The Treatment Action Campaign — having held its seventh national congress and reflecting on 24 years of historic achievements — knows its mission to get primary healthcare to the vulnerable and the poor is as monumental as ever. There is still “much to be done”, says newly re-elected national chairperson Sibongile Tshabalala. 

The right to access health services, found in Section 27 of our Constitution, is arguably one of the most important rights because without health we are unable to do much. Since it was founded in 1998, the community-led Treatment Action Campaign (TAC) has been campaigning for everyone to have equitable access to healthcare. It held its seventh national congress from 27 to 29 August 2022.

Delegates at the Treatment Action Campaign’s 7th National Congress. (Photo: Denvor de Wee)

“The TAC is one of the organisations that still has its independence from any political party or government institution. Our independence allows us to ask government hard questions and demand transparency on issues that affect communities. The TAC’s place is to stand on the principle of putting people’s needs first and to demand that the government listens and fulfils its promises. We are here to advocate for people to get services on the ground,” newly re-elected national TAC chairperson Sibongile Tshabalala told Maverick Citizen. 

The TAC made history in 2002 when it won a constitutional challenge forcing the government to make nevirapine, or a suitable substitute, available to pregnant mothers at public clinics. The Constitutional Court held that an extensive and inclusive antiretroviral treatment programme was a realistic and reasonable demand on the government and the public health system. This meant that being infected with HIV was no longer a death sentence since people could access life-saving treatment.

And it was thanks to the TAC that South Africa’s mortality and mother-to-child transmission rates have dropped significantly, according to director of the Rural Health Advocacy Project, Russell Rensburg.

“When I look back to when HIV/Aids was at its worst around 2001/2, our maternal mortality rate was skyrocketing, our under-five-years-old mortality rate was terrible. If it weren’t for the TAC we wouldn’t be in the position we are today where our mortality rate is almost down to the universal health coverage goal [with a] significant drop in mother-to-child HIV transmission. I think all that can be attributed to TAC activism. They were the big push that changed the public health system,” he told Maverick Citizen.

“With the professionalisation of civil society, the TAC is still one of the few organisations that is still democratic and that still has a direct link to its constituency and is organised in that way.” 

Since its establishment the organisation has used the Constitution as a means for advocacy, ensuring ordinary people know their constitutional rights, but has also consistently focused on getting people to understand the science behind the medication they take and its effect on their bodies — so they are literate on their own healthcare and adhere to treatment. 

Measurably the TAC’s impact has led to millions of lives saved in South Africa, which has the highest HIV/Aids infection rates in the world.

Speaking at TAC’s recent congress on 27 August, chairperson of the TAC board Fareed Abdullah said: “Just 20 years ago our healthcare system had an all-time low life expectancy rate of just 55 years and maternal mortality was quite high. Without the leadership shown by the TAC on early response to HIV, we wouldn’t be in the place where we are today, where life expectancy has now increased to over 60 years. The insistence and power of activists in getting access to lifesaving HIV treatment is what makes us stand firm with the TAC in realising the right to health for all.”

Because of the TAC’s large footprint across the country, it has been conducting public health facility monitoring campaigns and reporting its findings to the government in order to hold it accountable for the state of the public health system, as well as working to ensure that the 80% of the population who depend on the public health system get “equal access to quality and dignified healthcare services”. 

Treatment Action Campaign members spend the night in protest outside the office of Gauteng Premier David Makhura on Tuesday, 10 August 2021. (Photo: Anele Yawa / TAC)

In the dead of winter 2021, more than 70 TAC members slept for two days on the pavement outside Gauteng premier David Makhura’s office, following a protest that featured them holding a coffin symbolising the many deaths occurring at the hands of the department. This demonstrated their willingness to put even their bodies on the line for the rights of ordinary South Africans.

Looking forward

Speaking to Maverick Citizen, Tshabalala said that while she was happy that the TAC had entrusted her yet again with leading the organisation, there was still much to be done. 

“Noting that the politics of the country is always turning in terms of healthcare services, we’ve seen what’s been happening now in terms of people being chased out of hospitals because they are ‘non-South Africans’. We cannot sit back and allow people to violate other people’s rights to services. This is a political matter because the government is not saying anything. The healthcare system is not collapsing because of non-South Africans, but because our government is corrupt and is taking a lot of money from the healthcare system, and we have evidence of a lot of gaps in the system.

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“My focus during my term will be to strengthen the TAC and grow our international solidarity with partners, and I would like to see TAC as a mass movement that is more effective on the ground and district level where the issues are not just at a national level.

A Treatment Action Campaign activist addresses attendees at a World Aids Day event in 2021. (Photo: Denvor De Wee / Spotlight)

“I will also be working on building more women’s leadership within the organisation. I don’t want to be the chairperson forever; I want to move towards more of a mentorship and support role for upcoming women’s leadership.”

Tshabalala said the TAC had been working on Covid-19 programming that involved going out into communities to educate people about the virus as well as vaccines and why they should vaccinate. “We have in many communities worked with the Department of Health so that after we educate people on vaccines, the department would be there to then offer vaccines to people, which has made so much of an impact. As we did with HIV, people need to understand first what the vaccine is and also see others who have been vaccinated sharing their stories.”

Greatest strength

Public health specialist Dr Lynne Wilkinson told Maverick Citizen that the TAC’s greatest strength had always been to be very independently minded and led only by community needs.  

“The TAC’s role in community-led monitoring through the Ritshidze Project is critical. This needs to be scaled so that we grow community monitoring and ensure that the people actually using the public health system have an effective way to feed back what is not going right, what they want… without the TAC, that can play that role between individual users and government, people’s voices won’t be heard.

“We mustn’t underestimate the strength of a voice like the TAC to push for things to be done. I think the difficult part is that there is so much to be done for equitable access to medicines and health services and if you spread yourself too thinly you may not achieve any of these, and it’s [for] the TAC to decide where they can make the most impact.

Members of the Treatment Action Campaign and partner organisations march to Parliament in Cape Town, South Africa. The protesters demanded that the government do more to halt the spread of tuberculosis. (Photo: Gallo Images / The Times / Esa Alexander)

“A people’s healthcare movement has to be made up of multiple actors all working together, and as much as TAC can play a role, the better. It may also mean mentoring and allowing more localised organisations to grow and take on specific issues so that the TAC isn’t trying to take on everything.”

Asked whether the government takes the TAC seriously, Wilkinson said: “I think they take the TAC more seriously than we give credit for, but where they don’t take them seriously enough is having a permanent seat at the table and not only when things go wrong like drug stock-outs or [when] something terrible has happened somewhere and the TAC calls it out and people stand up.”

The government should not only take accountability when its “back’s against the wall”.

It is clear that the role of a mass, community-led organisation is important for the realisation of people’s access to healthcare. The task at hand seems to be how the TAC can use its mass-based power to get the government to consistently deliver primary healthcare to vulnerable communities that are not part of the privileged 16% of the population who can afford medical aid. DM/MC