This is a department at war with itself. 

At times it's goings on are sufficiently beyond belief as to think we are in Wonderland.  At other times in Dreamland, currently we are in Upside Down-Land. 

Were we in IFP-Land, we would be more concerned with the health of people than in political or personal power. 

More concerned with the state of facilities that supply health care, whether public or private than with populist prejudices. 

More concerned with the quality of nurses, doctors, pharmacists and medicines and treatment of all illnesses than with our own political agendas. 

More concerned with incentivising people in industry to share and punishing them when they cheat than with telling them what to do. 

And posting charters that achieve little all over the place. 

In IFP-Land we would have national framework legislation, well supported, authoritative district health councils with reliable information systems, integrated across the country. 

We would have the private and pubic sector work hand in hand with each other, full utilization of hospital beds by both sectors in all hospitals and partnerships to deal with HIV and TB, with every business, NGO or unit donor willing to join forces with us in addressing staff shortage, medicine shortages, staff training and zero morale.

We would rely on accreditation, ombudspersons and courts for accountability more than on charters.

 Instead of strangling the private sector, we would improve minimum standards, foster initiatives and enforce transparency. 

The appropriate metaphor that comes to mind is: 

"Jack and Jill went up the hill to fetch a pail of water. 

Jack (Public Sector) fell down and broke his crown, 

And Jill (Private Sector) came tumbling after" 

Equity is the goal of the Minister.  Hence, her rallying call being equal access and quality care for all South Africans. 

On that score alone, she has failed.  Expenditure in districts ranges from R150 to R500 per capita per annum. 

Nevirapine uptake by babies born to HIV mothers ranges from 9% to 88%.  23 of 52 districts achieve less than 50% uptake. 

On the issue of quality care, these are the indicators, 489 000 South Africans enrolled in the ARV programme with 350 000 on treatment.  524 000 require treatment. 

Any statistics we obtain from the Department suggesting an improvement in health outcomes must be questioned as they are invariably in conflict with a darker truth reported by independent analysts. 

Congratulations must go to the Department for its lifestyle programme, but overweight is on the rise, diabetes likewise.  I am considering drafting a Bill on Trans-Fats use in prepared food sold to school children or in food establishments.  At least let us try the easier route to prevention when we struggle so with cures. 

We have a laissez faire approach to GMO's entering our food chain but there is no proper trial and no knowledge of long term consequences.

We have no regulation of cell phones.  They should be regulated by the sub-Department controlling hazardous radiation, pregnant women warned not use them, warnings placed on boxes and radiation levels revealed.  More and more info emerges about the harmful effects of these ubiquitous toys. 

Those workers we have in national health state that life expectancy is down to 50.  5.6 million people have HIV, 21 000 children are on HIV treatment while 123 000 need medicines. 

The TB cure rate is below 50% in 13 districts. 

67 Out of 100 000 babies are dying before they are 5, of these 40 000 are preventable and due to inadequate health facilities, poor care and lack of transport. 

If we look at the public facilities where health care is provided, the picture is dismal.  Equipment, blankets and food are stolen, staff and patients fear for their lives.

In many hospitals toilets are not useable.  In many clinics, treatment means Panado. 

This brings us to the issue of medicines.

Medicines are regulated by the MCC - whose budget is hidden inside the Department of Health.  Since the excellent and long serving Dr. Peter Folk was dismissed for criticizing the Minister on Virodene, various health Ministries have tried to control that council.

The courts overturned our Minister's desire to suppress Nevirapine.  The urgent re-structuring of the MCC into SAMMDRA did not take place.  The MCC is a law unto itself - no report - no budget - long waiting lists - increased cost for registration.  Is it the cash cow of the health department?

Now as the long awaited restructuring is looming to include complementary and traditional medicines and medical devices, the Minister wants final control to trump science and decide which medicines may or may not be registered. 

What a recipe for disaster, in the light of her support for Dr Rath's unethical promotion of untested vitamins as a cure for AIDS.

The IFP strongly supported greater use of traditional medicines.  But the 185 000 traditional healers are still not regulated, and will be a nightmare to manage because Abaprofete, prophets and faith healers are included as an entity.  In spite of the Presidents task team on African traditional medicines, and the MRC's traditional medicines research centres' umpteen collaborating partners, no registerable, marketable product has yet emerged.

Biological species are being exploited, valuable medicinal plants will soon become extinct and the Ministers approach is again upside down.  As for amending current laws to reduce hospital costs, if they were based on greater transparency on regulating medical equipment and devices, or preventing medical schemes hiding profits in administration, well and good but they are based on a flawed report form the CMS and call for collective bargaining between medical schemes, hospitals and Doctors.  Yet, the competition commission outlaws collaborative price setting and the hospital association was not even consulted for the report. 

We should remove the moratorium on new private hospitals, the obstructions to hospitals employing specific categories of Doctors and to private training of nurses. 

How do we reach the Millennium Development Goals?

We go to the root of the problem in our constitutional dispensation. 

We decentralize.

We strengthen districts and improve coordination between hospitals, clinics and mobiles in rural areas. 

We coordinate at the practical and implementation level.  We create functional integrated information systems.

Constitutionally further we have a voting system that makes political representatives accountable, we don't give rights to the wrong people.  We create independent institutions to protect democracy. 

These measures will cope with crime, efficiency, accountability and delivery.  We put the private sector to work for the state through contracts that go to the best bidders and not best buddies.  We reduce costs by enforcing transparency in medical schemes, hospital, medicine prices and require everyone with a job to contribute to a medical scheme of their choice, offering a minimum state funded scheme as an option. 

We elect the statutory councils for all health professionals democratically and make them vigorously independent for the sake of transparency and accountability to the public, not to the Minister of Health. 

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, STDs, vulnerable children and our mushrooming population of mentally disturbed persons. 

It would turn our health department the right way up.  
 

FOR MORE INFORMATION CONTACT
Dr Ruth Rabinowitz MP
082 579 3698