According to a review of South Africa's national strategic plan to deal with HIV, published by advocacy group the Treatment Action Campaign (TAC) and social equality group Section27, Mpumalanga is "one of the provinces where South Africa's plans to fight HIV and tuberculosis has been most poorly implemented".
A report on the national strategic plan in December 2012 shows that the Mpumalanga Provincial Aids Council was only launched in November 2009, almost three years after the national health department's strategy document, titled the National Strategic Plan of 2007-2011 for HIV, Sexually Transmitted Infections (STIs) and Tuberculosis, had been implemented.
"It might have taken even longer, had it not been for pressure exerted by civil society organisations including the TAC in Mpumalanga," the report says.
As a result, the drafting process of the province's own strategic plan for HIV, STIs and TB was only concluded in 2010, a year before the end of the plan itself.
According to government figures, almost three-quarters of TB patients are also infected with HIV, which means the functioning of HIV bodies has a huge impact on the management of TB.
A national strategic plan is a document, agreed to by the government and civil society, that guides the implementation of the government's strategy and provides concrete goals that should be reached; for instance, how many HIV or TB infections should have been prevented by the end of the plan, how many people should have been treated or how the government would help patients to adhere to their treatment.
According to the review group, the late publication of the provincial strategic plan for 2007-2011 was partly due to a lack of political will from Mpumalanga Premier David Mabuza, who delegated his responsibilities as chair of the provincial Aids council to the MEC of health at the time, Clifford Mkasi.
In March, Mabuza quoted the latest provincial strategic plan, for 2012-2016, in his state of the province speech: "We will strengthen the implementation of the national and provincial HIV, STIs and TB strategic plan for 2012-2016 and improve co-ordination among all sectors of society."
Accessing the plan
To track down a copy of the provincial plan – which should be freely available to the public – has proven to be problematic.
When the Mail & Guardian asked Mpumalanga health spokesperson Ronnie Masilela for a copy, he referred us to the provincial HIV directorate, which then referred us back to Masilela. The M&G then contacted the TAC in Mpumalanga to find out whether it had a copy.
The TAC's Nqobile Shabalala told us: "I have a draft of the provincial strategic plan, not the final version. My draft version excludes the monitoring and evaluation sections that I understand have not been done. I received the draft in February this year." He said the delay in the finalisation of the new plan is due to "a lack of political buy-in from the premier and provincial Aids council".
"The TAC, however, marched against this issue in April in Secunda this year, and after that the premier has committed to driving the process and getting the South African National Aids Council to assist with the plan," he said.
Nomsa Ntimba from the provincial health department confirmed that the monitoring and evaluation of the plan is still lacking and that the national Aids council would intervene. "The rest of the plan has, however, been published," she said.
Malfunctioning Aids council
According to the national Aids council's head, Fareed Abdullah, all provinces generally experience problems with monitoring and evaluation components, but Mpumalanga faces deeper problems due to the malfunctioning of its Aids council.
"We've been asked to revitalise the provincial council and have so far guided the appointment of new staff and improvement of the civil society component," he said.
The M&G eventually tracked down a copy of the latest provincial strategic plan from a source outside of government who does not want to be named. This week, Abdullah also sent the M&G a copy. Shortly before our deadline the Mpumalanga health officials sent us a copy of the report – almost a week after we requested it.
According to the plan, the number of multidrug-resistant TB (MDR-TB) cases in the province had more than doubled from 152 in 2007 to 308 in 2010.
"This is attributed to the failure rate of new smear positive treatment outcomes [a test that indicates whether drugs are effective and a patient has become less infectious], which increased from 1.7% in 2007 to 2.3% in 2009," the plan states.
MDR-TB is a form of TB for which ordinary TB medicine does not work. It is much more complex and expensive to treat.
The national health department's decentralisation MDR-TB policy, which was approved in August 2011, has largely not been implemented in Mpumalanga. According to the policy, MDR-TB patients should be able to collect their treatment from health facilities close to their homes.
Mpumalanga health department figures sent to the M&G by the provincial health department spokesperson show that MDR-TB drugs are not available at Mpumalanga clinics, but only at the province's five TB hospitals.
Sydney Masinga is a Bhekisisa health journalism fellow