Editorial

World AIDS Day 2008 saw a turning point in the way leadership in South Africa is addressing HIV and AIDS. For the first time in history government, business and labour spoke with a united voice and called for action to halt the spread of new infections. There were no arguments about who caused the epidemic, why we have an epidemic, how it should be treated and where the money should go. The message and theme for WAD 2008 from the SA National AIDS Council, the Deputy President, the Minister of Health and Cosatu was simple and clear:

“Leadership and unity. Individual and collective action to stop HIV and AIDS.”

As we reflect on 2008, we can ask ourselves as business in SA whether we have failed or succeeded in addressing the impact of HIV and AIDS. Have we been successful in our workplace programmes this year? Have we made a big enough contribution to the communities within which we operate in? Being business men and women, we would also like to follow the formal route of doing such an assessment instead of relying on opinions and hear say evidence. The monitoring and evaluation of our HIV and AIDS workplace programmes is crucial for us to ensure that we are achieving our goals, obtaining returns on our investment and ensuring that we can motivate ongoing budget allocations for HIV and AIDS in the workplace.

This edition of AAAO focuses on Monitoring and Evaluation. See our Research and NSP Fact file to obtain a better understanding of what we mean with M&E. Linzi Smith, an expert on management system standards provides us with a great summary on what management system standards are, and introduces us to the HIV and AIDS workplace management system standard, SANS16001: 2007. This standard is an excellent tool to help us achieve best practice in our HIV and AIDS workplace programmes.

From the AAAO editorial board and the Metropolitan team, we would like to wish you a wonderful Festive Season. Drive safely and remember to use a condom.

Nathea

What is a Management System Standard?

• Management System Standards consist of a set of absolute requirements for achieving specific outcomes through actions deemed to be in line with currently accepted best practice.
• These outcomes must be objectively verifiable by an auditor trained in the specific field being audited.
• Formal management system standards are created by National Standards bodies such as SANS (South African National Standards)
• All management system standards are based on the philosophy of continuous improvement
• Consists of interrelated components all working together to achieve specific outcomes

Most HIV programmes have isolated components that do not interrelate or complement one another. An HIV and AIDS management system will bring all the components of your HIV programme together to ensure that they are all working towards achieving the targets and objectives and success criteria set out in your Policy and Strategic Plan.

The picture below depicts all the components required for a VW Golf. The components however are not working together. As long as they remain separate, the car will not be a car.

Most HIV & AIDS programmes do not have all the components required for a management system. There is some information and awareness, some HIV testing and some treatment, care and support. Many of these programmes are operating in isolation and do not feed into or support one another.

Management System Standards are therefore:

A benchmark of achievement based on a desired and stated level of excellence which includes both qualitative and quantitative data.

How do management system standards work?

• First, they are designed to mitigate risk.
• Second, they are written in collaboration with stakeholders (technical experts, consumers, industry and regulators), working together to define best practice.
• Third, they are regularly updated to stay abreast of best practice. The year immediately after the number of the standard denotes the latest updated version. E.g. SANS 16001:2007 or OHSAS 18001:2007
• Fourth, and most importantly they can be audited and verified by a recognized certification body. This ensures top management buy in, leadership, commitment and accountability and prevents ‘window dressing’ or ‘lip service’.

Professionals in the HIV & AIDS field are mostly unfamiliar with management system standards.

Fields such as Quality Management, Environmental management and Occupational Health and Safety management are however very familiar with management system standards, the most common of which are:
ISO 9001 – Quality
ISO 14001 - Environment
OHSAS 18001 – Occupational Health and Safety
SA 8000 – Social responsibility
ISO 27001 – Information security
ISO TS 16949 – Automotive quality
ISO 22000 – Food safety

SANS 16001:2007 – HIV and AIDS workplace management system standard
 
SANS 16001:2007 was launched in July 2007 by the SABS (South African Bureau of Standards) as a workplace response to the hyper-endemic epidemic experienced here in Southern Africa.
SANS 16001 is compatible with the most commonly utilised management systems in business, namely: ISO 9001, ISO 14001 and OHSAS 18001. This makes the SANS 16001 management system easy to introduce into an already entrenched and accepted business management system. The introduction of systems that are too different from already existing business systems causes resistance from operations as HIV & AIDS management is still not accepted as a business imperative as it is not deemed ‘core business’.

The standard (like all other management system standards) operates within a continuous improvement cycle: The APIME cycle.
A = Assessment (of HIV & AIDS related risk and current interventions)
P = Planning (based on the assessment utilising the logic model)
I = Implementation (of the plan to achieve outcome and impact indicators)
M = Monitoring (continuous monitoring of the plan and implementation to immediately identify problems and to ensure the plan is executed)
E = Evaluation of outcome and impact indicators for return on investment, reduction of new infections and effective management of those already infected.

The final evaluation is done by carrying out a certification audit.
There are a total of 28 clauses and sub-clauses contained within the SANS 16001 Standard that an organisation must achieve in order to gain certification.

Risk based certification auditing provides:

• Excellent information to top management regarding the gaps between commitment, reporting and actual responses and achievements.
• Improves the organization’s ability to meet their stated strategic and operational targets and objectives and outcome and impact indicators.
• Prevents ‘window dressing’ and ‘lip service’.

