Strictly Personal
With elections and NHI, this is a big year for healthcare in SA, By Marcus Low
Published
7 months agoon
![](https://africanewswatch.com/wp-content/uploads/2024/01/SOUTH-AFRICA-MEDICAL.jpg)
South Africa is barrelling towards its most consequential and most competitive national and provincial elections since 1994, expected to take place in May. That the ANC’s share of the vote, will be further eroded this year seems inevitable, given ongoing power cuts, failing railways, water management problems, high crime rates, and dysfunctional basic education and public health systems.
Covering elections is tricky at the best of times for media houses. Spotlight plans to follow the advice of Jay Rosen, journalism professor at New York University, to focus on reporting “not the odds, but the stakes”. As far as the odds does go, however, it seems likely that the ANC – alone or in coalition – will govern nationally, but they could lose power in the country’s two most populus provinces, Gauteng and KwaZulu-Natal.
The stakes in these two provinces could not be higher when it comes to healthcare. The day-to-day running of our public healthcare system is after all the domain of provincial health departments.
Limping from crisis to crisis
Take Gauteng. From alleged health department corruption worth more than R1.2 billion in 2007/2008, to the Life Esidemini tragedy of 2016, to more recent issues such as the lacklustre response to alleged corruption at Tembisa Hospital, ongoing problems with food and security contracts, and the persecution of whistleblowers like Dr Tim de Maayer, the province’s health department has stumbled from crisis to crisis under the ANC for well over a decade now. New starts under new members of the executive council (MECs) and heads of department have been a dime a dozen, but if anything, the quality of governance has decayed over time. What is at stake is literally basics like whether there is sufficient food available for people in hospital.
There is, of course, no guarantee that this atrocious situation will be turned around if, for instance, a multi-party coalition of the DA, Action SA and others run the province – but the prospect of such a change certainly is intriguing. Just imagine the DA’s Jack Bloom having a go as Gauteng’s MEC for Health after decades of holding other MECs and heads of department to account from the sidelines.
The future of NHI
The year’s other headlining health story seems set to again be National Health Insurance (NHI), which promises healthcare for all – employed or unemployed – South Africans, permanent residents, refugees, inmates, and specific categories of foreign nationals. After making it through Parliament at the end of last year, the NHI Bill is likely to be signed into law by President Cyril Ramaphosa any day now. Much of the bill won’t come into effect for quite some time, and we are sure to see several court cases challenging its constitutionality. There is also an outside chance that later this year the balance of power in Parliament could shift against NHI, or at least certain elements of NHI. It is not too much of a stretch to say the future of NHI is one of several important things on the line at the ballot box.
Also at stake in the elections is government’s response to seemingly intractable problems like South Africa’s shortage of healthcare workers, budget shortfalls, and health sector corruption. It would be naïve to think a change in power will solve these problems overnight – much of the world is struggling with shortages of healthcare workers and South Africa’s budget restraints are all too real, but some will argue that a change in power may nevertheless be a necessary first step given the extent to which all three of these issues have been allowed to drift in recent years. There is certainly an argument to be made that the current lack of progress is rooted in a lack of state capacity and that the lack of state capacity, in turn, is a consequence of the ANC’s explicit policy of cadre deployment.
Whether or not voters again back the ANC, some specific questions should provide a good gauge of progress in 2024. Will we finally see convictions for the alleged corruption uncovered by public servant Babita Deokaran? Will government publish an implementation plan for addressing our healthcare worker crisis (we already have a good strategy) and, this is the key, put money and political capital behind its implementation? Will the new Parliament pass a good State Liability Bill (which could help reduce the state’s liability for medico-legal claims) and finally get round to amending South Africa’s Patents Act to better balance medicine monopolies with the right to health (as set out in a policy adopted by cabinet back in 2018)? Will the establishment of the National Public Health Institute of South Africa remain stalled? Will government continue to ignore recommendations from the Competition Commission’s Health Market Inquiry on how to better regulate private healthcare in South Africa (the commission’s very impressive report was published in 2019)? Will the new health MECs and heads of provincial health departments appointed after the elections bring real change?
HIV, TB and NCDs
The National Department of Health has generally produced good HIV and tuberculosis (TB) policy over the last decade or so. In some respects, those policies have been well implemented – think the massive amount of HIV testing done in the country, in other respects they have been undermined by the general dysfunction in the public healthcare system – think long queues, staff shortages, and poor TB screening and infection control. Some innovations, like pills to prevent HIV or new TB treatments, could have been rolled out more quickly and better marketed to users.
At stake in the elections is thus not so much whether we produce good policies in areas such as HIV, TB and non-communicable diseases (NCDs), but whether we will get the leadership we need to ensure better and faster implementation of those policies.
On the HIV front, we will be keeping a close eye this year on the ongoing rollout of HIV prevention pills. While the rollout has gathered some momentum in recent years, the pills are generally still too hard to get hold of for those who could most benefit from it. Pilot projects should shed light on how to best make breakthrough new HIV prevention injections available in South Africa, but the high price of these injections is likely to mean the many young women who could most benefit from it won’t be able to get it.
