Health

The Department of Health says its policy on the treatment of Tuberculosis patients, especially those who have Multi-Drug Resistant TB (MDR-TB) and Extreme-Drug Resistant (XDR-TB), will not be changed in any way.

The Department of Health is stalling the introduction of treatment that can prevent more than 90% of pregnant HIV-positive women from passing the virus to their babies. Currently, as many as 30 000 infants in one province alone are being infected with HIV by their mothers each year.

Got a cure for AIDS? Maybe you're convinced that large doses of vitamins can do the trick or that you have found the answer scores of scientists over the last 25 years could not. If you live in South Africa there is little to prevent you from packaging your wonder product in an old coke bottle or a fancy pill container, depending on your means, and selling it for whatever price you can get.

As concerns continue to be expressed about the departure of African medical professionals for wealthy countries, South Africa says it is not recruiting health workers from developing nations -- something that also reflects the country's own experience of the medical brain drain.

An illegal medicines industry is rocketing out of control as unregistered products - many claiming to cure diseases such as cancer, TB and AIDS - are sold across the counter or on the streets.

The KwaZulu-Natal health sector is short of about 20 000 medical professionals who would enable it to operate very efficiently, the health department has said.

Tamiflu, the anti-viral drug used to combat the H5N1 strain of avian influenza, which has already reached Africa and is predicted to reach South Africa in six months to a year, has officially been registered for use in the country.

Zambian health officials have warned of the emergence of strains of the HI virus that are resistant to current antiretroviral (ARV) drug treatment. Dr Ben Chirwa, director general of the Central Board of Health, said a recent laboratory study conducted at the University Teaching Hospital in the capital, Lusaka, had confirmed the drug-resistant strain, and its emergence was clearly an indication that people are not being consistent with their medication. AIDS expert and former health minister, professor Nkandu Luo, told PlusNews the problem was immediate and urgent because of its implications for drug policies and the cost of health care. Last year the government responded to the high cost of ARVs - around US $250 per month - by introducing heavily subsidised medication through the public health system for 10,000 HIV-positive people, at around $8 a month. In Chipata, one of the poorest areas in eastern Zambia, the challenge of resistant strains appears especially alarming, as information on drug adherence and compliance is often not provided by health officials. The community mainly comprises poor subsistence farmers, deeply rooted in a culture of polygamy and early marriages, with an HIV infection rate of 16.8 percent (compared to the national average of 19 percent). Daniel Musoka, 43, a former supervisor at a major bank, was on ARVs for three years, paid for by his employer. When he was retrenched in 1999, as per its policy, the bank paid for only one more year of his treatment. He moved to his father's village in Chipata and continued to buy medicine with his retirement benefits, but the money ran out last year. I had been off treatment for almost eight months. I had an idea about the dangers of stopping treatment, but I did not believe it could be that serious. Musoka has tuberculosis and is not responding well to treatment - the doctors have told him he has developed resistance to the medication and are now experimenting with various ARV combinations. I am bitter that I face death because of a measly 50 [US] dollars (the cost of his monthly treatment), he told PlusNews. He feels the government should institute some kind of medical scheme for people on ARVs, so that they do not jeopardise their lives further by stopping treatment. He blames medical workers, too, for not emphasising the importance of continuity and the consequences of stopping medication. Musoka's health care provider, Nomsa Chembe, says some of her patients who cannot afford to buy their medicines from private chemists or pharmacies have, after a pause in treatment, switched to the cheaper government-supplied drugs provided by clinics and hospitals, with catastrophic results. She suggested better collaboration and a uniform procurement policy for ARVs between the government and private pharmacies, to avoid problems such as Musoka's. Chembe maintains that health workers provide adequate information on compliance and adherence, just as they are trained to do. Patients are told to take their medicines at regular times, eat before taking their doses, and drink at least three litres of water a day to hydrate the body because the medicines are strong. But the reality is that many patients forget to take their doses, thereby confusing their regimen, and find it difficult to access clean drinking water, Chembe said. Most areas are serviced by wells which do not always have fresh water. Food is also a problem - many people can only afford to eat once a day, Chembe noted. Initially, Chembe's clinic gave out packets of high-energy protein (HEP) mix with the medication, but stopped not only because the HEP donations ran out, but entire families of seven or eight began to depend on the 5 kg mix for sustenance, leaving the patient with little or nothing to eat. In the meantime, Luo is trying to get the government and aid agencies to move faster in addressing the emergence of resistant strains. I am frightened. I heard President Mwanawasa saying government would provide ARVs for a further 100,000 people this year ... I am screaming 'stop', look at what is happening with just 10,000 people on treatment. (Source: UN's IRIN humanitarian information unit http://www.irinnews.org)

