Thoughts on South African and international politics and culture

Thursday, July 29, 2004

SA's collective health in trouble
The annual South African Health Review has just been released, and it does not offer any reasons for celebration.

The report shows that HIV and Aids is reversing all the health gains that have been made in the past two decades and is affecting South Africans at every age and stage of their lives. In addition, our increasingly unhealthy lifestyles are killing us.
The report also exposes a deterioration in the quality of healthcare services for a range of reasons including a significant lack of staff. The number of women dying during childbirth, a critical measurement of health sector progress, has increased markedly in the past five years, almost doubling since 1998. The number of children perishing before the age of five are also increasing, although this is largely due to AIDS.

So who do we blame? The report lays it at three doors: AIDS, the brain drain of doctors and policy implementation. Let's look at doctors first.

The report revealed that "the exodus of skilled health personnel for the year under review has been substantial - 600 South African doctors are registered in New Zealand and 10 percent of Canada's hospital-based physicians and six percent of the total health workforce in the United Kingdom are South African."

So why do they leave? I assume this report must have been formulated before the recent slew of dispensing and practice regulations brought in by Manto, but it just goes to show the environment that we create for our doctors here. In a globalised world, we cannot try to force our doctors to act in ways that are contrary to their career or life requirements, they will simply take their skills to other markets, and this is exactly what has happened. Personally, I feel extremely sympathetic to doctors, and I don't think of their emigration is a 'treasonous' action. They work incredibly hard to achieve a career that ultimately is in the best interests of the country, and yet their goalposts are incessantly being moved.

The second issue is the issue of AIDS, and only the most unintelligent pundit could possibly come to the conclusion that the government's current HIV/AIDS policies have given those infected any type of chance for recovery. Manto's efforts have been disastrous, and her and Mbeki's viewpoints shamefull. Yet, even after the TAC won the right to receive antiretrovirals, when government stated that deadlines would be laid out for the dissemination of the drugs, the deception continues. Under this supposed second Mbeki term of delivery, Manto will not publicly release the deadlines for the rollout, an appalling slap in the face to all those who have waited so long and fought so hard for their right to live.

Which brings us to policy implementation, which is purely a management issue. Manto has clearly not set up her department for delivery, and her staffing has been a shambles. The head of the School of Public Health at the University of the Western Cape, David Saunders says "The reason there is this huge gap (between policy and implementation) is the lack of capacity of human resources at all levels. When we say the health systems are not functioning it is because the human resources are not functioning." And nobody can claim that the health department does not have a budget, it is merely run poorly. Manto has stumbled from one disaster to the next and the faith placed in her by government is inexplicable. This is one moment that I wish South Africa was a country of opinion polls, because it would be fascinating to see the confidence that our populus has in our Health Ministry.

And to top it all off, the front page of the New York Times carries a story today on the 'recycling' of graves in Durban because "city is being battered by an AIDS pandemic so sweeping that people are dying faster than the city can find space to bury them." At least the article doesn't attempt to investigate Mbeki or Manto's checkered past with the HIV/AIDS question, but the paper's influence in world affairs. Some might say it's great that the AIDS pandemic in South Africa is getting such substantial publicity to encourage aid, I just hope the publicity forces the world to put pressure on our government's infantile AIDS policies.

Clearly we need change, and when it influences the collective health of all South Africans, change cannot come to soon.