Cablegate: South Africa Public Health August 26 Issue
This record is a partial extract of the original cable. The full text of the original cable is not available.
UNCLAS SECTION 01 OF 04 PRETORIA 003481
SIPDIS
DEPT FOR AF/S; AF/EPS; AF/EPS/SDRIANO
DEPT FOR S/OFFICE OF GLOBAL AIDS COORDINATOR
STATE PLEASE PASS TO USAID FOR GLOBAL BUREAU KHILL
USAID ALSO FOR GH/OHA/CCARRINO AND RROGERS, AFR/SD/DOTT
ALSO FOR AA/EGAT SIMMONS, AA/DCHA WINTER
HHS FOR THE OFFICE OF THE SECRETARY,WSTEIGER AND NIH,HFRANCIS
CDC FOR SBLOUNT AND DBIRX
E.O. 12958: N/A
TAGS: ECON KHIV SOCI TBIO EAID SF
SUBJECT: SOUTH AFRICA PUBLIC HEALTH AUGUST 26 ISSUE
Summary
-------
1. Summary. Every two weeks, USEmbassy Pretoria publishes a
public health newsletter highlighting South African health
issues based on press reports and studies of South African
researchers. Comments and analysis do not necessarily reflect
the opinion of the U.S. Government. Topics of this week's
newsletter cover: South African Government Continues Strong
HIV/AIDS Spending Commitment; Government Issues Bid for Civil
Servant Medical Care; Guns Significant Health Care Cost; Health
Department Releases Human Resources Plan; Erratic Infant
Formula Supply Pose HIV Transmission Problems; SA Private
Hospitals Cheaper than U.S. and Australia; and Poverty and
Gender Inequality Hamper South Africa's Response to HIV/AIDS.
End Summary.
South African Government Continues Strong HIV/AIDS Spending
Commitment
--------------------------------------------- -------------
2. The 2005/6 National Budget shows a continuous commitment of
the national government to increase AIDS spending through
earmarked transfers to provinces and specific allocations to
national departments. Total HIV and AIDS budgets (including
conditional grants, which are earmarked spending transferred to
provinces) increased from R1.4 billion ($220 million using 6.4
rands per dollar) in 2004/5 to R1.9 billion ($300 million) in
2005/6, increasing in real terms by 36 percent. Conditional
grants continue to be a major source of HIV/AIDS funding for
provinces.
3. Three government departments use HIV/AIDS funding. The
Health Department spends its funding on prevention, treatment,
care and support interventions. The Education Department uses
HIV/AIDS funding for HIV/AIDS Life skills and prevention
education in schools while the Department of Social Development
spends its money on HIV/AIDS community and home-based care
activities. The Health Department remains the provider of most
HIV/AIDS services. The national HIV/AIDS Life skills program
(managed by the Department of Education) is the slowest growing
budget, declining by 3 percent in 2005/6 in real terms and by 1
percent over the 2005/6-2007/8 medium term, reaching R152
million ($24 million) by 2007/8. The Social Development
Community and Home Based Care Services grant (the Department of
Social Development's HIV/AIDS contribution) recorded a real
growth of 88 percent in the 2005/6 budget, and will increase by
27 percent in real terms over the medium term reaching R195
million ($30 million) by 2007/8. The National Health HIV/AIDS
budget increases by 38 percent in real terms in 2005/6,
increasing 23 percent over the medium term to reach R2.1
billion ($330 million) by 2007/8. The South African government
plans to spend R6.6 billion ($1 billion) over the medium term,
of which 85 percent is allocated to the Health Department.
These budget allocations exclude provincial discretionary
allocations sourced from the provinces' own budgets. The
provincial health departments are allocating an additional R2.3
billion ($360 million) from their own budgets, raising the
total HIV/AIDS budget to R8 billion ($1.25 billion) over the
medium term.
4. For implementation, monitoring and evaluation purposes,
HIV/AIDS allocations between national and provincial
departments indicate who is responsible for the bulk of
implementation. In 2005/6 53 percent of the total health
HIV/AIDS spending was conditional grants sourced from the
National Government and spent by provinces, increasing to 55
percent by 2007/8. The provinces contributed 30 percent of the
total health HIV/AIDS budgets from their own discretionary
budgets. Spending at a national level decreases as a share of
the total health HIV/AIDS budgets, from 17 percent in 2005/6 to
15 percent in 2007/8. Three provinces (Free State, Limpopo,
and Northern Cape) do not add provincial funds to the HIV/AIDS
conditional grants, with Kwa-Zulu Natal spending 54 percent and
Guateng spending 57 percent of their total Health HIV/AIDS
budget from provincial sources in 2005/6. Some provinces do
not report their discretionary spending on HIV/AIDS and
official budget and expenditure documents do not disclose the
amount of donor funding and how much was spent, making complete
monitoring and evaluation of HIV/AIDS funding difficult.
