PORTFOLIO COMMITTEE BREIFING
MANAGING HIV AND AIDS IN THE PUBLIC SERVICE WORKPLACE
1. BACKGROUND
In January 2000, the Minister for Public Service and
Administration, Minister Fraser-Moleketi, launched the Public Service Workplace
HIV and AIDS response and called it “The
Impact and Action Project”. The aim of the programme was to mitigate the impact
of HIV and AIDS on the Public Service. As part of this programme, the Public
Service Regulations (PSR), 2001 were amended to include minimum standards for
managing HIV and AIDS in the Public Service workplace (see attached copy for
details).
This programme was
initiated in recognition of the potential impact the HIV and AIDS epidemic
could have on the ability of the Public Service to continue rendering services
if not managed appropriately. It was also initiated in response to calls from
the International Labour Organization (ILO), the SADC region, as well as the
Department of Labour for employers to develop and implement workplace
programmes to mitigate the impact of the epidemic. The Public Service framework
is thus in line with the Codes of Good Practice developed by these agencies.
In line with the amended PSR, it is mandatory for all
heads of departments (HOD’s) to ensure that their departments develop and
implement HIV and AIDS programmes which include all the minimum standards
outlined in the attached document. As a result, all government departments have
initiated department-specific workplace programmes.
The Public Service programme is recognized by the ILO
as an international good practice model and is documented as such in ILO
publications. Other expert international agencies like UNAIDS, GTZ etc also
view the programme as a model of good practice and have thus referred and/or
sponsored other countries to learn from the South African experience.
2.
PROGRESS TO DATE
2.1 Regulation
After in-depth consultation with employees through the
Public Service Coordinating and Bargaining Council (PSCBC) and other relevant
structures, the framework was added to the PSR and is now mandatory.
2.2 Improved Employee Benefits
The introduction of this Framework has led to improvements
in some of the employee benefits within the Public Service. These include,
among others:
-
The development and implementation of the Government
Employees Medical Scheme (GEMS). GEMS was necessitated by a realisation during
the Impact Assessment Phase of the Project that about 40% of mainly the lower
level employees had no medical cover and would thus not have been able to
access adequate HIV and AIDS related care when necessary. GEMS started
recruiting members in January 2006 and includes a comprehensive HIV and AIDS
disease management package with all cover options. GEMS offers 100% subsidy for
employees in Level 1 – Level 5.
-
The development of guidelines for the management of
incapacity and ill-health retirements. These guidelines were published,
implementation systems approved by Cabinet were put in place and the DPSA
provides on-going support to the departments.
-
The Government Employees Pension Fund (GEPF) was improved
through the introduction of an orphan’s pension, funeral benefits as well as
the redefining of “spouse” to be more accommodating to the different cultures
and real life situations of employees.
2.3 Implementation of the Framework
The implementation of the HIV and AIDS workplace programme
is constantly improving. There are some variations, with some departments
offering more than what is stipulated in the PSR, while others are still
struggling with the implementation of the prescribed Minimum Standards.
The necessary co-ordination structures were put in place at
national and provincial levels (the Interdepartmental Committees or IDC’s). A
manual entitled “Managing HIV and AIDS
in the Public Service – A Guide for
Government Departments” was developed to provide step-by-step guidance
to departments as they develop and implement their department-specific
programmes.
Despite some problems here and there, departments have come
a long way in allocating the necessary financial and human resources to
implement the programmes. Most departments have appointed Directors and have
put in place the necessary systems for the implementation of the programme.
Some best-practice cases have developed from within the
Public Service. To acknowledge departments that are doing exceptionally well,
as well as to promote learning from the experiences of these departments, these
best- practice case studies have been documented and will be published.
The annual Indaba’s continue to be important platforms for
shaping and strengthening the programme. The Public Service is the only
employer in the world holding such conferences which bring together around 500
hundred people, mainly implementers of the programme in the departments, to
focus on this important programme for 3 days every year since 2001. The Indaba
attracts a lot of interest from even private sector institutions and continues
to grow each year.
2.4 Recognition and acknowledgement
The programme continues to be recognised by the
International Labour Organisation (ILO) and other multinational agencies like
the UNAIDS, GTZ etc as a model of good practice.
The DPSA team has been called upon to provide technical
support to other institution outside the Public Service. These include, among
others, the SADC Desk in
2.5 Communication Strategy
A communication strategy was developed for the programme.
This has resulted in the development of a dedicated internet-based Public
Service information programme accessible as a link from the DPSA website.
