Business Day, Ailing state health 'fails SA's poor', 29 July 2004

State buckles under burden of AIDS, swelling patient numbers reports
Science and Health Editor

CAPE TOWN Despite significant increases in public health expenditure over the past decade, SA's public health system is failing the most vulnerable citizens, say two new reports released by the health department last night.

HIV/AIDS, growing child mortality and swelling patient numbers add to the system's burden, say the reports, which underscore a yawning gap between policy and practice.

The findings are likely to pile pressure on government to address failures in health-care human resource management.

The 2003 South African Health Review and the National Primary Healthcare Facilities Review, both conducted by the Health Systems Trust, highlight major discrepancies in health spending across SA.

The poorest districts spend less than R50 a patient a year, compared with the richest, which spend close to R400.

Health Systems Trust CEO David Mametja said there had been both "substantial gains and reversals" in the quality and availability of services provided by the public health sector.

Mametja said that HIV/AIDS was a major drain on the healthcare system, eroding many of the gains made in previous years.

The review says the public health sector has not compensated adequately for the financial burden of HIV/AIDS, which it estimates costs the public health system R6bn a year.

For example, even though 94% of pregnant women receive antenatal care, the standard of care during pregnancy has "steadily deteriorated" in the past decade, and the death rates of children under five are rising.

Although the increase in child mortality is due in part to HIV/AIDS, the study's authors say many of the deaths are due to common infectious diseases such as diarrhoea, and poverty.

"Children should not be dying from malnutrition in a middle income country," they say.

The review highlights SA's failure to put many of its globally respected health-care policies into practice. For example, SA has introduced the World Health Organisation's DOTS treatment strategy for tuberculosis, but is failing to curb the epidemic. Only about half of patients are documented to have successfully completed their treatment, a far cry from the WHO target of 85%.

Mametja stressed some important positive developments in the provision of health care in the public sector, such as recent efforts to attract doctors and nurses into underserviced rural areas with increased salaries.

But he conceded that the shortage of skilled health workers was a major problem, and that poor management undermined many health-care programmes.

The Primary Healthcare Facilities Review presents a similar ly mixed bag.

Although more patients have access to clinics than was the case 10 years ago, and most clinics provide basic medical services, many clinics in poorer provinces fail to make the grade.

Only 42% of clinics have adequate toilet facilities, and more than 15% of clinics have no telephones or radios. In Eastern Cape, the percentage rises to 36%.

National health department spokesman Sibane Mngadi questioned some of the findings of the primary health-care survey, saying the data on toilet provision were "clearly not accurate."

He said the department 's upcoming 2003 District Health System survey would shed more light on the effect of HIV/AIDS.




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