CAPE TOWN — The respected medical journal The Lancet has urged President ’s administration to speed up health reform, saying SA’s burden of illness, death and injury posed the biggest threat to the country since apartheid.
The Lancet is today expected to publish a series of articles detailing SA’s troubled health landscape. They highlight the paradoxical fact that although SA is a middle-income economy and spends 8,7% of its gross domestic product on healthcare (more than any other African country), the results are worse than many low- income nations. For example, SA is one of only 12 countries in the world where infant mortality rates have risen since 1990, largely because of poverty and HIV.
The country is home to just 0,7% of the world’s population, but 17% of the global HIV burden. And SA’s HIV epidemic is inextricably linked to a growing number of people who are infected with tuberculosis, as people infected with either one of the diseases become more vulnerable to the other. And while infectious diseases grab headlines, a growing number of South Africans are also falling prey to deadly lifestyle-related illnesses such as diabetes and heart disease.
Tackling these problems would require “unprecedented leadership” from Zuma, the journal’s editor, Richard Horton, said in a telephone interview.
“You cannot achieve dramatic change overnight but you can achieve it faster than many people think. Under Jacob Zuma there is a chance for a fresh start,” he said, urging the government to provide more information on its plans for national health insurance (NHI).
“We need to know what’s in the NHI package. The details are not clear, and we need a vigorous public debate. It’s absolutely key, and there’s no reason at all it would damage the facilities in the private sector,” he said. “It’s not about lowering the quality of the private sector, it’s about raising the quality of the public sector.”
Horton said the new administration needed to instil a new culture of competence and accountability among health managers. “It means setting very high basic standards, and it means zero tolerance to failure,” he said.
The Lancet’s focus on SA coincides with an international meeting of experts today who will be discussing ways to tackle the country’s health problems.
Today’s The Lancet series includes an article on maternal and child health that underscores how poor implementation of government policies has caused thousands of unnecessary deaths. The authors estimate that between a quarter and a half of the deaths of mothers, babies and children are caused by “avoidable health system factors”. Better neonatal care could save 11500 babies a year, while improvements to the care provided to HIV-positive women and their infants could prevent the death of another 37200 children a year by 2015, they write. They estimate it would cost 15,7bn a year to provide basic neonatal care, dual therapy to HIV- positive pregnant women, and guidance on feeding their infants to 95% of the population in need. “The actions required are affordable, possible and sustainable for SA. Since our future lies in healthy women and children, can we afford not to undertake them?” the journal asks.
kahnt@bdfm.co.za