NARRATIVE
ON THE IMPLEMENTATION OF THE PUBLIC SERVICE WORKPLACE HIV AND AIDS POLICY
PRESENTED TO THE PORTFOLIO COMMITTEE ON PUBLIC SERVICE AND ADMINISTRATION ON
WEDNESDAY, 13 SEPTEMBER 2006
1.
BACKGROUND
HIV and AIDS affect all sectors of our society. The
country is experiencing an epidemic which grew from below 1% in 1990 to above
30% in 2005 (DOH). The epidemic requires that all sectors of society be
involved in implementing the comprehensive response lead by the national
Department of Health which has seen an increase in government expenditure from
R30M in 1994 to above R30 billion in 2005-06, resulting in the UN General
Secretary commending the country for this. The country’s Antiretroviral
programme has also been reported to be “swifter than in any comparable country”
by the Health Systems Trust which is an independent reputable research agency.
Given the reality that the epidemic affects all
sectors of the society, including workplaces, it is necessary for workplaces to
participate in the broader country-wide efforts to manage the epidemic. There are three main motivations for
employers to develop and implement workplace HIV and AIDS programmes.
First, there is a moral case for this.
Employees commonly spend so much time at work that it would be unfortunate if
the opportunity was not used to provide them with ways staying HIV-negative if
they still are, or equipping them with knowledge, skills and support in dealing
with either being infected or affected.
Secondly, there is a business case for employers
to implement workplace HIV and AIDS programmes. Employees are the most valuable
assets for any workplace. Even the highly automated industries require people
to run the machines. For environments like the Public Service, which cannot
even consider automation, employees become even more precious and necessary if
the mandate of the Public Service to create a better life for all South
Africans as well as to create a developmental state is to be realised. In other
words, irrespective of what the “core business of the employing organization
is, employees are required to deliver on that core business and thus directly
drive the business of that organization.
Lastly, the legal case for implementing
workplace HIV and AIDS programmes gives employers no other option but to
implement such programme for the sake of compliance. South Africa is one
country where the legal case is well presented in the current legal and policy
framework instituted by the Department of Labour. The existence of a relatively
strong labour movement is also good for the country because it means that employees are able to demand legal
compliance from their employers.
2. THE
PUBLIC SERVICE RESPONSE
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 prgrammes
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.
3. PROGRESS TO DATE
3.1 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.
3.2 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 Programme (HIV DMP) on all of the scheme’s five (5)
benefit options. The HIV DMP includes access to clinical consultations,
tele-counselling, educational material, ARV’s, therapeutic monitoring and
hospitalisation where necessary.
The new medical subsidy policy in the public service, which
took effect on 1 July 2006, ensures that all new employees and uncovered
employees access an enhanced subsidy on GEMS. Existing employees on open medial
schemes are also eligible to access the enhanced subsidy when moving to GEMS.
In addition, the subsidy provides a full subsidy (100%) for employees on Job
Level 1 – Level 5 of which there are 191,000 employees who currently do not
access the subsidy in this salary band. The new subsidy therefore ensures that
employees have equitable access to GEMS and its comprehensive HIV and
AIDS-related services.
-
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. S
Since the
implementation of the guidelines in the pilot departments, the number of ill-health retirements has
decreased from 1721 in 2002 when the pilot project started to 439 after the
first full-year implementation in 2004. This more efficient management process
saved the Public Service millions while at the same time allowing for the more
adequate management of those who genuinely require more leave than the
allocated days.
-
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.
3.3 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.
3.4 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 Botswana, SALGA as well as other
African states -Sierra Leone, Sudan, Zambia, Malawi and Kenya.
3.5 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 SOUL CITY and SOUL
BUDDYZ to ensure that all employees and their families are reached through the
television, radio and print programmes offered by the SOUL CITY Institute.
The print material developed
through this partnership is already being distributed throughout the Public
Service. The SOUL CITY and radio
programmes are already on air and the Public Service workplace programme is
being featured.
4. AUDITED 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:
4.1 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 Mpumalanga, Northern Cape and Free State
provinces, the response rate was acceptable. These three provinces are the ones
were the level of implementation is known to be low from previous reports.
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.
4.2 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 (Mpumalanga, Free State and Northern
Cape).
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.
4.3 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.
4.4 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 Western Cape Province, using e-mail as a platform
like in Statistics South Africa, using drama and many other different ways.
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.
4.5 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 Western Cape Province has gone
as far as equipping all official vehicles with first aid kits while the
Independent Complaints Directorate (IDC) offers Hepatitis A and B vaccines to
investigators who go out to crime scenes.
4.6 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.
4.7 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.
4.8 HIV
Testing
No pre-employment HIV testing is
required for Public Service employment except for the Military personnel who,
in terms of UN procedures, must be tested for deployment on foreign missions.
The conditions under which soldiers live when on these foreign missions would
also be extremely risky for individuals
with compromised immune systems like HIV-positive people are. The
pre-employment testing for the military was tested in court and found to be an
inherent job requirement, thereby granting the military legal authority to
continue the practice.
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. Given the inherent
limitation of currently available methodologies, results of such surveillance
are treated with caution.
4.9 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.
4.10 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.
4.11 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.
5. 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.