Combating HIV and/or AIDS: A challenge to Millennium Development Goals for disaster managers in the Southern African Development Community

Disaster management is a process of planning and implementation of measures involving multiple disciplines and sectors; hence Millennium Development Goals (MDGs) cannot go unnoticed. Approximately 189 member states agreed to endeavour to achieve MDGs which should be accomplished by 2015. The purpose of this research was to establish the primary involvement of the disaster management fraternity within the Southern African Development Community (SADC) region in this agreement. SADC countries are the countries with a high prevalence of HIV and AIDS and they feature on the disaster manager’s priority list of hazards, hence the focus on MDG 6 for this study. Various data gathering tools were employed and included making use of indicators developed by the United Nations to review disaster management statutes or civil protection statutes and scholarly documents on the progress of MDG 6. Structured interviews were carried out with heads of disaster management centres of SADC countries through the guidance of MDG 6 indicators. The main findings were that most statutes do acknowledge the fight against epidemics and most disaster managers are aware of MDG 6 and are involved in its achievement. It was recommended that disaster managers should be part of the Post 2015 MDG delegation.


Introduction
In the year 2000, the heads of 189 countries signed the United Nations Millennium Declaration to commit to the combating of poverty, hunger, disease, illiteracy, environmental degradation and discrimination against women by the year 2015 (United Nations 2010). Disaster management plays a big role within a countries' government service, of providing humanitarian assistance, and because of the nature of the Millennium Development Goals (MDGs), the disaster management sector is likely to be expected to contribute immensely in the achievement of these goals. The disaster management fraternity encompasses non-governmental, governmental and private sectors which all contribute to humanitarian activities. However, for the purposes of this research, only the government sector will be explored. The focus is only on this sector because the state is responsible for setting up the environment and the legal framework in which its departments and other organisations operate. The government of a country oversees all the activities that are carried out by different organisations: national and international, private and non-profit making organisations, hence the signatories include heads of states. The term Disaster Managers as humanitarian officials is used in this research, however, in different SADC countries these humanitarian officials are given different titles.
According to United Nations Development Program (UNDP) (2013a) the MDG 6 goal aims at combating HIV and AIDS, Malaria and other diseases. The anticipated outcomes of MDG 6, with HIV and AIDS in particular, are amongst the many targets that many countries are struggling to reach. Although the universal access to antiretroviral therapy for all who need it was anticipated to be reached by 2015, it was evident that this target was beyond accomplishment by the year 2010. This is worrisome because of the infection rate in low and middle income countries where approximately 820 000 women and men aged 15-24 were newly infected with HIV in 2011. According to the United Nations (2013), basic knowledge about how to prevent HIV amongst young women and men in Sub-Saharan Africa remains low, as it is a region that is globally hardest hit by this epidemic. Sub-Saharan Africa is the region with the most number of people living with HIV worldwide.
As discussed above, the complex nature of MDG 6, in particular HIV and AIDS, has made it a cause for concern and is of interest to the researchers. As the researchers are in the disaster management profession, they focused on disaster management as a humanitarian fraternity Disaster management is a process of planning and implementation of measures involving multiple disciplines and sectors; hence Millennium Development Goals (MDGs) cannot go unnoticed. Approximately 189 member states agreed to endeavour to achieve MDGs which should be accomplished by 2015. The purpose of this research was to establish the primary involvement of the disaster management fraternity within the Southern African Development Community (SADC) region in this agreement. SADC countries are the countries with a high prevalence of HIV and AIDS and they feature on the disaster manager's priority list of hazards, hence the focus on MDG 6 for this study. Various data gathering tools were employed and included making use of indicators developed by the United Nations to review disaster management statutes or civil protection statutes and scholarly documents on the progress of MDG 6. Structured interviews were carried out with heads of disaster management centres of SADC countries through the guidance of MDG 6 indicators. The main findings were that most statutes do acknowledge the fight against epidemics and most disaster managers are aware of MDG 6 and are involved in its achievement. It was recommended that disaster managers should be part of the Post 2015 MDG delegation. with regards to their involvement in the achievement of this specific goal. This study was undertaken with two objectives, which are as follows: • To review disaster management statutes of SADC countries, to identify if they support the achievement of the MDG 6 with a focus on HIV and AIDS. • To determine if the disaster management fraternity within the SADC region recognises the Declaration and the importance of achieving the millennium goals.
The successful achievement of MDG 6 and all the other MDGs requires country ownership and commitment by the government, to spur the institutional changes that are needed to effectively ensure the sustainability of capacity building efforts. This research was strictly undertaken on the scrutiny of the Disaster Manager's involvement and contributions towards the achievement of MDG 6, with a focus on HIV and AIDS, hence the purposive exclusion of the health statutes review and the Health Ministries of the respective countries.