New HIV figures from Tembisa, the leading mathematical model of HIV in South Africa, will be keenly watched this year since it will integrate recent findings from the Human Sciences Research Council (HSRC) survey (which contained some unexpectedly positive numbers). On the negative side, the HSRC survey also indicated that condom use was significantly down in 2022 compared to 2017 – this while a recent HIV investment case found that condoms are the only cost-saving HIV intervention for the health system. Either way, the extent to which condoms are made easily available will remain an important measure of government’s commitment to fighting HIV, both now and after the elections.
Last year, we saw significant changes in how TB is tested for and treated in South Africa. In short, many more people became eligible for TB tests and eligibility for TB preventive therapy was dramatically expanded. How impactful these new policies will be this year will depend on how well they are implemented, which again brings us back to the ongoing problems of healthcare worker shortages and a lack of management capacity in most of our provincial health departments. Maybe then, in a context of generally reasonable HIV and TB policy, what matters is not so much what different political parties have to offer on these diseases specifically, but what they can do to improve the functioning of our healthcare system more generally.
That said, one notable thing with TB is that, despite South Africa having often made good TB policy and having played an important role in raising the profile of TB at the United Nations, TB has never really become a political or elections issue here in the way one might expect from a disease that claims over 50 000 lives, of mostly poor people, in the country per year. So far, there is no indication that any political parties are set to change this in 2024.
Finally, while the long-term trends with HIV and TB are downward, the trend with non-communicable diseases (NCDs) like diabetes and hypertension in South Africa is in the opposite direction. Government has set HIV-style diabetes and hypertension targets and published a national plan, but again there are serious questions about whether these plans will be implemented and whether the public health system has the capacity to offer the levels of testing, treatment and care that is required. Meanwhile, breakthrough weight loss medicines that made headlines in 2023 are likely to remain out of reach for most people in South Africa and interventions like the sugar tax will remain highly contested before and after the elections.
Whatever happens at the ballot box, one thing is clear, given the rising NCD threat, healthcare worker shortages, budget shortfalls, and endemic corruption, whoever is in power nationally and provincially after this year’s elections will have their work cut out for them. While we will not endorse any political parties at Spotlight, we do urge voters to consider what is at stake in these elections when it comes to healthcare. Part of the picture will of course be painted by political party manifestos (which we will analyse in detail in the coming months), but as important as the policies, is the track record of what parties have done when they’ve held power. Whether in Gauteng, the Western Cape, or nationally, voters will hopefully send a clear message on whether or not they think those currently in power are on the right track.
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Strictly Personal
Here is Raila’s Africa Union road to nowhere, By Tee Ngugi
Published
5 days agoon
September 2, 2024![](https://africanewswatch.com/wp-content/uploads/2023/03/Raila-Odinga1.jpg)
On August 27, the Kenya government officially endorsed Raila Odinga as its candidate for chairman of the African Union Commission in a ceremony held at State House.
In attendance were William Ruto, Yoweri Museveni of Uganda, Tanzania’s Samia Suluhu Hassan, South Sudan’s Salva Kiir, former president of Nigeria, Olusegun Obasanjo, former president of Tanzania, Jakaya Kikwete , among other dignitaries. The platitudes spoken at the ceremony, and the grandiose reception of the VIP dignitaries resembled a mini African Union heads of state gathering.
Watching the gathering and listening to the speeches, I was struck by two sad truths.
One truth was of a tone deaf generation totally incapable of understanding the problems of Africa. The other was that these same people continue to be in charge of Africa’s affairs or determine or influence its future. Let me expound on these two issues by reference to the speech made by Raila Odinga.
Odinga touched on several problems plaguing Africa including peace, the poverty that forces people to flee to Europe, and intra-Africa trade.
Yet not once did he hint at, let alone mention, the root cause of all these problems. Lack of peace in Africa is caused by failed governance.
The governance style fashioned by the independence leaders is characterised by what Ali Mazrui called “deification” of political authority.
By this process, the president becomes a god. He uses government positions and public resources to buy support or reward sycophants. Significant resources are used for self-aggrandisement and to fulfill megalomaniacal ambitions.
It is a wasteful and corrupt system. The state employs an elaborate police apparatus to intimidate citizens. A case in point: A few weeks ago, and not far from State House , the Kenya regime stationed snipers on rooftops to execute unarmed protesters.
The African governing elite is also adept at using tribalism as a political tool. The war in South Sudan is a competition for power by individuals who mobilise the support of their communities.
The deadly conflagration in Sudan is traceable to Bashir’s dictatorship which weakened systems and impoverished the country. Now those close to Bashir are fighting to be the next “deity” and continue to plunder the country.
Odinga evoked the ghosts of Nkrumah, Jomo Kenyatta, Sekou Toure and Haile Selassie — dictators who designed the oppressive parasitic state. Evocation of these dictators was ominous, because it signaled continuation of the AU defence of the broken system they designed and which successive regimes have perpetuated.