Given the reality that not all Public Service employees are
literate and have access to the internet, the communication campaign has been
expanded in partnership with
The print material developed through this partnership is
already being distributed throughout the Public Service. The
3. CONSOLIDATED REPORT ON IMPLEMENTATION OF MINIMUM STANDARDS
In preparation for the Portfolio Committee briefing, all
government departments were requested to submit reports on the implementation
of the Minimum Standards. For the purpose of these reports, departments were
requested to use the items of the Minimum Standards as headings and were
further requested to report on the budgets available for the programme in the
current financial year. The following is a summary of the consolidated report:
3.1
Response Rate
The request was sent to all (139) departments and reports
were received from ninety-one (65%) departments (Appendix A). With the
exception of
These are also the provinces were the Premier’s offices are
not taking the lead in coordinating the programme at provincial level. To
address this problem, discussions are currently underway with the USAID-funded
POLICY Project to support these provinces.
3.2
HIV and AIDS Policy
Departments generally do have the necessary policies in
place. Seventy-one (78%) of the ninety-one departments that submitted reports
have signed-off policies and thirteen (14%) have draft policies currently being
finalised. The remaining seven departments did not indicate whether they have
policies or not and it is assumed that some of these do have policies in place.
The provinces that have strong coordination by the Premiers’
departments are more likely to have policies in place than the three where this
is lacking (
The intervention currently being negotiated with the POLICY
Project will commence with supporting these provinces in developing the
necessary policies and will further support them in implementing these
policies.
3.3
Senior Manager
Responsible for Programme
All departments have a senior manager (Director or above)
responsible for the programme. Some departments have appointed a Director for
the programme while others have designated a Director who has other
responsibilities.
The Minimum Standard is to “designate” a senior manager to
champion the programme. However, where departments have appointed dedicated
Directors, the level of implementation seems to be significantly higher that
where a senior manager is designated.
A common challenge is that, especially where a manager is
designated, there is lack of commitment to the programme. The reason commonly given is that, despite
the expectation that the designated manager shall capture the responsibility on
his/her performance contract, the programme is still seen as an add-on
responsibility and sometimes not even considered during performance
appraisals.
To adress this challenge, the lack of commitment from
designated and/or appointed senior managers will be dealt with through
performance management processes.
3.4
Information, Education
and Awareness
This is the most implemented item of the Minimum Standards
in departments. All departments make HIV and AIDS-related information and
training available to employees. The frequency and type of interventions varies
from departments that only share information on important calendar days (World
AIDS day, TB day etc) to those that have detailed and on-going programmes.
Departments use creative ways of sharing information like
the printing of relevant information at the back of payslips as was done in the
Peer education through trained peer educators is also used
significantly in departments. The challenge in some departments is that the
Peer Educators have no time to do it because they have other responsibilities.
This is being addressed by ensuring that the responsibility is captured and
given time on their performance contracts.
Another challenge is that there is currently no common
approach in the training of Peer Educators. The DPSA is finalising a model that
will lead to standardisation in identifying, training, supporting and using
Peer Educators.
3.5
Occupational Exposure to
HIV
Most employees work in an administrative environment and
thus have a very low risk of contracting HIV at work. Majority of the
departments that submitted reports (63%) stated that all employees in their
departments would know what to do should they be exposed to risky situations.
The Department of Health’s protocols are used in cases of exposure.
Departments train their safety representatives who provide
first aid in emergencies on universal precautions against occupational
exposure. Departments also provide safe first aid kits in offices.
The
3.6
Confidentiality and
Non-discrimination
All departments stated that their policies explicitly
prohibit discrimination and employees have recourse through the Grievance
Procedure should their confidentiality be breached. Practitioners sign a pledge
of confidentiality and some departments outsource their counselling services to
protect the confidentiality of employees using such services.
Information regarding the employees’ HIV status is not
recorded on any official files and where service are used, identification codes
are used to store information instead of names and the files are locked up.
3.7 Care and Support
Various models are used to provide care and support to
employees in departments. Where the departments have suitably qualified
professionals employed for the programme, the initial sessions with employees
requiring care and support is with those internal staff members who then refer
employees to outside services based on the identified needs.
Some departments have outsourced the service which would
typically commence with anonymous counselling offered through a toll-free
telephone service, followed by face-to-face sessions based on needs. Other departments offer both models and
employees choose the one they feel comfortable with.
3.8 HIV Testing
No pre-employment HIV testing is required for Public Service
employment. Voluntary counselling and testing is promoted by all departments
that submitted reports, with seventy (77%) of these reporting to be making the
service available to employees either as part of calendar events or on a more
regular basis through outsourcing arrangements.
