Business

Private healthcare prices in South Africa have to be regulated, Health Minister Aaron Motsoaledi said.

Speaking at the Board of Healthcare Funders conference at Sun City, Motsoaledi called for a pricing negotiation forum, saying healthcare in South Africa was "predatory".

He said the health structure was worse now than during apartheid.

"There is a tendency to believe that a long and healthy life is the right of those that can afford it and that is totally wrong," he said.

"The reality is that our people are dying in large numbers. We are running a healthcare system in this country that is not working."

The solution lay in re-engineering the primary healthcare system.

Motsoaledi announced a plan to introduce three streams of care, which would have a particular impact in rural areas.

Board spokesman Heidi Kruger welcomed Motsoaledi's comments, saying: "I think it's brilliant. The sooner it comes through the better. We can't have a situation where there is no containment on costs."

Kruger said private healthcare providers charged whatever they wanted, "pushing up" medical aid premiums.

The current system was an "open-ended liability for funders" so medical schemes could not budget properly.

Regulating healthcare costs would be "very constructive" and "provide certainty", Kruger said.

Motsoaledi is hoping to begin setting up the pricing forum by the end of the year.

However, he told delegates at the conference that hospitals were creating a stumbling block in the process because that sector did not want to have its prices regulated.

Motsoaledi accused the public and private health sectors of "engaging in destructive, unsustainable practices". He was particularly outspoken about the high cost of private hospital treatment and called for a stronger emphasis on primary care, rather than the present curative system with its "rapidly escalating" costs.

"The public health system is in a crisis of quality and I am going to deal with it head on, but it is not an excuse for profiteering," he said.

"Our country is going in the wrong direction . all of us, public and private," he said. "We have a predatory healthcare system where the sick and the vulnerable are the ones who get attacked."

My grandfather, an immigrant, barely made ends meet with farm work when he arrived in South Africa around the start of the 20th century. He was lured into swapping the open fields for underground life as a worker on the gold mines.

There is no doubt that mine workers with occupationally acquired lung diseases get a raw deal in South Africa. Their counterparts in other industries receive monthly pensions for life.

Two years ago Mopeli Mofoka, 39, left his wife and child in Maseru, Lesotho's capital, and joined the more than 50,000 men pushed by poverty and unemployment in their home country to seek work on mines in neighbouring South Africa. It was his second stint as a miner the first had been 15 years earlier. This time he was hired as a sub-contractor, which meant that despite testing positive for HIV during his preliminary health screening he did not have access to the on-site health services available to mine employees. When his health began deteriorating 18 months later, he went to a local public hospital but was turned away because he lacked a South African identity document. His only option was to return home, where he is receiving treatment for tuberculosis (TB) at a government clinic run in partnership with international medical aid organisation Medecins Sans Frontires (MSF) in Morija, about 50km south of Maseru, the capital.

Closing date: IGLHRC will begin reviewing applicants on February 20, 2009 and continue until a suitable candidate is identified.

The International Gay and Lesbian Human Rights Commission (IGLHRC) is committed to working with local, regional and international partners to fight human rights abuses based on sexual orientation and gender identity worldwide. In mid-2007, IGLHRC opened a regional office for Africa in Cape Town, South Africa, to more effectively manage its operations on the continent and to build partnerships with African LGBT and human rights organizations. The Africa Program Coordinator will manage this office and IGLHRC's Africa program.

Rarely in South Africa can a minister have come to power carrying such a weight of expectation as Barbara Hogan. Her first major public speech at the Aids Vaccine Conference in Cape Town in October was greeted with enthusiasm, and even international delegates speculated about the bright future that seems to lie ahead at last for South African healthcare. Her speech was reminiscent of one of those games where one has to bash crocodiles on the head as they pop up apparently randomly through holes in the floor. Politely, and without naming names, Hogan took a baseball bat and bashed all the major crocodiles on the head: Matthias Rath and his vitamins, for instance. Most of all she asserted the fact that HIV causes Aids.

HIV is thought to have a kill rate of close to 100%, higher than even the notorious haemorrhagic diseases such as Ebola. But, unlike such virulent attackers, HIV kills its hosts through a steadily attrition of the immune system, giving ample time for new infections to occur. The result is a slow-burning epidemic steadily destroying lives and eroding South Africa's development potential. HIV/AIDS was regarded as effectively untreatable in South Africa. The drugs were too expensive: Supreme Court of Appeal Judge Edwin Cameron had to have financial help to afford the antiretrovirals that have now kept him alive for so many years. Effectively, antiretroviral therapy (ART) was seen as something for the wealthy elite - and, so the argument went, even if it were affordable, then poor and unsophisticated people were unlikely to be able to take it properly.

By virtue of the physical nature of their jobs, South African miners receiving treatment for HIV and AIDS are vulnerable to discrimination when they are not at peak performance, because of the drugs' side-effects. This is one of the challenges that workers in the mining sector deal with, as HIV rips through the industry. Benchmarks Foundation estimates that about 16 to 30 percent of mineworkers are HIV-positive, a problem which, according to experts, has yet to receive adequate attention.

The good news on medical schemes is that the industry is turning around from huge losses. The bad news is that nobody's tracking how much medical costs consumers are carrying. On average, the industry performed pretty well, according to acting registrar of medical schemes Patrick Matshidze.

Zena Stein, Ida Susser and Marion Stevens report from Mexico on the diaphragm: inexpensive a single purchase may last for years easy to use and virtually hidden from the partner. Would it give harm reduction to HIV, as it did for pregnancy?