Southern African Development Community region
The Southern African Development Coordinating Conference (SADCC) was formed in 1980 (later to become SADC), and functioned as an informal partnership with the main aim of coordinating development projects. Through the Windhoek Treaty of 1992, the SADC replaced the SADCC and became a development community with a legal identity, to promote unity, social and economic integration and development in the region. The SADC consists of 15 Member States and is a relatively large sub-region (6.2 million km²) composed of countries of diverse sizes (SADC 2008). The map in Figure 1 shows the SADC member states.
The SADC, since its inception, has understood the importance of the role that the health sector and health provisions impact on all areas of development in the region. Heads of member states agreed to set up the SADC Protocol of Health of 1999, which became operational in 2004. The protocol recognised HIV and AIDS as major areas of focus for the health sector (SADC 2008).

Overview of HIV and/or AIDS in Southern African Development Community
According to the UNAIDS Global Report (2013) (Botswana 2010;Lesotho 2006).
The key drivers fuelling the spread of the disease in the region are the widespread practice of polygamous relationships as well as the multiple sex partners that many men have at any given time. The crippling effects of the HIV epidemic have far-reaching social and economic consequences, affecting not only the health sector but every aspect of governance and development in the region. The scenario presented above does not bode well for the region's ability to meet MDG 6 (UNAIDS 2013).

Research design and methodology
The research made use of a qualitative approach because of its exploratory and interpretive nature. The content of relevant literature was systematically examined in detail for the purpose of identifying specific themes and biases which influence the support of MDGs by the disaster management public sector within the SADC countries. For the research design and methodology of the study, various data gathering tools were employed. This included the use of indicators developed by the United Nations to monitor and evaluate the progress of the set targets that have been imposed with the goal of combating HIV and AIDS. MDG 6 has three main targets but this research focuses on only two target areas and the indicators are listed in Table 2.
The indicators were used in this study to analyse the achievement of SADC countries in reaching these targets, and to analyse if disaster managers in each country made any contribution. The indicators were also used in the telephone interview questionnaire asked to heads of SADC national disaster management centres.
Heads of the Disaster Management centres for the 15 member states were contacted telephonically for their input. Contact details were collected from the United Nations (UN) website for the individual countries. Questions for the telephone interviews were compiled according to the indicators for MDG 6. During the telephone interviews the heads of the centres were interviewed to determine their knowledge of each target, and in which indicators they were involved or made a contribution. Document analysis and review formed part of the methodology with Disaster management statutes of all the SADC countries being collected and reviewed in detail to examine if they support the MDG 6. Most of the documents analysed were downloaded from the websites of the various countries. The key terms that were focused on were not limited to health related issues, HIV and AIDS and epidemics. Other documents relating to MDG 6 were reviewed to ascertain the measures taken by the SADC's disaster managers to achieve this goal. The findings were presented in a narrative form under each methodology and objective.

Limitations of the study
Reviewing and obtaining the statues was restrictive because not all countries have their documents loaded and accessible on the internet. Additionally, some of the documents obtained were either in French or Portuguese. However, the documents were loaded onto Google translate but the language translations proved difficult to follow. Despite this, 9 out of 15 countries statutes were reviewed, which represents 60% of the SADC countries. Obtaining working telephone numbers for SADC disaster management centres was also an obstacle and, furthermore, holding an interview with some of the officials could not be accomplished. Questionnaires were also emailed which resulted in a limited response. Some of the officials were not willing to discuss anything despite the assurance that the research is for academic purposes only, thus, questionnaire responses were limited.

