIDS – focus on large scale public-private partnerships, treatment and care and wide-spread behavior change; • To recommit to the Global Agenda of achieving universal access to HIV/AIDS prevention, treatment, care and support by the year 2010; • This would require leadership by captains of industry and implementation of company specific plans and dynamic engagement at the national level.

10. 4. CONCLUSION As the interests of business are intricately intertwined with those of South Africa as a whole, as business we have no choice but to champion and support implementation of a programme to realise the Summer of All People scenario.

12. HIV&AIDS and STI Strategic Plan for South Africa, 2007 – 2011 and the Private Sector Strategy: The Four Zero's Brad Mears

13. Vision To empower South African Business to take effective action on HIV/Aids, in the workplace and beyond

14. Four Strategic Areas of Delivery • To speak on behalf of Business and to co-ordinate the private sectors response to HIV • To empower Business to respond more effectively to HIV • To manage knowledge and conduct research • Develop internal capacity

15. Four Zero’s Vision • Zero Tolerance for New Infections • Zero Tolerance for Babies Born with HIV • Zero Tolerance for Deaths Due to HIV • Zero Tolerance for Discrimination

16. Underpinning Principles • Human Rights Framework • Non discrimination • Reduce social and economic inequalities • Achieve gender equity • Respect for the rights of the child

17. Underpinning Principles • Outcomes based scientific knowledge and research • Culture of health seeking behavior • Universal applicability of the policy • Achievement of partnerships between sectors

18. Critical Success Factors • Gain universal commitment to the Vision • Every person to know and manage their status • Create a culture of individual accountability • Track achievements through effective monitoring and evaluation

19. Zero Tolerance for New Infections • Identify and utilize all effective HIV prevention measures, and to effectively monitor and evaluate these measures • Prevention and early treatment of STI’s • Identify, understand and challenge any aspect of social or cultural practices that increases the risk of infection • Communication must be targeted, measured, effectively timed, and proven to lead to behavior change

20. Zero Tolerance for Infections From Mother to Child • Ensure that the risk of transmission is clearly understood by all. • Ensure that HIV positive women receive the necessary care and counseling in the first trimester

21. Zero Tolerance for Aids Deaths • Have early diagnosis of the condition • Have all HIV positive people on a wellness program that supports positive living. In order to achieve this the following is essential • Break stigma associated with HIV • People to know how they access treatment • On-going monitoring to be conducted

22. Ongoing psycho-social support and support iro partner to partner disclosure • Good nutrition and lifestyle management • Receive sufficient exercise, sleep and rest • Reduce smoking, drug and alcohol abuse and stress • Create a culture of compliance • Effective management of co-infections such as TB

23. Zero Tolerance for Discrimination • Create a human rights culture through education and awareness, especially in the workplace • Promote the rights of women, children and those living with HIV • Address circumstances which lead to socio-economic injustice

24. Current Developments • Development of the Four Zero’s • Collaboration with Labour, Government and Civil Society in NEDLAC • Completion of a Situational Analysis • Alignment of Business responses with NSP in Northern Cape, Western Cape and Gauteng • Developing an M&E system for the private sector

25. Way Forward • Completion of Private Sector Strategy Document • Assess and amend the Code of Good Practice • Continue aligning Businesses response to the NSP in all nine provinces • Develop and implement an effective monitoring and evaluation system for the private sector

26. Conclusion

28. Keynote AddressJay Naidoo Chairman, DBSA November 2008

29. 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!

30. % More than one in ten South Africans already infected HIV Negative 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 10.34% 11.58% 11.73% HIV Positive 1985 1990 1995 2000 2005 2008 2010 2015 Source: current ‘best knowledge’ as captured in ASSA models

31. 2015 The ‘healthcare Tsunami’ 6,000,000 People infected 5,500,000 5,000,000 They can die 4,500,000 Coming to a town near you in the next 5-8 years: 5,5m people 4,000,000 3,500,000 They can swamp the healthcare system 3,000,000 2,500,000 2,000,000 1,500,000 They can get ARV’s Current people On ARV’s: 450,000 adults, 50,000 children 1,000,000 500,000 0 Source: Current projections from the ASSA models

32. Our outcomes are poor, and are declining... Life expectancy at birth Maternal Mortality Infant Mortality (per 1,000) Botswana UAE India India India SA EU SA Iraq Afghanistan Namibia China Botswana China Namibia Lesotho Brazil Brazil Swaziland Chile Chile SA UK UK Sierra Leone NL NL Angola 2000 2005 Source: Unicef; WHO Maternal Mortality Report, 2007, StatsSA; Monitor Analysis

33. 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?

34. 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 Objectives of the Programme CASE EXAMPLE • 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) • 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 Overall Objective • Integration of HIV & TB Services • 50% co-infection rate Partners 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

35. Lusikisiki has an Example of a Community Supported Programme that Improves Outcomes Despite a Profound Lack of Resources CASE EXAMPLE The Lusikisiki Challenge: Decentralized HIV/AIDS Care The Lusikisiki Model HIV Prevalence at Antenatal Care (2006) Objective: Descriptionof theProgramme Partners • Introduce ARVs into a remote Primary Healthcare Clinic • 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 Percentage National Lusikisiki Doctors* per 100,000 population (2006) 350 329 77 50 Number • Médecins Sans Frontières (MSF) • The Infectious Diseases and Epidemiology Unit of the School of Public Health, University of Cape Town (UCT) 0 National Average Lusikisiki Euro27** 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

36. Private Sector / NGO Partnerships Appear to be Able to Increase Access to Healthcare Beyond the Immediate Employees and Their Families CASE EXAMPLE The Bushbuckridge Project: Funding: Anglo Coal and Virgin Unite A corporate partnership to serve Bushbuckridge • Anglo Coal • Virgin Unite • President Bush’s Emergency Plan for AIDS Relief, (PEPFAR) • National Union of Mineworkers • 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 Objective: Partners: • 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 • 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 The Bushbuckridge HIV / AIDS Challenge: HIV Prevalence 2007 • Médecins Sans Frontières (MSF) • The Infectious Diseases and Epidemiology Unit of the School of Public Health, University of Cape Town (UCT); Percentage National Bushbuckridge Source: AIDS and the Private Sector : The case of South Africa, Overseas Development Institute

37. Lessons Learnt by Employer Lead Initiatives are being Translated into Community-Wide Programmes CASE EXAMPLE The MBSA Siyakhana Project: Funding: Mercedes-Benz South Africa HIV & AIDS Workplace Programme • 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) • Mercedes-Benz South Africa • Local Chamber of Commerce • Buffalo City Municipality • National Union of Metalworkers Objective: Partners: • 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 Source: AIDS and the Private Sector : The case of South Africa, Overseas Development Institute, Mercedes-Benz South Africa

38. So, what’s needed?

39. So, what’s needed?

40. 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

41. So, what’s needed?

42. 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?

43. So, what’s needed?

44. Innovation – nothing new!

45. So, what’s needed?

46. 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

47. 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

48. 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?