PORTFOLIO COMMITTEE 20 OCTOBER 2004

1. PORTFOLIO COMMITTEE20 OCTOBER 2004 MANAGEMENT OF HIV and AIDSIN 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. PHASE I: IMPACT ASSESSMENT • 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

7. PHASE II: POLICY REVIEW • 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

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 (www.dpsa.gov.za)

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 ofEmployee 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