Around the globe health care has similar challenges, and whether it is Democrats under Obama or Socialists under Motlante, the IFP believes that governments must opt for solutions that work.  

Appropriate solutions require the right questions.  

- What constitutes good health? 

- How do we provide all citizens with health care? 

- Keep costs down? 

- Improve efficiency in state facilities? 

- Curb the greed and exploitive practices of the private sector? 

- Train and maintain standards of good doctors and nurses?  

- Prevent corruption in the health industry? 

- Achieve the millennium development goals, reduce infant mortality and increase longevity? 

The specifics in South Africa relate largely to AIDS, TB, malaria and of late cholera. Our public sector is under pressure of collapse and in the private sector, people are paying more often for less. 

How to respond? 

A healthy lifestyle is the cornerstone of preventive, primary health care, to promote physical, emotional and spiritual balance.  As in the East, let's organise daily work outs in public spaces; switch off TV and mobile phones and switch on sports, music and art in schools and in our homes. Immediately ban Transfats as proposed in my Bill agreed to by the department and the private members legislative committee. They are artificially produced for commercial gain and contribute to heart disease, diabetes, weight gain and cancer.  

When it comes to treatment, register conventional doctors, homeopaths, acupuncturists, chiropractors, naturopaths, ayurvedic and Chinese doctors through a single, independent, democratically elected Medical Council.  

Draw health practitioners to underserved areas through incentives and open more nursing colleges in partnership with the private sector.   

All other therapies of holistic health modalities should form part of an Holistic Healers Association. A traditional healers' council should deal only with herbalists, surgeons and birth attendants, not abaprophete and sangomas who work on a metaphysical dimension and cannot be monitored or controlled. 

Ensure that at national and regional level, formal structures exist to provide for co operation and collaboration between all these health professionals.

This should follow through into working groups that tackle issues like AIDS, TB, malaria and cholera together regionally and locally. 

Collaborative research between traditional, complementary and conventional practitioners should be encouraged and funded. 

For years we have watched impractical policies fail us. The most damaging of these is the centralised model, with unfunded mandates, bureaucratic conditional grants and the idea that one size fits all and one seat of power can decree accordingly. 

Hence, the current system, which is confusing and lacks accountability should be decentralised and simplified. 

Let Provincial and Local Governments make decisions, control funds and choose priorities.  

Let discipline be meted out close to where doctors and nurses work.  

Build stronger health districts and improve coordination between hospitals, clinics and mobiles in rural areas and between these, schools, and local police.   

Coordinate responses at the practical and implementation level and build functional integrated information systems. for tracking numbers of vulnerable children, people tested, diagnosed and on treatment, or applying for grants.  

Remove constraints that prevent districts, municipalities and hospitals from negotiating partnerships with the private sector. Districts should also work closely with NGOs and international donors. Currently most NGO funding is politically motivated, weakening the impact it has on the major epidemics in South Africa.   

Private Public Partnerships (PPP's) 

Put one of the best private health care systems in the world at the service of one of the worst public ones through PPP's that go to best bidders and not best buddies. 

Contract the private sector to run mobile services in rural communities and manage clinics or hospital wards.  

Appoint independent health ombudsmen or standards compliance bodies that ensure minimum standards everywhere.  Charters are no substitute for accountability. 

Do away with licensing according to NEED. It is subjective and open to patronage and corruption. Rather draw health workers to underserved areas through incentives which achieve more than coercion. 

HIV TB 

The greatest burden on public hospitals is HIV and TB.  The IFP suggests many changes to the way those diseases are handled.

Let us treat HIV like an ordinary disease without need for special secrecy provisions. Testing should be the norm with an opt out provision for those who refuse it. 

Change the focus of rights from the right to privacy to the right of non-discrimination.  No persons should lose their jobs because they have HIV or receive a lesser chronic medical benefit.  If they die of HIV they must receive full death benefit and full life payout.  

But, the excessive focus on privacy adds to the culture of denial and gives people the sense that HIV is something to be ashamed of. HIV should be regarded as commonplace as TB, diabetes or hypertension.   

How do we reduce medical costs? 

Free choice that engenders competition, minimum controls that ensure fairness and vigorous policing are the keys to effective health funding at the lowest possible cost. 

We should implement a form of social health insurance, with everyone who works paying a percentage towards a medical scheme of their choice. Government should offer a low cost scheme for people who can't afford the current private medical schemes.  It should enforce caps on medical scheme administration fees, which enable schemes to accumulate and hide huge profits.   

In hospitals, let government hospitals retain profits and establish private wards. Let government bring prices down by bulk purchasing of private hospital services to registered, government-funded patients paid for per day or per capita or per procedure. 

Where medicines are concerned, enforce transparency along the entire chain of medicine supplies so that similar discounts are offered for bulk purchases without prejudice or favour, but encourage discounting and competition.   

Put a reasonable cap on retail mark ups, but allow competition on prices and let any store sell medicines through a pharmacist. Contract pharmacies to provide chronic medication to registered patients.  

This above framework would remove perverse incentives and contradictory regulations. It would prevent the private sector misleading the public through marketing and the public sector doing so through populism.  It would provide a far stronger health system to cope with HIV/AIDS, TB, STD's, cholera, vulnerable children and our mushrooming population of mentally disturbed persons. 

It would help us face current challenges.