Improvements in secondary and tertiary hospital capacity should not come at the expense of basic care for the poor, the Health Systems Trust (HST) says. The Durban based NGO was responding to a speech by Minister of Health Manto Tshabalala-Msimang, in which she said R2 billion would be spent on upgrading and revitalising hospital facilities next year, including the building of 18 new facilities. The minister also said inequities in the funding allocated to primary healthcare in different provinces would have to be addressed, with some provinces allocating R50 per person each year, and others R300. But Antoinette Ntuli, HST information dissemination and equity director, urged her to ensure resources and initiatives are "fast-tracked in poor, rural areas".
Equity in Health
The proposed Certificate of Need (CoN) for doctors, which they claim intrudes on their right to freedom of movement, will remain. This was the word from Health Minister Manto Tshabalala-Msimang in a February media briefing. "The government will move on the CoN framework to achieve our goals in terms of the constitution," the minister said. "The CoN will remain. It is intended to transform the healthcare sector in South Africa."
On the 10th of February, the Treatment Action Campaign (TAC) and the AIDS Law project held a joint seminar on transformation of the South African Health System, including both the public and private sectors. This is part of preparations for a conference to be held in May with the aim of developing detailed policy positions for TAC's Campaign for a People's Health Service. Presentations made at the workshop can be found on the TAC website.
The South African Medical Association (SAMA) organised a protest march by doctors to the opening of parliament on 6 February. Amongst other grievances, the march was over controversial new legislation that includes a proposed Certificate of Need (CON) that would impact on where doctors are able to practice. SAMA said in the build up to the march that the CON would intrude "on doctors’ right to human dignity; freedom of movement and residence; freedom of trade, occupation and profession; and property rights". This sparked a debate when the Peoples' Health Movement came out in support of the CON, saying it represented an attempt to address the greatest inequity in S.A.'s health system, namely the widening gap between the public and private health sectors. Read the PHM press statement and a report from the SAMA website about the march by clicking on the link below.
The developed world is breaking its pledges to fund sexual and reproductive health care in the developing world, says a new report published by the Alan Guttmacher Institute and the United Nations Population Fund. "It is time for developed countries to live up to the pledges they made at the 1994 International Conference on Population and Development (ICPD). In 2000, these countries provided $2.6 billion (£1.4; €2.1bn) for sexual and reproductive health services in developing countries - less than half of what they had pledged at ICPD for that year," the report states.
In mid-December, the World Health Organisation (WHO) released its annual World Health Report, the first under the leadership of Director-General Jong-wook Lee. Building on its earlier announcement of a plan to bring AIDS treatment to 3 million people by the end of 2005 (http://www.africafocus.org/docs03/who0312.php), the WHO called for a return to the goal of "Health for All" adopted twenty-five years ago. The report calls for strengthening health systems across the board to address the widening gap between rich and poor countries, and it stresses that AIDS treatment will not be sustainable unless it is linked to the strengthening of primary health systems. The report thus presents a sharp contrast to the U.S. model of commercialized health care and the bilateral approach stressed by President Bush's new AIDS initiative. U.S. officials have used the weaknesses of national health care systems in African and other developing countries as an argument for a slower pace in funding for AIDS programs. The WHO reverses that argument, stressing the need for immediate steps to build additional health care capacity. This posting from the AfricaFocus Bulletin contains excerpts from the WHO's World Health Report, as well as links to additional recent reports from late 2003.
HIV/AIDS awareness campaigners from developing nations are mobilising themselves to form a strong bloc to confront the World Trade Organisation (WTO), which they claim has made it difficult for people living with the disease to access treatment. They claim that the trade body articulates interests of western nations, which have suppressed developing states, giving way to unfair trade. This, the campaigners say, has made it impossible for poor nations to obtain cheap drugs, especially antiretrovirals (ARVs).
“At least tens of thousands of children die every year” because the World Health Organisation and the Global Fund for AIDS, Tuberculosis, and Malaria (GFATM) continue to fund (or support the funding) the purchase of old drugs by African countries rather than the newer, more effective and dramatically more expensive artemisinin-class combination therapies (ACT), according to an editorial “viewpoint” published in the January 17th issue of The Lancet. The editorial, written by academic malaria specialists and some researchers in the developing world accuses both organisations of “medical malpractice” and blames them for caving into pressure from donor governments such as the USA, whose aid officials say that ACT is too expensive.
Senior WHO and World Bank officials have warned donor countries and developing countries that many poor nations are behind in meeting the millennium development goals (MDGs) by the target date of 2015, and stressed that more resources and good policies and programmes are needed. The health-related goals include: halving maternal and child mortality rates by 2015; halving the proportion of people who suffer hunger; combating HIV/AIDS and other infectious diseases; and enhancing access to safe drinking water and essential drugs. A recent study by the World Bank concluded that so far no sub-Saharan African country is on target to reach the MDGs.
The South African AIDS advocacy group Treatment Action Campaign, which has been nominated for the 2004 Nobel Peace Prize, announced plans in January for a new campaign in its battle for universal AIDS treatment that would target inequities between the country's public and private health care systems, Reuters reports. South Africa's health care system has retained its apartheid-era structure of "elite" private hospitals, which primarily care for wealthy whites, and public hospitals, which are overburdened in their attempts to care for the majority of blacks, Mark Heywood of TAC said. In its campaign, TAC plans to target private hospitals, which it says are "too expensive," and push for a "people's health service for a people's antiretroviral program," Heywood said.