Strategies implemented to achieve Millennium Development Goal 6 targets
There are strategies that have been put in place to avert HIV and AIDS. According to the United Nations (2013), condoms are one of the most efficient means available to help prevent and mitigate the sexual transmission of HIV. This is followed by abstinence, being faithful to one partner and antiretroviral treatment (ATT). It is then imperative to investigate which strategies disaster managers have contributed towards, or implemented as a strategic entity. These will be discussed under interviews carried out with national disaster management heads.

Content analysis: Southern African Development Community countries disaster management statutes
This section of the study discusses the findings obtained from the review of disaster management statutes of SADC countries, to examine if they support the achievement of the MDG 6. The documents obtained were labelled differently, as: policies, decrees, acts, frameworks, reports, plans and bills. Table 4 illustrates the list of countries and the collected statutes for each country.
Each statute was analysed in detail for any mention of HIV and AIDS and MDGs. This was presented in Table 5. Any mentioning of any of these words in the statutes is assumed to be a possible state of readiness for dealing with MDG 6 through the existence of clinics, Paramedic and Health Ministries. MDGs are an international initiative which  require national legal documents to support the initiative and share the same goals.
The disaster management statute of each SADC country is discussed in relation to the MDG 6, its recognition of health issues, support of the involvement of different disciplines and sectors in preventing and mitigating the impact of diseases are also taken into consideration.

Angola
According to IFRCS (2012) there are various legal documents for Disaster Management operations in Angola, however, there is no standalone document. Disaster management activities are mainly addressed by a National Plan of Preparation, Contingency, Response and Recovering from Calamities and Natural Disasters (NPPCRRCND). These documents could not be found on the internet for analysis.

Botswana
The policy recognises and supports active participation in international conducts like the International Decade for Natural Disaster Reduction (IDNDR). The policy recognises the Ministry of Health as the focal point for dealing with epidemics. Identification and recognition of these national and international organisations is a positive indication for fighting and mitigating the impacts of diseases as well as possible support for MDGs (Botswana 2010).

Democratic Republic of Congo, Mozambique and Madagascar
In the DRC the only document that was found, was last developed when the DRC was still named Zaire. Unfortunately this document is in French and could not be interpreted. According to Dr J.T. Lukusa, a Congolese disaster management student, there is no whole Act for Disaster Management but each relevant ministry has a section of disaster management.

Malawi
The Department of Disaster Management Affairs (DDMA) supports the assistance of international organisations like the UN and the UNDP in pursuit of achieving the MDGs.
HIV and AIDS is mentioned in the Act (24 of 1991) as a cross cutting issue, which makes it an important area of concern for the Malawi government. Plagues, epidemics and diseases are mentioned in the definition of disaster, as possible occurrences that might threaten life or the wellbeing of a community. Additionally, the Secretary for Health and Population sits on the National Disaster Preparedness and Relief Committee of Malawi.

Mauritius
Only a bill, cited as the Mauritius Fire and Rescue Service Act of 2013, was found on the internet. This could be an indication that Mauritius is still reactive rather than proactive about this epidemic, or their Act was not posted online.

Namibia
In its definition of disaster, plaques, epidemics and diseases, these are identified as possible events that might threaten a community's health and thereby take precedence over other circumstances. In addition to this the National Disaster Risk Management Committee has the Ministry of Health and Social Services as one of the advisors to the President and Cabinet. There is the possibility that this Ministry also advises and updates the President about the advancement in MDG 6. The Namibian Vulnerability Assessment Committee, constituencies and sub-committees have representatives for health emergency management and nurses who are usually the primary health care providers and best advocates for fighting diseases. Furthermore, according to Griffiths and Maben (2008) nurses are crucial to the delivery of 21st century healthcare. Another positive aspect of the Disaster Risk Management Act (10 of 2012) is the support and participation of organisations such as the WHO for health issues in Namibia.