Steps for organisations wishing to align their HIV workplace programmes to SANS 16001:2007

1. Top management is to make the decision to align their HIV programme to SANS 16001 and communicate such decision to all stakeholders.
2. Appoint one or more employees to establish, implement, monitor and continually improve upon the HIV & AIDS management system and communicate such appointment to all stakeholders.
3. Send the appointee/s on SANS 16001 Implementation training
4. It takes about 1 year for a well entrenched HIV programme to align against the Standard and about 18 months to 2 years for a company without any existing HIV programme. This does however depend on the size of the company, the level of commitment to achieve certification and if other management systems are already in place (this makes it easier to establish SANS 16001)
5. Contract a SANS 16001 auditor to carry out an internal audit (this is a requirement prior to carrying out an external certification audit) or if your organisation has multiple sites you can train up a few internal auditors that fit the criteria to do the internal audits. Auditors should not audit their own work.
6. Correct all non-conformities found by the internal audit
7. Call for the external certification audit
8. Receive certification
9. Maintain the system by continually improving the system and maintaining certification

Auditors and auditing

Most people are familiar with financial auditors, but unaware that there is a whole world of management system auditors. These are people who are technical experts within their field who have been trained to become auditors in that specific field.

ISO 19011:2002 is the international standard that sets forth:

• A clear explanation of the principles of management systems auditing.
• Guidance on the management of audit programmes.
• Guidance on the conduct of internal or external audits.
• Advice on the competence and evaluation of auditors

All management system standard auditors training includes ISO 19011 plus the particular standard that the learner wishes to become an auditor in.

There are two bodies that register such auditors who have complied with and passed both ISO 19011 and the relevant standard.
The first is IRCA – the International Register of Certified Auditors and
The second is SAATCA – the Southern African Auditors and Training Certification Association.

Due to low level or concentrated HIV epidemics in the first world, ISO does not have an HIV & AIDS management system standard (as yet). The SADC region is the only region in the world with a hyper-endemic epidemic and thus it makes sense that the South African Bureau of Standards developed a National HIV & AIDS Workplace Standard. The standard is based on the ISO format and the ISO requirements for both training of auditors and conduct of audits.

SAATCA is therefore the body that registers and ensures that SANS 16001 auditors comply with continuous professional development.

Organisations should be very selective when contracting auditors to do SANS 16001 audits. Some organisations are advertising that they do SANS 16001 auditing or auditor training; however they do not have SAATCA approval or SAATCA quality control measures in place.

SAATCA registers individual auditors if they comply with the SANS 16001 criteria as well as approves SANS 16001 auditor training programmes if the training programme complies with the SAATCA, ISO and IRCA criteria. Auditor training can only be carried out by a SANS 16001 lead auditor. At this point in time only Linzi Smith (the author of this article) is registered with SAATCA as a Lead Auditor in the SANS 16001:2007 scheme.

There is however several other technical experts who have been trained as SANS 16001 auditors and who are currently completing the required number of hours to gain their registration with SAATCA.

The next SANS 16001:2007 auditors’ course will be in the first week of March 2009 in JHB.
To ensure that SANS 16001 auditors are of the highest quality there are specific minimum criteria that must be complied with to gain entry to the auditor’s course. This is to protect organisations from contracting SANS 16001 auditors that are not experts in the field of the management of HIV in the workplace and thus having no value added to their HIV workplace programme.

Conclusion

SANS 16001:2007 is not another component to add to your existing HIV programme. It is the overarching system that all components of your current programme will fit into in order to achieve current best practice in the management of HIV and AIDS in the workplace. It is therefore far more than merely a monitoring and evaluation tool.

Many business leaders have become complacent about HIV & AIDS workplace risk management due to the epidemic having been around for 28 years now.
What most do not consider is that we moved from having a low level epidemic up to 1991, then on to a concentrated epidemic from ‘91 to ‘94. We then moved into a generalised epidemic which means that 5% or more of our adult population was infected with HIV. We have been in a hyper-endemic epidemic since 1999. This means that more than 15% of our adult population is infected with HIV. The SADC region is the ONLY region in the world with a hyper-endemic epidemic.
We should therefore be asking top management who are not aligning their HIV programmes against SANS 16001:2007 if they are too afraid or embarrassed to expose their HIV programmes to external auditors or perhaps they are simply unaware of the existence of the Standard?

Linzi began her career as a nursing sister at Addington Hospital in KZN where she looked after her first AIDS patient in 1982. She then moved to the Dept. of Health (Local Govt.) where she initiated the HIV & AIDS programme in 1988. She facilitated all aspects of the programme until 2000 when she left to start ETC. ETC provides comprehensive HIV programmes to the workplace (this excludes Disease Management). Linzi has qualifications in General nursing and midwifery from Addington Hospital and went on to study Community Science at Durban University of Technology, Education and Psychiatry both at the University of KZN and the Management of HIV in the workplace at Stellenbosch University. She is currently studying corporate psychology at UNISA.

Published by
Metropolitan Holdings

Editorial Board

Leonie Engelbrecht
(021) 917 3294
lengelbrecht@metropolitan.co.za

Nathea Nicolay
(021) 917 3090
nnicolay@metropolitan.co.za

Nosipiwo Ngxabazi
(021) 940 5150
nngxabazi@metropolitan.co.za

Tjaart Esterhuyse
(021) 940 4950
testerhuyse@metropolitan.co.za