epidemics

Since the 2009 Lancet Health in South Africa Series, important changes have occurred in the country, resulting in an
increase in life expectancy to 60 years. Historical injustices together with the disastrous health policies of the previous
administration are being transformed. The change in leadership of the Ministry of Health has been key, but new
momentum is inhibited by stasis within the health management bureaucracy. Specific policy and programme changes
are evident for all four of the so-called colliding epidemics: HIV and tuberculosis; chronic illness and mental health;
injury and violence; and maternal, neonatal, and child health. South Africa now has the world’s largest programme of

Every day, approximately 1000 women die in childbirth or from a pregnancy-related complication.1 Maternal death can occur at any time in pregnancy, but delivery is by far the most dangerous time for both the mother and the baby. The vast majority of these deaths can be prevented if access to emergency obstetric care is ensured.

Experience shows us that at least 15 percent of all pregnant women worldwide encounter a life-threatening complication. In a conflict or a crisis, pregnant women are even more vulnerable because health services have collapsed, are inadequate or non-existent. But these women need access to quality emergency obstetric care whether they live in a conflict zone, in a refugee camp or under plastic sheeting after a devastating earthquake.

Many countries with a high burden of HIV infection also face burgeoning epidemics of noncommunicable diseases. Similar to HIV, noncommunicable diseases are most frequent in low- and middle-income countries, and the age-adjusted death rates from noncommunicable diseases are nearly twice as high in low- and middle-income countries as in high-income countries. People living with HIV often also have high rates of noncommunicable diseases. With HIV programmes rapidly expanding, people with HIV are living longer and ageing, and are developing non-HIV-related chronic conditions similar to the rest of the population.