Some departments (Health, Education etc) have conducted
anonymous and unlinked sero-prevalence surveillance. Based on the results of
these, Public Service employees seem to be having an HIV infection rate equal
to that of the members of the general South African population matching their
demographic profile. In fact, educators were found to be having a slightly
lower rate of infection. Given the inherent limitations of currently available
methodologies, results of such surveillance are treated with caution.
3.9
Monitoring and Evaluation
While fifty-five (60%) of the departments that submitted
reports stated that they have structured internal monitoring and evaluation
(M&E) systems in place, this is known to be the weakest area of compliance.
Reports are submitted as required to the Inter-departmental Committees and to
the DPSA but very few departments report internally on a regular basis.
While the designated senior managers are mandated to capture
the responsibility on their performance contracts to ensure implementation,
this is said to be seldom considered during performance appraisal. The DPSA is currently finalising an M&E
framework that will include norms and standards and will adress the related
performance management issues.
3.10
Resources Available
The Minimum Standards do not prescribe what resources must
be made available in departments for the implementation of the programme except
that a senior manager is to be designated and that adequate resources are to be
made available by heads of departments (HOD). As a result, some departments
have appointed professional practitioners and allocated dedicated budgets to
the programme, while others have neither dedicated staff nor budget assigned to
the programme.
An analysis of the reports submitted clearly demonstrates
that departments with dedicated practitioners and budgets are more compliant
than those without the necessary resources. This has informed the more
prescriptive approach adopted in the Public Service Employee Health and
Wellness Framework currently being finalised which will encompass the HIV and
AIDS programme.
3.11
Limitations
A significant limitation is that the report is based on
self-reports signed for by HODs. HODs have obligations in terms of the PSR and
non-compliance directly means non-performance by the HOD. It is thus not
impossible that some positive aspects may be overstated and that some negatives
may be understated.
However, the reports used for this report do not differ much
with reports obtained through other routine processes in stating levels of
implementation in departments. It is thus assumed safe to accept these reports
as an adequate reflection of levels of compliance with the Minimum Standards.
4. THE CURRENT FOCUS AND THE FUTURE
When the Programme was initiated, the focus was on managing
HIV and AIDS so as to mitigate the potential impact of the epidemic on the
Public Service. However, the need for a more comprehensive approach focusing on
broader employee health and wellness issues has always been recognised and is
stated in the PSCBC Resolution of 2000 through which the framework was adopted.
The challenges of stigma and duplication of services
experienced during the implementation of the HIV and AIDS framework have
necessitated the review of the programme to adopt a more comprehensive employee
health and wellness approach.
The DPSA-based unit has been given more posts to support
this expanded approach. The process for developing Employee Health and Wellness
Guidelines for the Public Service is well underway and will be concluded in a
few weeks.
Through this programme, it is envisaged that employees will receive
information; support and other related services (as feasible) to deal with any
physical, emotional and social issues that might have an impact on their
ability to function at optimal levels. Programmes that enhance the general health
and wellbeing of employees will be promoted and as far as feasible, be provided
given the obvious benefit this will have in ensuring that employees function
optimally.
It is further envisaged that the programme will result in the
minimisation of situations that might impact negatively on the health and
wellbeing of employees in the workplace. These include but are not limited to
the following:
-
Occupational hazards
-
Physical work environmental
safety
-
Stress
-
Stigma and discrimination
The actual scope of the programme is being mapped out as part of the
process of finalising the relevant guidelines for the programme. Some broad
parameters have been defined and the programme will have the following broad
pillars:
-
HIV and AIDS
-
Employee Assistance
Programmes (EAP) There is currently no
guidelines on EAP. This has resulted in the programme being implemented
differently in different departments and thus impossible to assess.
-
Occupational Health and
Safety
-
Disaster management
-
Disease prevention and
health promotion
-
Management of ill-health
-
Enhancement of work life
quality
The main focus at present is on:
-
The finalisation of the health and wellness guidelines.
-
The development of an implementation strategy that will
outline:
i.
The necessary human resource and other requirements for the
programme
ii.
The process to achieve compliance with the legal
requirements ( Occupational health and safety, disaster management,
Compensation for occupational injuries and disease, etc)
iii.
The necessary M&E and communication frameworks
iv.
The capacity building plan for the programme
-
The further strengthening of the HIV and AIDS programme by
dealing with the related stigma and discrimination. This will include the
adapting and implementation of the UNAIDS’ Greater Involvement of People living
with HIV and AIDS (GIPA) Model.