Should he succeed, Raila will become the next spokesman and defender of this fundamentally flawed governance which the youth of Africa want to overthrow.
His legacy will be cast in the same lot with that of dictators who have ruined and continue to ruin Africa.
Strictly Personal
Mpox crisis: We need an equity-driven pandemic treaty, By Magda Robalo
Published
6 days agoon
September 1, 2024![](https://africanewswatch.com/wp-content/uploads/2022/07/Monkeypox-UN.jpg)
The current multicountry Mpox outbreak started in January 2022. It has now been declared a Public Health Emergency of Continental Security (Phecs) by the Africa CDC and, for the second time, a Public Health Emergency of International Concern (Pheic) by WHO, under the International Health Regulations (2005) highlighting critical deficiencies in the global public health response.
Endemic to West and Central Africa, the first human case of Mpox was detected in 1970 in the Democratic Republic of Congo (DRC). Nigeria experienced a large outbreak in 2017 and 2018. Only sporadic cases occurred outside endemic areas before 2022.
According to the World Health Organisation, most people suffering Mpox recover within two to four weeks. The disease is transmitted through close, personal, skin-to-skin contact with someone who has Mpox, contaminated materials, or with infected animals. Transmission could also occur during pregnancy or childbirth and among people with multiple sexual partners, who represent a high-risk population.
Despite early warnings, failures in implementing robust surveillance, contact tracing, and containment strategies have allowed the virus to spread across at least 120 countries. In the DRC, where the outbreak has been particularly severe, two distinct outbreaks are evolving, caused by clade Ia and the newly emerged clade Ib.
Increasingly, and rightly so, voices are coalescing to demand an urgent, coordinated international action and global solidarity toward an equity-driven, focused response to curb the virus’s spread and mitigate its impact.
Loud calls for equitable vaccine distribution are being heard, a reminiscence of the Covid-19 dramatic experience. But vaccines are only one complementary tool in the box of interventions against the outbreak. Two fundamental questions we should be asking are: whether we have done enough to prevent the outbreak from becoming Pheic and Phecs, and if we are doing all we can to contain it, beyond placing our hopes on the still scarce doses of vaccine.
The Mpox outbreak underscores the urgent need for a comprehensive, equity-driven pandemic treaty, to coordinate global efforts to improve pandemic prevention, preparedness and response. The potential impact of this treaty is substantial, promising to address critical areas such as public health infrastructure, equitable access to treatment, vaccines and other supplies, and enhanced international cooperation during health emergencies.
The spread of Mpox across multiple continents in the aftermath of the Covid-19 pandemic confirms the persistence of significant vulnerabilities in national and global health systems, particularly in surveillance and rapid response—areas a well-crafted treaty could strengthen.
A united voice from Africa is critical to the negotiations. Without systemic changes, the world risks repeating the mistakes of Covid-19 and the ongoing Mpox outbreak in future outbreaks. Global health security depends on timely action, transparent communication, and a commitment to protecting all populations, regardless of geographic or socioeconomic status. It depends on strong health systems, based on a primary health care strategy and underpinned by the principles of universal health coverage.
There is no doubt that the world is facing an emerging threat. The scientific community is confronted with knowledge gaps in relation to Mpox. Several unknowns persist on the real pace of the evolving outbreak, its modes of and transmission dynamics, evolutionary routes and the human-to-human transmission chains. It is uncertain if we are moving toward a sustained human-to-human transmission and its potential scale and impact.
However, despite the fragility of health systems in most of its countries, Africa has decades of vast, diverse, cumulated experience in dealing with major epidemics, such as HIV/Aids, Ebola and most recently Covid-19, in addition to the decades of surveillance for polio eradication and containment of outbreaks.
In recent decades, African countries have improved their human, technical and infrastructural capacities and capabilities to detect, diagnose, and respond to outbreaks and large epidemics. Expertise and skills have been built in disease surveillance, infection prevention and control, diagnosis, epidemiological data management, including pathogen genomic sequencing.
Communities have developed systems to fight stigma and discrimination, built resilience and capacity to respond to and address their unique challenges, including poor access to information, education, communication tools, as well as to treatment and prevention interventions.
Admittedly, the response to this outbreak continues to expose significant flaws, particularly inconsistent and inadequate surveillance and monitoring systems to track the spread of the virus, contact tracing, and infection prevention measures (isolation, handwashing, use of masks and condoms, etc).
Many countries still lack the necessary infrastructure or have relaxed these measures, leading to delayed detection and widespread transmission. Moreover, a reluctance to deploy aggressive contact tracing and isolation protocols, partly due to concerns about stigmatisation, resulted in missed opportunities for early containment.
While negotiating for potential vaccine doses to protect high-risk populations, countries should invest in and deploy what they have learned and now know how to do best, based on the lessons from polio, HIV/Aids, Ebola and Covid-19. It is imperative that we contain the Mpox outbreak before it is too late. It is time to put our best foot forward. We have no reasons for helplessness and hopelessness.
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