CHAPTER 1
INVESTIGATING AND EVALUATING THE ADEQUACY OF INTERVENTIONS IN THE FIELD OF HIVAIDS
Concepts, like individuals, have their histories. Søren Kierkegaard
INTRODUCTION
The first chapter of this dissertation sets out the motivation, the historical background, the nature and scope, as well as related aspects of the research project. The responses by Government to HIV/AIDS and motivational factors that stimulated the researcher‟s curiosity and generated interest to investigate and evaluate health and welfare interventions are discussed under the background. In order to build a logical structure to address the problem, the central concept adequate, which is embedded in the research question and concepts related to it is defined and clarified. The central concept is linked to the research problem and related concepts are linked to the central concept while conceptual instruments are linked to HIV/AIDS as a real life phenomenon in South Africa. Basically, the aim of this study is to investigate the adequacy of governmental responses to one of the worst pandemics in history. This includes the investigation and the evaluation of whether programmes and projects were appropriate and accessible between 2000 and 2005 or not.
The information and data on Human Immune Deficiency Syndrome (HIV) and Acquired Immune Deficiency Syndrome (AIDS) governmental interventions were obtained through the review of literature and official documents. The literature review is organised in such a manner that the objectives of the study are linked to conceptual instruments developed in order to measure and evaluate the adequacy of governmental responses to HIV/AIDS. To collect evidence relating to responses, the researcher made use of libraries, the internet and official data from the national Department of Health (DOH) and the national Department of Social Development (DoSD), National Treasury, as well as media reports. However, the researcher avoided the use of media reports during the literature review because such reports are not
necessarily scientific. The inevitability of involving more than one department and discipline is influenced by a plethora of HIV/AIDS problems that are multidimensional and that cut across social classes and age groups. It is in this context that inter-sectoral and inter-disciplinary approaches in response to HIV/AIDS are investigated and evaluated in this study. The choice of the period between 1997 and 2005 was mainly influenced by the fact that the 1996 Constitution of the Republic South Africa, 1996 (hereafter referred to as (the 1996 Constitution), and the White Papers on Transformation of Health Systems and Social Welfare were all adopted in 1997. The national HIV/AIDS and Sexually Transmitted Infections (STIs) Strategic Plan covered the period between 2000 and 2005. To help the reader or user of this study get a sense as to why there was a need to investigate and to evaluate responses to HIV/AIDS in this specific period, the researcher considered it essential to start by providing a historical background in relation to responses to HIV/AIDS.
HISTORICAL BACKGROUND
The formal review of the African National Congress‟s (ANC‟s) National Health Plan of May 1994 gave birth to the National AIDS Coordinating Committee of South Africa (NACOSA) in 1998. The Plan came ten years after the first two AIDS cases were officially confirmed (Torkington 2000:170). When NACOSA and the South African National AIDS Council (SANAC) were being formed, HIV/AIDS was being defined as a moral problem requiring bio- medical attention. The unwritten moralistic presuppositions underlying debates permeated the political arena and had an influence on HIV/AIDS policy-making and implementation (Fourie 2006:175). According to Fourie, one of the concerns during human rights debates was the continued invective against antiretrovirals (ARVs) and mother-to-child transmission (MTCT), in connection with which NACOSA and SANAC failed to provide guidance. This is despite the objectives of NACOSA and SANAC being, among others: (a) to guide government departments in implementing the National AIDS Plan (NAP) and the National Integrated Plan (NIP); (b) to co-ordinate HIV/AIDS service-delivery nationwide; and (c) to democratise HIV/AIDS policy-making process in South Africa.
In order to be able to translate the objectives of NACOSA into action, the National AIDS Plan (NAP) was conceived in order to, among others, produce climate conducive to the coherent and coordinated prevention and care for HIV/AIDS infected and affected individuals. In the opinion of Fourie, one of the reasons for the failure of the NAP and NIP to deliver effective and efficient HIV/AIDS services was lack of accountability by both NACOSA and SANAC. This was influenced by the fact that the NAP was accepted by the African National Congress (ANC) caucus during the existence of the Government of National Unity and as a result, the ANC did not take full ownership and responsibility of the NAP (Fourie 2006:110–119). The demise of the NAP in 1996 led to the development and the implementation of the NIP under the auspices of SANAC.