Seychelles
According to Ms Divina Sabino, the head of Risk and Disaster Management which is a division within the Ministry of Environment and Energy, the disaster management policy is currently being updated and has been submitted to the cabinet for endorsement.

Tanzania
In the Disaster Relief Coordination Act (9 of 1990), under the definition of disaster, medical care is mentioned as a need that should be provided. This is a possible indication that MDG 6 is provided for by the disaster management fraternity.

Swaziland
It is stated in the Act (1 of 2006) that the Minister in charge of disaster management shall ensure integrated systems and structures for HIV and AIDS management in Swaziland and this stands as a positive initiative for achieving MDG 6. To show its support for attaining MDG 6, the Act has on its committee the Health and Social Welfare portfolio.

South Africa
The . To keep abreast of international developments, the framework has key performance indicators, and one relevant indicator specific to this study is that a disaster risk management forum must be established for the purpose of co-operation with countries in the SADC region, for effective operation. South Africa's commitment to contributing to and achieving MDG 6 is found in these two statutes.

Zambia
In the respective Act (13 of 2010), health care is mentioned as an essential commodity, which is a positive recognition when it comes to dealing with any diseases that might threaten Zambia. Epidemics are listed as potential hazards that might affect the country, and this is a form of preparedness. For the successful achievement of MDG 6, all relevant experts needed to avert epidemics are required to be involved on the Zambian National Disaster Management Council (Zambia 2011). The Ministry of Health forms part of this council. Records showing the location of health facilities and the particulars of health practitioners are mandated to be included.

Zimbabwe
Epidemics, plagues and diseases form part of the country's definition of disaster. This is a positive perspective. There is also a National Civil Protection Committee mentioned in this definition, of which the Secretary for Health should be a member. This reinforces the government's commitment to disaster relief. Whilst a declaration of a state of disaster is in force, the civil protection officer may, by order in writing, direct any person to maintain specified stocks of medical supplies and other supplies for use during the disaster. This is a positive section in the Civil Protection Act (5 of 1989) which indicates support for the forestalling of any disease and the possible contribution to the achievement of MDG 6, given the availability and accessibility of resources in the country. However, this Act does not show any support or mention of any international arrangements. Table 6 illustrates the countries which were contacted and the various responses encountered. From the 15 SADC countries all disaster management centres were contacted via telephone numbers obtained from the UNDP website. However, there was no answer from Madagascar, Tanzania or Angola. The number listed for Mauritius was for the Weather Services Department and, hence, there was no success. For the DRC, Botswana, Namibia, Zambia, Lesotho and Swaziland, the respondents requested the questionnaire to be emailed to them, but it was never returned. Numerous follow-up The interview questionnaire was disregarded in this instance.

Interviews with heads of national disaster management centres
South Africa: Mr Ken Terry the head of the NDMC indicated knowledge of MDGs, in particular MDG 6. Their successes and strategies, in dealing with this MDG, were: • effective disaster response coordination • contingency plans per hazard in the process of being developed • integrated disaster response planning with the Department of Health (DoH).
The challenge with this is that the DoH has not developed a disaster management plan for the health ministry in particular, and that no meetings with MDG's on the agenda were attended by the NDMC representatives. The only involvement of the NDMC was that of participating in awareness programs for halting communicable diseases at local, District and Provincial levels. The specific diseases in which they were strongly involved included cholera, Ebola and H1N1. With regards to rating themselves in terms of how far they have gone in achieving the targets in South Africa as a whole from a scale of 1% -100%, they rate themselves at 60%. This is because of the strong role that disaster management plays in coordinating and supporting the relevant sectors in achieving the targets.
Seychelles: The representative of disaster management in this country, Mr Paul Labaleine, stated that they were aware of the MDGs, and he clearly gave the accurate description of MDG 6. As a country, they explained the following: 'The Seychelles government is successfully providing free medical care for all Seychellois and residents, free of charge. This included anti-retroviral treatment. The government has also ensured tap water is safe to drink and invest in proper sewerage systems to ensure hygiene and sanitation standards in Seychelles are on par with international standards.' On the issue of the disaster management office participating in meetings that included MDGs as part of the agenda the respondent replied: 'Yes. Our office has been involved in the preparation of the National report for the 3 rd International Conference on Small Island Developing States'.

