Health provision: The Year ahead

Addressing Parliament’s Portfolio Committee on Health, a Deputy Director General in the department, Dr Nthari Matsau, said they had “slipped” in the way that they had handled home-based care workers.

“DOTS workers have migrated to HIV/AIDS because there is money to pay them,” she said.

She said multi-drug resistant TB increase was mainly attributed to treatment interruption, a scenario DOTS supporters prevented.

Multi-drug resistant TB is extremely difficult to treat with cure rates varying between 30 and 50%. It is also costly to treat – between 10 and 20 times more expensive that regular TB treatment.

Mortality rates are also high, ranging from 30 to 50% within two years.

The health department’s annual report, which was presented to the committee, revealed that South Africa is ranked near the bottom (ninth) of the international league table in terms of the extent of the problem, and still the epidemic is growing.

It is widely accepted that the HIV epidemic is one of the main driving forces fuelling the TB epidemic, but the disease can be cured quite effectively whether the person is HIV positive or negative.

Matsau said the department was in the process of developing “master carers” as opposed to home-based carers.

“We want a carer who can go to a home and address anything from nutrition and TB to HIV/AIDS – not only selective diseases,” said Matsau, adding that the carers would be paid for their services.

“We are really overly concerned about home-based care workers who go to a home and only care for the person on their list, unable to assist any other people living in the home,” Matsau said.

Dr Kami Chetty, a Deputy Director General in the health department indicated to the committee that the long-awaited National Health Bill had been published for public comment and should reach parliament in the first quarter of the year.

In terms of making AIDS a notifiable disease, Matsau said “we are not ready to force it in that direction”.

She said her sense was that the department needed to continue trying to remove stigma and encourage acceptance before such a decision could be made. In terms of the information that went onto the death certificate, she said, “it needs to be addressed at a political level”.

Matsau also expressed concern over the “emerging and serious” problem of orphans. “We need to look at ways of giving more comprehensive support to these children so that they are not exploited by adults.”

The department identified 10 strategic targets to assist in prioritising and focusing its efforts:

• Improving the health status of the population by decreasing morbidity and mortality through strategic health interventions;
• The delivery of an essential package of services through the district health system;
• Revitalisation of hospital services;
• Improving quality of care at clinic and hospital level;
• Reorganisation of certain support services;
• Improving resource mobilization and management;
• Strengthening co-operation with international partners;
• Legislative reform;
• Improving human resource development and management;
• Improving communication and consultation with stakeholders.
• In her foreword, Health minister, Dr Manto Tshabalala-Msimang pointed out that: “It is impossible for us to ignore developments such as genetic modification of foods and the possibilities of human cloning, although the more common realities might be hunger among our nation’s people and birth defects arising from nutritional deficiencies.