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
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
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.
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
- 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.