Source: IDASA Budget Brief No. 156, August 5.
GOVERNMENT ISSUES BID FOR CIVIL SERVANT MEDICAL CARE
--------------------------------------------- -------
5. The South African government has finally issued its long-
awaited tender for a new compulsory medical insurance plan for
public servants. The government intends for the new plan to
simplify the provision of medical benefits to its employees,
drive down costs, and increase the number of civil servants on
medical insurance. Eight contracts are available for bids,
among them: an administrator, a clearing house to manage
members' prescription medicines, two providers of primary
health-care services, an HIV management company, a hospital
service provider, a managed care organization and an IT firm.
Bids have to be prepared by September 1, and the bid should be
finalized by October 7. Among the bid specifications are the
equal weightings of 20 percent for price and empowerment
status, in anticipation of which a number of black economic
empowerment deals have been arranged. From January 2006, all
public servants will be required to join the Government
Employees Medical Scheme, including those who already belong to
a medical scheme, and those who have no medical insurance yet.
Public-sector trade unions and the Congress of South African
Trade Unions oppose the government insurance plan, arguing that
it could have adverse implications for low-income workers that
would amount to a change in conditions of service. Among the
top contenders for the scheme's administration contract are Old
Mutual Healthcare, which announced an empowerment deal with
Kwacha earlier this week, MxHealth, and SA's two biggest
administrators, Discovery Health and Medscheme. An estimated
300,000 public servants' families are already covered under
medical insurance plans and an additional 150,000 to 200,000
families would eligible for coverage. Source: Business Day,
August 18.
GUNS SIGNIFICANT HEALTH CARE COST
---------------------------------
6. South Africa could be spending up to R200 million a year
($31 million) just on treating people with serious abdominal
gunshot wounds, according to researchers in the latest South
African Medical Journal. Dr Denis Allard, a surgeon at Cape
Town's GF Jooste Hospital, and University of Cape Town
professor of medicine Dr Vanessa Burch, assert that this amount
does not include the cost of gunshot injuries to other parts of
the body. Their estimate is based on extrapolation from a
study of wounds at GF Jooste, a state hospital on the violence-
wracked Cape Flats. They found that over a seven month period,
surgeons at Jooste did an average of one emergency laparotomy -
surgical entry into the abdominal cavity - a week for firearm
injuries. On average, each of the 21 patients treated at
Jooste from admission to discharge cost the state health
service about R10,269 ($1,600), 13 times the government's per
capita health spending. Source: Sapa, August 18.
HEALTH DEPARTMENT RELEASES HUMAN RESOURCES PLAN
--------------------------------------------- --
7. The Health Department's human resources plan has finally
been released, and now further discussions are underway about
how to ensure that the country has enough health workers to
serve the nation. The challenge of ensuring that the country
has enough health staff to serve citizens properly has been
complicated by the exodus of skilled staff to wealthy health
systems, a "changing disease profile" and a lack of a
"developmental approach" to HR planning and management, notes
the plan. By 2001, over 23,000 South African-born health
professionals were working in Britain, U.S., Canada, Australia
and New Zealand. By March this year, the entire public sector
was left with only 42,373 professional nurses, 7,784 doctors
and 1,561 pharmacists. The emergence of HIV, the persistence
of tuberculosis (and complications such as multi-drug resistant
TB), the re-emergence of diseases such as cholera and the
increase in chronic "lifestyle" diseases such as diabetes have
increased demands on the health sector. The plan's admission
that there has been a "lack of a developmental approach" refers
mainly to the fact that training institutions have not kept
pace with the demands of the population. Between 1998 and
2003, only 4,018 new professional nurses were trained. This
did not even keep up with population growth over the period.
Yet, during the same time, the public health sector shifted
care from hospitals to primary health clinics, meaning there
was an even greater need for more nurses. The plan itself
concedes that proper management is a key problem. South Africa
spends 8.5 percent of its GDP on healthcare, which is a very
substantial portion in global terms. Treasury has also set
aside about R4.6 billion ($720 million) for provinces to train
and develop health professionals over the next three years.
For the next two weeks, the health department will be briefing
stakeholders including trade unions, professional bodies and
training institutions. Stakeholders have until 15 September to
make written submissions on the plan. By January, a program to
develop national training standards for health workers is to be
in place. Source: Health-e News, August 9 and Financial Mail,
August 19.