Medical practitioners are objecting strongly to certain provisions of the Medicines and Related Substances Act, such as the ban on dispensing. The National Convention for Dispensing (NCD) – representing around 8 000 doctors – has already lodged a High Court application in Gauteng challenging several aspects of the controversial Act and its regulations, which came into effect on 2 May. The NCD alleges that the legislation suspends doctors’ statutory right to dispense medicines, replacing it with a system of licensing. However, the necessary regulatory infrastructure for dealing with such licence applications does not yet exist. Therefore, the NCD claims that it’s not “objectively rational” and thus unconstitutional. A trust has been set up to ensure that the NCD’s legal action runs its course and that the Act and its regulations are fully contested. NCD convenor Danie Struwig says that the controversial provision dealing with dispensing – as well as Government’s plans to change doctors’ training so that they’re unable to practise overseas – will have devastating consequences for healthcare, which SA cannot afford. Struwig says that about 50% of SA’s GPs dispense medicines and that this represents about half of their income. “If this income falls away, we can expect to lose about 40% of our doctors.” Health director-general Dr Ayanda Ntsaluba has stated that only doctors must prescribe medicines and that only pharmacists must dispense them. Doctors doubt whether this makes sense in the new dispensation since there will only be a professional fee charged per prescribed item. Apart from the dispensing ban significantly cutting doctors’ incomes, the impact this will have on less affluent patients is also a source of concern. In Pretoria alone, there are more than 110 000 patients dependent on doctors dispensing drugs. According to Duvenhage if this one-stop service falls away, it will mean that patients least able to afford it will pay more for medicines, plus transport costs to pharmacies or State hospitals. He says that the perception that dispensing doctors are “more expensive” than non-dispensing ones is a fallacy – and medical schemes confirm this. GPNet specialist network director Dr Lex Visser, who represents the company on the NCD, says the new legislation and regulations are redundant. Another anomaly is that a doctor administers intravenous medication in his consulting rooms, which has potentially far more serious consequences than prescribing a cough syrup. Carecross Health MD Dr Reinder Nauta says that the Act will make medicine more expensive for the poor and cheaper for the rich. An estimated 20m people in SA make use of GPs who offer an affordable package service. In terms of the new Act, the doctor’s consultation fee of around R60 to R100 is expected to remain the same. However, for medicines the patient will now have to visit a pharmacy or Government hospital, which will put further pressure on the already overburdened State sector.(Source: Finance Week, 28 May 2003).

The Health Department was seeking legal advice on reports that there was a loophole in the Tobacco Products Control Act that allowed smoking public places. New legislation is supposed to put a blanket ban on smoking in public, and then make exceptions. Health spokeswoman Jo-Anne Collinge issued a short statement on Wednesday evening saying the department had contacted the relevant officials in the Cape Town Metropolitan Council and the Western Cape Police Commissioner's Office. Police in the Western Cape have been told by a legal adviser that a loophole in the anti-smoking law means smokers cannot be prosecuted for lighting up in public places. In an e-mail to station commanders, head of legal services in Cape Town's West Metropole, Senior Superintendent Melville Cloete said the Tobacco Products Control Act forbade smoking in a public place. However, it did not specifically declare it an offence. Cloete said police should therefore be aware that smoking in a public place is not an offence. His opinion follows hot on the heels of the first conviction under the law, of two Port Elizabeth men who served part of a 20-day day sentence when they were unable to pay the R200 fine for smoking in a magistrate's court in the city. (Source: SAPA, 15 August 2001)