Issued by: Department of Health
22 January 1998
DEPARTMENT OF HEALTH ACHIEVEMENTS AND HIGHLIGHTS OF 1997
From a fragmented health system that served the needs of a few, 1997 will be known as the year the Department of Health put in place the mechanisms that will make the National Health System accessible and affordable to all South African citizens.
The White Paper on Health, published in April 1997, set out the Department's vision, mission and goals across the whole spectrum of health-related issues to the year 2000.
The department's mission statement is: "To provide leadership and guidance to the National Health System in its efforts to promote and monitor the health of all people in South Africa and to provide caring and effective services through a Primary Health Care approach."
Considerable progrees has been made this year towards the attainment of this mission and establishing key pillars of health care, which included:
This focus on improved access and improved quality and affordability of services underlies the National Drug Policy, of which the Standard Treatment guidelines and the Essential Drug list for Primary Health Care are critical elements.
The drug policy is aimed at controlling costs and improving distribution management of drug supplies, to ensure rational drug use by both health providers and patients. In addition, recently passed legislation is aimed at reducing the price of drugs through parallel importation and the use of generic substances.
The Department has been on steep learning curve into uncharted territory in its desire to fulfill its mission, attracting both praise and criticism in the process. What cannot be questioned is the Department's commitment to its mission to increase equitable access for all to health care. The Department looks forward to the challenges of the new year with the commitment to the nation to do whatever it can to improve the health status of all in South Africa.
In our view, the following are the highlights and achievements of the Department during 1997, a continuation of our mandate to achieve health care for all.
1. Protecting the vulnerable
In 1994, President Nelson Mandela announced as part of the Presidential Lead Projects, a feeding scheme for all primary school children and free access to primary health care for pregnant mothers and children under the age of six. This project has been developed further to a programme of adequate nutrition for primary school children.
At the end of August 1997, the department was providing meals to 4,6 million children at 14 001 primary schools nationally. Reports indicate that this programme has a significant impact on this target population.
School attendance has improved, school drop-outs decreased and improved levels of concentration in the classroom have been reported.
The lack of proper nutrition in South Africa leads to low birth weight in babies and damages growth and development. Available data indicate that the prevalence of stunting in children may be up to 30%. The DoH has developed and is ready to implement the National Nutrition surveillance System from next year as part of the National Health Information System to monitor the nutritional status of pregnant and lactating women, pre-school children and the levels of micro-nutrient deficiency.
In addition, all provinces are presently preparing to implement the Integrated Management of Childhood Illnesses to counter respiratory infections and diarrhoeal diseases that are a major cause of child mortality.
The Department continued to immunise children routinely against the seven diseases -poliomyelitis, measles, hepatitis, diphtheria, whooping cough, tetanus and tuberculosis.
The last in a series of three mass immunisation campaigns was conducted in May and June this year. A total of 3.9 million children were immunised against polio, and 6,8 million children against measles in these campaigns. The aim of the campaigns is to stop the virus from spreading, prevent epidemics and pave the way for the total elimination of these diseases.
The Department is also working towards the achievement of a Polio-Free South Africa certificate from the WHO. The next disease for elimination is measles.
2. Women's health
The introduction of free primary health care for pregnant women and children in June 1994 eliminated the cost of health care services as a barrier to access. Independent evaluation suggests that this policy has achieved its aims; attendance has increased at antenatal and family planning clinics, and nearly three-quarters of health workers surveyed believe that the policy was successful in preventing serious illnesses or death among pregnant women.
In February this year, the choice on Termination of Pregnancy Act of 1996 was implemented to extend safe services for the termination of pregnancy to women. A total of 92 public health facilities and 73 private hospitals have been designated to perform TOP's. By the end of August 1997, 15 545 terminations were done nationally.
The Department will be launching during the month of December 1997 the Women's Health Card, which has been translated into all 11 languages. The card will be retained by the client or patient and will help care-givers with information which would normally not be available to them.
From 1 December 1997, maternal death, a too common cause of death of women, became a medical notifiable condition in South Africa. The notification will inform the Minister and the DoH of the preventable causes of maternal deaths.
The Department also amended the regulations regarding the Artificial Insemination of Persons and Related Matters Act, providing for artificial fertilisation to be made available to unmarried women. Previously only married women were eligible for artificial fertilisation. The adjustment of the Act brings it in line with the Constitution which prohibits discrimination on grounds of marital status.
3. Community Involvement
The Constitution promotes decentralisation of government responsibilities to the provinces and local government structures. The DoH has adopted a district health system as the vehicle for the delivery of Primary Health Care. This system puts decision making in the hands of the local government and community involvement in decision making is maximised.