ERRATIC INFANT FORMULA SUPPLY POSES HIV TRANSMISSION PROBLEMS
--------------------------------------------- ----------------
8. The Health Department met with representatives of Nestle,
an international food and beverage company, to discuss
shortages of the infant formula, Nan Pelargon, provided by the
state to the babies of HIV positive mothers. The company is to
provide a full report to the South African government on how it
is addressing the erratic supply of infant formula to public
health facilities. The company holds a government tender for
providing infant formula to 2,525 sites countrywide for the
national prevention of the vertical HIV transmission of HIV
program. Exclusive formula feeding reduces the risk of
transmission via breast milk by one-third, and women enrolling
in the program are advised to bottle-feed. But the shortfall
in supplying the formula could jeopardize the vertical
transmission campaign. According to Nestle, the shortages were
partly due to a 20 per cent increase in demand for the formula
in 2004, which had been exacerbated by a strike at production
facilities. In a statement the company said: "In order to
address the shortage, we have reopened our Bethal factory and
have commissioned our Brazilian market to assist us to meet our
backlog and current needs. The supply will improve over the
coming weeks and should gradually normalize as of October."
Source: IRIN News, August 19.
SA HOSPITALS CHEAPER THAN U.S. AND AUSTRALIA
--------------------------------------------
9. According to a study sponsored by the Hospital Association
of South Africa, private hospitals in South Africa perform much
of their surgery better, faster and cheaper than those
hospitals in Australia and the United States. The report shows
that South Africa is up to 50 percent cheaper than the US and
Australia with regard to procedures requiring hospitalization.
On average, the private hospital industry invests R8 billion
($1.3 billion) in health-care technology annually, about 45.7
percent of the sector's revenue. According to the study, the
average combined cost of hospital and surgical fees, drug and
surgical equipment for an uncomplicated Caesarean section in a
private hospital in South Africa is about R15,431 ($2400),
almost half the R29,445 ($4600) in Australia and a quarter of
the R58,602 ($9200) cost in the U.S. The cost of a colonoscopy
in a private South African hospital, R3,458 ($540), is one-
third less than the cost of the identical procedure in
Australia, R5,305 ($830), and 30 percent of the U.S. cost of
R11,760 ($1800). A tonsillectomy performed in South Africa is
between 53 percent and 58 percent cheaper than in Australia and
less than 10 percent of the U.S. cost. A hip replacement is 77
percent cheaper than in Australia and 58 percent cheaper than
in the U.S. A vasectomy costs R3,883 ($610), which is 10
percent of the R39,900 ($6200) charged in the U.S. The length
of time a patient spends in South Africa's private hospitals is
among the lowest worldwide. The average stay for an
uncomplicated Caesarean section is four days in a private
hospital in South Africa, compared with 3.38 days in the U.S.
and 5.9 days in Australia. Patients who undergo a
straightforward hip replacement in South Africa's private
hospitals spend an average of 5.58 days in hospital, while the
length of stay for the identical procedure in the U.S. and
Australia is 4.59 and 9.5 respectively. Source: Sapa and Mail
& Guardian, August 15.
POVERTY AND GENDER INEQUALITY HAMPER SOUTH AFRICA'S RESPONSE TO
HIV/AIDS
--------------------------------------------- ------------------
10. Speaking at a recent HIV/AIDS forum organized by the
HIV/AIDS networking organization, HIVAN, and the World Council
of Religion and Peace (WCRP), Hoosen Coovadia, Professor of
HIV/AIDS Research at the Nelson Mandela Medical School of the
University of KwaZulu-Natal (KZN), asserted high unemployment
rates, poverty and lack of access to basic services is such a
problem in South Africa that enough resources could not be
utilized to control the HIV/AIDS pandemic. He noted that
recent statistics released by the national Department of
Health, showing that HIV prevalence in South Africa had risen
from 26.5 percent in 2002 to 29.5 percent in 2004, indicated
that there was "something terribly wrong with this country's
HIV/AIDS program. Nevertheless, Coovadia acknowledged the
country's success in implementing one of the most extensive
prevention of mother-to-child transmission (PMTCT) programs in
the world, and enrolling more than 50,000 people in the
national treatment plan. He called on researchers to pay
greater attention to the link between HIV/AIDS and gender, and
to remember that women were at higher risk of infection.
Approximately 25 percent of South African women are raped or
suffer domestic violence. According to Cookie Edwards,
provincial coordinator of the KZN Network of Violence Against
Women, HIV/AIDS and the abuse of women were often regarded as
unrelated. Discussants at the forum also asserted that the
country's fight against HIV/AIDS relied heavily on medical and
technical solutions, while largely ignoring social factors,
such as behavior, beliefs, traditions and inter-personal
relationships. Source: PlusNews, August 18.
TEITELBAUM