The health minister was speaking yesterday (FRI) at the opening plenary of the People’€™s Health Assembly (PHA), a five-day international meeting taking place under the umbrella of the People’€™s Health Movement (PHM).

Motsoaledi said South Africa would face legal opposition similar to that experienced by US president Obama as he tried to implement a health plan that would see 50-million people in ‘€œone of the world’€™s superpowers’€ access proper and universal healthcare.

‘€œSouth Africa has a similar pattern emerging and as we finalise our plans for National Health Insurance (NHI) and craft our version of a universal health care system, just like the US, we know they are going to take us to court,’€ Motsoaledi, said in a veiled reference to some players in the private health care sector.

There was also an expectation that certain players in the alcohol and food industry would challenge moves to regulate them.

Motsoaledi was frank in acknowledging ‘€œwe have levels of mortality that we are not proud of’€ but while the country was attempting to achieve the targets of better health for the poor, there had to be an understanding that the current   health system was not been designed for the poor.

‘€œWe urgently need new health care systems that are useful to the poor,’€ he said.

In South Africa, only 16 percent of the population is guaranteed access to health via the private sector.

‘€œWhen people want to legally challenge the implementation of an equitable health system in South Africa, the US and rest of the world, it is a clear indication that the health system is designed for the rich and the powerful,’€ he said.

Motsoaledi said social movements such as the PHM would become increasingly critical stakeholders as governments attempt to implement equitable, universal health systems around the world, but face opposition as the same time. The PHM has members around the world and is working hard to bring voices from communities affected by poor health to the global platform.

Motsoaledi said he was working hard to build the foundations for the NHI, which included among others improving the availability of drugs, developing well-trained health workers and re-engineering the primary health care system.

‘€œHistory will judge us on what we did to make the world more just and equitable,’€ he said.

The minister continued steadfastly despite a brief interruption by an unidentified woman who heckled him, accusing him of having blood on his hands. A few minutes later she approached the stage shouting: ‘€œYou are talking crap’€. She was removed by University of the Western Cape security guards.

At an earlier press conference international public health expert and convenor of the PHA Professor David Sanders said South Africa had health outcomes that reflected mortality rates three times higher than countries with much less wealth.

Countries such as Brazil, Costa Rica, Thailand and ‘€œonce a basket case’€ Bangladesh are doing much better. Thailand has an under five mortality rate that is one fifth of South Africa, despite being much poorer.

Sanders warned that despite PHM’€™s support for NHI, it would not work unless some key criteria was met:

–             Proper funding of the NHI by Treasury (the 10 NHI pilot sites have been given a paltry R11-million each);

–             Remedying of key inequalities specifically when dealing with buying services from the private sector, which would for example have very little impact in an area such as Mt Frere in the Eastern Cape where there are no private health care providers;

–             Training more health care providers and making sure that those who do work are equitably distributed so the poor benefit. Brazil, one of the countries South Africa is looking to for health care models, invested heavily in the training of health workers, building 26 state schools of public health.

The PHA takes place amid poor health indicators around the world:

–             32 percent of the children in the developing world are underweight;

–             240 maternal deaths per 100 000 live births in the developing world, compared to between 5 and 8 per 100 000 in the developed world;

–             An increase in gender based violence, which is often not ‘€œcultural’€ but rather driven by intense frustration and anger amid massive poverty.

The PHA ends on Wednesday.

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