Issued by Ministry of Health
10 September 2001
During August, the President wrote to me in my capacity as chair of the Social Cluster of Ministers requesting that the social cluster review the profile of mortality statistics and consider whether our programmes are aligned with the needs of our people, as revealed by these figures.
Since then the relevant Departments have put in place processes to address this question. I would like to clarify the nature of our response and comment on the research conducted by the Medical Research Council.
We take issue with the suggestion in Business Day that this initiative is intended to de-emphasise the impact of HIV/AIDS. We do not view this as an exercise to reduce the resources and energy devoted to the HIV/AIDS programme, but as a critical appraisal of whether we are sufficiently focused in other areas of health care and social service. The significance of HIV/AIDS and the challenges it poses to our services as well as to our society in general are not in question.
But this country also records a large number of deaths annually due to cardiovascular conditions, injury (both intentional and accidental), respiratory dysfunction and cancers. These deaths will not diminish much even as the number of HIV/AIDS related deaths grow. We, therefore, need to consider whether the factors underpinning injury and chronic disease are also being tackled in an effective way as part of a broad government strategy to reduce the levels of mortality. South Africa remains a highly unequal society, with extremes of wealth and poverty, and this fact reflects in our complex burden of disease in which classic diseases of poverty combine with emerging diseases of lifestyle.
The President's request to the Social Cluster was explicitly based on 1995/6 mortality rates as these are the latest official statistics available and form the basis of international reports on our national health status. However, government has been conscious of the need for more current AIDS related mortality figures. This was one of the recommendations emanating from the Presidential AIDS Advisory Panel process, initiated to better understand the challenge of HIV/AIDS.
Largely as a result of this, an Interdepartmental Task Team on Mortality Statistics was set up. Statistics South Africa, a key participant in this task team, has prioritised the processing of general mortality data for the period 1997 to 2000 and is expected to release its figures around December. These figures will constitute new "official" death statistics for our country.
The report by the Medical Research Council (referred to by Business Day) should be seen as part of this broader process although it focuses quite specifically on the need for valid and current AIDS-related mortality estimates. Last Monday (3 September), the MRC's research results were presented to a meeting that included the Statistician General, the Head of Department of Home Affairs, the Director-General of Health and representatives of the HSRC and the population unit of the Department of Social Development. The meeting recommended that the report should be presented to Cabinet and the process of routing it to Cabinet has begun.
The purpose of presenting the research to Cabinet is to inform Ministers of the findings, not to seek endorsement. We believe that the figures that underpin policy on a matter as significant as HIV/AIDS (and related conditions) need to be interrogated and fully appreciated - in terms of their strengths and limitations - by national decision-makers. Given the stigma that still surrounds HIV/AIDS, the collection of data in this area presents special methodological problems and we need to understand how researchers have tackled these challenges in order to evaluate their work.
Dr Manto Tshabalala-Msimang
Contact: Sibani Mngadi at 082 772 0161
Jo-Anne Collinge at 082 787 0202