Findings: General discussion of statutes reviewed and interviews
As statutes are formally written enactments of a state or ministry for the purposes of prohibiting, declaring and commanding some action, it was significant for this study to review the SADC countries disaster management statutes in relation to this study. As mentioned earlier this achievement, of MDG's, requires national legal documents to support the initiative and share the same goals, hence the review of these statutes. All nine countries whose statutes were reviewed, made mention of health care issues and institutions, which was considered an acknowledgement and recognition of disaster management's close relations with other sectors and disciplines at both national and international level.
The mentioning of diseases, in particular HIV and AIDS, is considered a possible cause of concern for disaster managers. South African statutes contained the richest information sought after in this research. The mentioning of nurses in the Namibian statute was a unique highlight, compared to other statutes, because nurses are considered as primary health caregivers when it comes to dealing with diseases. In Lesotho, despite the declaration of HIV and AIDS as a disaster which was supposed to be a positive move in terms of obtaining international intervention, achieving the targets seems to be a challenge because of the socio-political and economic situation. The unavailability of documents on the internet, or those not in English, can make it difficult for humanitarian international investors to provide humanitarian assistance as statutes are very important for any intervention.
The initial response, from the South African National Disaster Management Centre, before the questionnaire was filled in by its Head, was that the disaster management centres are not involved in or deal with any issues related specifically to the health issues of the millennium development goals. A representative from Lesotho also made the same inference. Malawi's response to the questionnaire and findings in the statute analysis seems positive in terms of working within their mandate and their willingness to halt diseases. Given the responses from the Zimbabwean, Lesotho and South African officials, it can be assumed that the disaster management statutes are just bare documents created merely to fit in line with national government and international requirements. It should be a prerequisite for anyone, despite the directorate within the disaster management centre, to have comprehensive knowledge about the statutes that govern their operations. Besides the lack of knowledge about these statutes, disaster managers are supposed to lead and coordinate different disciplines and sectors to reduce risks and manage possible disastrous events, and definitely their involvement in all MDGs should not go unnoticed.

Recommendations
• Most of the countries statutes do not make any reference to international initiatives, health institutions, HIV and AIDS and other diseases, and also most interview responses indicate that the centres are not particularly involved in the achievement of MDGs. It is, thus, imperative for the Millennium Development Goal Post 2015 Development Agenda to make it mandatory for signatory countries to send their disaster management officials to form part of this delegation as they are the main coordinators of humanitarian work in the relevant countries. • Education, Training and Research, within the field of disaster risk reduction and management at a national and international level, should be compulsory for disaster management officials employed at national disaster management centres. Knowledge and participation in evolving trends within this field is vital. • SADC offices should create a comprehensive, updated database of resources and documents for research by providing an archive which has all disaster management statutes in English, as it is the main commercial language in the SADC region. It will also be valuable if all national disaster management centres submit their documents to the SADC office. • A regional approach to managing risk is essential hence national government disaster managers in member states of the SADC should form a well-coordinated, integrated, institutional protocol with a focus on coordination to deal with MDGs and other initiatives.

Conclusion
The formulation of the MDGs was an innovative initiative that was established to fight poverty and calamities.
With such an initiative the study aimed at investigating the involvement and contributions made by the disaster management fraternity since the establishment of this Declaration in the year 2000. This was accomplished through the analysis of national disaster management statutes, the review of literature and telephonic interviews with heads of disaster management centres. Telephonic interviews and the obtaining of statutes proved to be the most difficult method of data collection, especially considering that not all countries disaster management plans are well established. The analysis of some of the obtained statutes did indicate that they embraced the support to fight and contain diseases. However, the disaster management's role of coordinating humanitarian activities is clearly visible through the statutes analysed, but now the achievability of the specific goal depends on social, political and economic dynamics of the individual SADC states. Further research on the assessment of the SADC health ministries or departments, in the achievement of the sustainable development goals, with a specific focus on health issues, is strongly recommended.