Looking aheadLooking ahead
The 10th anniversary of freedom invited an opportunity to reflect how far we havemoved towards achieving the goals we held to bemost precious.
In health, our direction was determined from the outset by the simple principle that South Africa belongs to all who live in it and every citizen deserves access to essential health care at the time of need.
It is a responsibility that has demanded fundamental changes in the health system and the introduction of laws that have not always been popular.
Health care for all
One of the first requirements of our “health care for all” mandate was to establish the infrastructure for the effective delivery of primary health care services.We have substantially achieved this.
We claim progress not perfection in primary health care, because there is still an unacceptable variation in the standard of primary care that is being offered across the country, and this is linked largely to resources. Expenditure on primary health care per person per year among provinces ranges from R50 to R300.
Equity in service provision is the critical measure that determines who lives and who dies; who suffers permanent harm and who is restored to good health.
Let us never forget this reality as we rededicate ourselves to service in the second decade of freedom. The second major area of transformation in health care was the hospital sector, where physical revitalization, rational planning and better management were the key objectives.
The investment in capital projects has steadily gained ground. In the year ahead, about R2-billion will be spent on infrastructure and the building of new hospitals. R911-million will be spent on 27 major hospital projects including the building of 18 new hospitals.
The third major area of innovation was the expansion of programmes for disease control and prevention and the establishment of new programmes.
Immunisation
We have expanded the child immunisation programme in line with WHO guidelines and introduced additional vaccines against Hepatitis B and Haemophilus influenza and made immunization part of our every day clinic operations. The results have been the eradication of polio and the sharp drop inmeasles.
We have seen a drop in the number of deaths due to diarrhoeal disease caused by a combination of factors including improved access to clean water, sanitation, promotion of breast-feeding, and prompt treatment of diarrhoea and education of the public.
We tackled the long-standing problem of tuberculosis by introducing the community-based treatment programme. This improved our ability to identify TB patients, to test them and to supply them with the correct drugs all free of charge. TB remains amajor challenge and it is further complicated by development of a multi-drug resistant strain. We therefore need to re-double our efforts against TB. There is no room for complacency.
In the face of a huge escalation in malaria, we took the bold step of re-introducing residual indoor spraying with DDT and we did this with the consent of the international community.
By taking this step and working closely with Swaziland, Mozambique, soon to be followed by Zimbabwe, DRC and Angola we effectively turned the tide of malaria infection in the year 2000.
SA National AIDS plan
HIV infection and the impact of AIDS had begun to emerge as a serious public health threat by 1994, but there was no national programme to speak of as freedom dawned. In the past decade, enormous resources have been committed to HIV and AIDS and South Africa has indeed followed international best practice in its national strategy.
Few countries would be able to claim an increase of 2000% in AIDS spending in less than 10 years from R22m in 1994 to R660m (in the National Department alone). Few would be able to point to greater investment in prevention strategies; and few could claim such widespread mobilisation across sectors. The South African National AIDS Campaign is an achievement.
We should not allow our progress to be overshadowed by the sheer scale of HIV infection.We should take the magnitude of the problem as a challenge, not a defeat.
I would be the first one to concede that it is not sufficient to have stabilized our HIV infection rates we need to put them into reverse gear. Therefore, we are committed to strengthening the national response to HIV and AIDS through the Comprehensive Plan adopted by Cabinet. The Plan requires simultaneous action onmany fronts across the health sector.
South Africa is a member of the board of the Global Fund to Fight AIDS, TB and Malaria where it represents the Southern and Eastern Africa Region. We also chair the Afro Regional Committee of the World Health Organization.
Tobacco legislation
Through far-sighted Tobacco Control Legislation and tax policies, Government has reduced the size of the smoking population. Given the relationship between tobacco use and various cancers and cardiovascular disorders, the population is likely to reap the benefit of this decisive move by Government in years to come.