Andy Gray

THE government spends almost 60% of its health budget on personnel, yet cannot say precisely how many cardiologists, pediatricians or physiotherapists work for the state because of weaknesses in its data systems.

The picture gets even murkier when it comes to the private sector, as the professional councils that register doctors, nurses and other health workers do not record where people work, and whether they have emigrated or retired. The lack of accurate figures has hamstrung the public sector’s ability to manage staff, so getting a better handle on the data is a key aspect of the draft human resources strategy released by the Department of Health last week, says director- general Precious Matsoso.

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.

South Africa's Medicines Control Council has been accepted as a member of the Pharmaceutical Inspection Convention (PIC) and the Pharmaceutical Inspection Co-operation Scheme (PIC Scheme), generally referred to as the PIC/S, as from July 2007.

Bowing to huge international pressure, major pharmaceutical companies have made significant efforts to make their patented antiretroviral drugs available in Africa while ensuring that they - not generic manufacturers - maintain market control in the continent.

This, the 10th edition of the South African Health Review, has the major theme of Human Resources for Health (HRH). South Africa has made significant progress in producing policies supportive of a good quality of health for all residents. However, there are challenges and gaps in translating these policies into action. Probably the most important of these challenges is the lack of adequate human resources.

Table of Contents:

Cover, Foreword, Contents, Acknowledgements, Preface

Cross Cutting Health Systems Issues

Chapter 1: Strategic Priorities for the National Health System (2004-2009) contributions towards building a model development state in South Africa Author/s: Gail Andrews and Yogan Pillay

Chapter 2: Health Legislation Author/s: Andy Gray, Michelle Govender, Tanuja Gengiah and Jerome Singh

Chapter 3: The Private Health Sector Author/s: Natalie Leon and Ray Mabope

Chapter 4: The Health Act and the District Health System Author/s: Wendy Hall, Thando Ford-Ngomane and Peter Barron

Chapter 5: Financing Antiretroviral Treatment and Primary Health Care Services Author/s: Susan Cleary, Okore Okorafor, Wezile Chitha, Andrew Boulle and Siybonga Jikwana

Human Resources

Chapter 6: Human Resources: International Context Aurthor/s: David Sanders and Bridget Lloyd

Chapter 7: The Nursing Profession: production of nurses and proposed scope of practise Author/s: Hasina Subedar

Voice of a nurse: Staff Nurse Sibonelo Cele of Mahatma Gandhi Hospital, north of Durban, KwaZulu-Natal Aurthor/s: Kerry Cullinan

Chapter 8: Human Resources Policies: health sector reform and management of PHC Author/s: Nzapfurundi Chabikuli, Duane Blaauw, Lucy Gilson and Helen Schneider

Voice of a nurse: Sister Jaconuum Cupido of Springbok Clinic, Northern Cape Author/s: Anso Thom

Chapter 9: Human Resources: District Hospitals Author/s: Ian Couper, Marietjie de Villiers and Nontsikelelo Sondzaba

Voice of a doctor: Will Mapham of Madweleni, Mbashe District, Eastern Cape  Author/s: Anso Thom

Chapter 10: Building the Skills Base to Implement the District Health System Author/s: Uta Lehmann and Nonhlanhla Makhanya

Voice of an Environmental Officer: Sanjay Erra of eThekwini municipality, KwaZulu Natal Author/s: Kerry Cullinan

Chapter 11: Mid-level Health Workers in South Africa: not an easy option Author/s: Jannie Hugo

Voice of a nursing sister: Gugu Majola of Gateway Clinic at St Theresa's Hospital in Mount Frere, Eastern Cape Author/s: Kerry Cullinan

Chapter 12: The Pharmacist's Assistant: a case study of a mid-level worker option Author/s: Andy Gray, Tanuja Gengiah and Panjasaram Naidoo

Voice of a pharmacist: Ruth Ngbokota of Michael Mapongwana Day Hospital in Khayelitsha, Western Cape Author/s: Anso Thom

Chapter 13: CHWs and Community Caregivers: towards a unified model of practise Author/s: Irwin Friedman

Chapter 14: Information for Human Resource Management Author/s: Verona Mathews

HIV and AIDS

Chapter 15: Confronting HIV and AIDS through Mass Media and Community Action Author/s: Jo-Anne Collinge

Chapter 16: Operational Plan: implementation of the antiretroviral therapy component Author/s: Rob Stewart and Marian Loveday

Indicators

Chapter 17: Health and Related Indicators Author/s: Candy Day and Andy Gray

Glossary

Index

South Africans are abusing painkillers by using the wrong medication for their pain and increasing the dose when the medication does not work. The Pharmaceutical Society of South Africa spokesman Anita Heyl said major abuse of painkillers was cause for concern.

As government's national rollout of antiretrovirals intensifies, there is growing concern that the available sources of supply could be pressured by the demand.

Stronger warning labels will be added to paracetamol sold in the United States in an effort to curb accidental overdoses that have lead to hundreds of deaths in that country. The National Hospital Discharge Survey in the US indicated that there were an average of 26 256 hospitalisations per year related to paracetamol overdoses. In South Africa, Andy Gray, of the Department of Experimental and Clinical Pharmacology at the Nelson R Mandela School on Medicine confirmed that paracetamol poisoning (inadvertent and deliberate) was common. However, he said the challenge was finding a safe way to regulate access to something so ubiquitous. He said a few years ago the pack sizes of paracetamol (such as Panado) available on general sale were reduced (max 20 tablets/100ml) to avoid some dangers. A toxic dose in adults could be as little as 10 tablets. Gray added that some would say stronger measures were needed in South Africa: However, if made pharmacy-only, access in rural areas might be compromised, he said. He added that written warnings in English were least effective in the same (rural) areas. The British Medical Journal reported that many were surprised that the United States had not considered following the United Kingdom's policy of reducing the public's ease of access to paracetamol over and above the warnings. The reforms in the United Kingdom have also led to a substantial reduction in annual sales of tablets containing paracetamol and paracetamol compounds, from 123 billion to 84 billion. More than 200 people attended the two-day hearing in the United States, which focused first on paracetamol and then on aspirin and non-steroidal anti-inflammatory drugs, said to be associated with more than 16000 deats in the United States every year as a result of gastrointestinal bleeding. Paracetamol has been on the market since 1955 and is thought to be the most widely used pain reliever in the world. Registrar of South Africa's Medicines Control Council, Dr Precious Mtsoso, could not be reached for comment. Anso Thom, Health-e, 03-10-2002

Andy Gray discusses the widely contested nature of the ‘essential drugs’ response to HIV/AIDS in a developing country setting like South Africa