Finding solutions
Five of the eight goals are health-related, and include the eradication of hunger and extreme poverty; gender equality; reduced maternal and child mortality and combat HIV/AIDS and malaria.
Sadly, South Africa’s child mortality, hunger and poverty rates have worsened since our government pledged itself to the MDGs. It has made no progress in reducing maternal mortality and insufficient progress in combating HIV/AIDS.
‘A concerted effort is especially needed to reduce the number of new HIV infections. The HIV/AIDS emergency, however, should not overshadow the urgency of taking bold steps to tackle alcohol consumption, or behaviours associated with the growing prevalence of non-communicable diseases,’ state all the South Africa Series authors in the concluding paper.
Although South Africa’s poor health status paints a depressing picture, authors identify five main priority areas ‘ all premised on the idea that achieving health for all can only be achieved via primary healthcare.
Firstly, it points out that capacity to implement health policies needs to be built at local level. While the district health authorities are responsible for implementing health policies, they have not been given the authority to take operational decisions.
Secondly, health expenditure needs to be oriented towards primary health care. Instead, it continues to be dominated by tertiary hospitals with 30% of the health budget being spent on the ‘super-tertiary hospitals’ in Johannesburg, Cape Town and Durban although the health needs of the nation ‘will not be met by high-level centralised services’.
Third, HIV/AIDS care and treatment needs to be incorporated into a ‘comprehensive primary healthcare system’. At present, HIV services have created an ‘internal brain drain’ by attracting staff and resources away from other programmes.
Fourth, the establishment of a National Health Insurance scheme needs to be implemented to address ‘gross inequities’ in healthcare, including the fact that too many doctors and nurses are employed by private health (three quarters of GPs are in private health).
Finally, the ‘social determinants of health’ need to be addressed, including ‘strengthening families, decreasing violence, changing the existing culture of men’s behaviour towards women and children, creation of solutions to migrant labour and relief of poverty’. In addition, alcohol abuse, sexual violence, diet, physical activity and sanitation must be addressed.
The authors conclude: ‘We still have time to change the health trajectory of the country, and even meet the MDGs. The South African Government, installed in April, 2009, has the mandate and potential to address the public health emergencies facing the country’will they do so or will another opportunity and many more lives be lost?’ ‘ Health-e News.
The MDGs are:
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
6: Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8: Develop a Global Partnership for Development
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