Consequently all provinces have been demarcated into health districts, with the exception of KwaZulu-Natal. In total 153 districts have already been demarcated.
4. Primary health care (PHC)
The shift from tertiary to primary health care, in line with the policies of the World Health Organisation and the World Bank, redirects spending to where it is most needed. As a result, the new National Health System will be able to finance more PHC visits by the year 2005. The projection is that PHC expenditure will increase from R4,8 billion in 1995/6 to R7,2 billion in 2000-1, an average annual increase of 8,3%.
5. Clinic building
To ease overcrowding and to improve accessibility to PHC, particularly in previously under-served areas, the Department in 1997 increased its clinic building programme and built 279 new clinics, upgraded 40 existing clinics and purchased 57 mobile clinics. This means that on average, 23 new clinics were built each month.
The total value of the clinic upgrading and building programme from 1995 to 1998 is R743 195 146. This amount is made up of R258 816 491 from RDP funding and R495 501 936 from provinces' capital funds. In 1997, R430 603 320 was spent on building, upgrading and providing mobile clinics.
6. Community Service for doctors
Many parts of the country, notably rural areas and informal settlements, have limited access to doctors within the public health system. Whilst the primary health care system in South Africa will be nurse driven, there is a need for medical doctors to provide certain services at primary health care level and to provide the necessary back-up to the nursing cadre.
The DoH has a commitment to ensure that the quality of service in the rural areas and currently under-served urban areas is as good as those in the relatively well-served areas of the country.
In order to ensure that medical doctors are available to the public sectors in the required numbers, the amended Medical, Dental and Supplementary Health Services Professional Act makes provision for newly qualified doctors to perform one year's community service - which will become compulsory in July next year.
The employment of foreign doctors also ensures the continuity of health services in the rural and under-served areas in the interim until the transformation process of the health sector is completed. To date, a cumulative total of 272 Cuban doctors have been deployed in eight provinces in South Africa. Twenty-four Cuban lecturers also arrived during the first quarter of 1997 and are all employed at the University of Transkei.
7. Tobacco legislation
The health warning labels on tobacco have been well received by the public and have been effective in increasing awareness of the health risks of smoking. A survey conducted by the Human Sciences Research Council (HSRC) and Medical Research Council (MRC) indicated that 81% of adults believe it was a "good thing" to have the health warnings and most people (77%0 said that the warnings were easy to understand.
About 58% of smokers said the warnings made them want to quit or cut down or change to a lighter cigarette, while 38% of non-smokers said the warnings made them glad that they never started.
The DoH has introduced new anti-tobacco advertisements on radio with the cooperation of the Cancer Association and the Tobacco Action Group.
The Department also held a workshop early in 1997 with a range of stakeholders, which identified gaps in the current tobacco legislation that allow tobacco companies to advertise their products indirectly through the sponsorship of sporting and cultural activities. The workshop recommended that the legislation be amended to ban advertising and promotion of tobacco products, raise the legal age at which a child can buy tobacco to 18, restrict the use of vending machines and restrict smoking in work and public places.
8. Child, youth, women and family mental health
Following a consultative conference, the Department developed a plan of action to extend mental health support services to victims of violence and sexual abuse. The plan includes improved data collection, integrated services for violence victims, development of referral facilities and prevention programmes.
Data collection includes violence surveillance which will be carried out in conjunction with the Centre for Disease Control in the USA. Other initiatives will form part of the Victim Empowerment Programme of the National Crime Prevention Strategy.
The Department also participated in an inter-sectoral process to develop guidelines for victims of rape and other sexual offences. The health guidelines require training and expansion of forensic services and trauma service delivery.
9. HIV and AIDS prevention
The budget for HIV/AIDS and sexually transmitted diseases increased four-fold from R21 million in 1993/4 to R80 million in 1996/7. This year's budget is significantly higher if one takes into account donor funding.
Despite this significant increase in expenditure, however, the prevalence of infection has increased. The HIV/AIDS epidemic continues to grow with 7.5% HIV prevalence measured amongst women attending antenatal clinics of the public health services at the end of 1996.
With an estimated 2.5 million persons infected (including 157 272 babies), the epidemic will have a major impact on South African society. The Department has recently completed a review of all programmes with the aid of international experts and has embarked on a series of innovative projects to halt the spread of the disease. One such project is the "Beyond Awareness" campaign which is aimed at behaviour change.
A major achievement for the Department in 1997 has been the training of over 10 000 secondary school teachers and the launch of the life skills programme across the country. The theme of World AIDS Day 1997, Children Living in a World with Aids, will be carried throughout 1998, as efforts are made to reduce the risk of HIV transmission from infected mothers to their children and to prepare for the growing burden of orphans.