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Why nurses and teachers leave our shores: Emigration or relocation is no longer merely a white phenomenon.

The demand from developed countries for skilled professionals and trades people - be they nurses, doctors and dentists or tillers and plumbers - knows no skin colour code. Pro-active recruitment agencies and governments, realising their countries are facing a growing skills crisis, are quietly coming to South Africa to drain the country of these precious human resources to satiate demands back home.

More for the poor - Budget 2005

A priority over the decade ahead will be to ensure that a caring and competently managed health service is available in every community, Finance minister Trevor Manuel told Parliament during his presentation of the 2005 budget.

Quad Squad Day Campaign

The public is encouraged to buy their Quad Squad Brick for R10, to show their support for quadriplegics and help build self help centres for independent living for quadriplegics. The campaign information contact number is 086 1100989

Drug fight hamstrung by resources

South Africa has seen an explosive rise in the availability and rates of addiction for hard core drugs such as Mandrax, cocaine, heroin and amphetamines. According to the latest edition of the SADC Epidemiology Network on Drug Use, South Africa consistently outstripped neighbouring countries in police seizures of hard drugs, as well as treatment demand and primary drug use. However, a lack of resources and capacity has severely curtailed the CDA's ability to carry out its mandate. 

Health system faces an uphill task

After months of government debate over whether to provide antiretroviral medicines, the health department now faces the daunting task of complying with the cabinet's instruction to develop a strategy on how these drugs are to be distributed to the HIV-positive people who need them. This is going to be the biggest treatment plan in the world. It would be an absolute catastrophe if the health department produced a plan demanding X number of pilot sites per province, says Dr Eric Goemare, the South African head of Medicines Sans Frontières. He believes the department needs to take account of the wide discrepancy in preparedness between provinces, and put each province in charge of developing its own plan that would meet the basic parameters. The financial resources required are immense. A joint health department and treasury task team estimated that providing a comprehensive package of care and treatment to just 50% of the 120000 people who would be clinically eligible for antiretroviral medicines in 2008 would incur an annual bill of between R9,6bn and R10,5bn. The funds are in the budget, although the task team has acknowledged that HIV/AIDS expenditure has crowded out other healthcare services. Earmarked funding for HIV/AIDS in financial year 2003-04 is budgeted at R5,982bn, and is set to rise to R7,588bn in the next two years. The most severe bottleneck is likely to manifest around the critical shortage of skilled doctors and nurses. By 2010 there will be a shortfall of 20000 nurses in SA, according to the Human Sciences Research Council. It is probably the single greatest risk facing the introduction of an antiretroviral programme, says Peter Barron, a director of the Health Systems Trust, a health policy think tank. Communities with the highest HIV prevalence rates are in rural areas, and these are the very places where the skills shortage is most acute, says Barron. He believes government and SA's academic institutions will have to find ways to fast-track training, or import the skills. Barron also warns that many hospitals and clinics do not have the infrastructure or systems in place to provide good quality primary healthcare, let alone antiretroviral treatment. The very real risk of drug resistance is why we have to make sure we do it right the first time round, says Fareed Abdullah, deputy director-general for health in Western Cape. He says ensuring HIV-positive patients stick to their pill-taking schedules will require considerable investment in counselling and support services. One of the most closely scrutinised aspects of government's treatment strategy which they have two months to develop will likely be the consideration of who gets treatment first, and the speed with which it will be provided to the rest. Jonathon Berger, a researcher with the AIDS Law Project at the University of the Witwatersrand, says the legal implications are simple: The state has an obligation to use existing capacity to provide the services, and where the capacity does not exist, it must develop it. Last year's constitutional court ruling, which directed government to begin providing the anti-HIV drug Nevirapine to pregnant women to reduce the risk of transmission from mother to infant, indicated the state must use existing capacity to provide these services, and where the capacity does not exist, the state is obliged to develop it. Kariem advocates a spiralling approach, which would in all likelihood meet the state's constitutional obligations. Start with the places that already have the infrastructure in place, get the operational aspects correct, an then progressively move into other areas, he says, But you need to have programmes that are geographically specific you can't transplant a metropolitan programme to a rural area. (Source: Tamar Kahn: Business Day, 12 August 2003)

Antiretroviral lessons

While the Treasury and Department of Health(DoH)number-crunch to determine whether government can afford anti-retroviral (ARV) treatment in public health, a number of small ARV programmes are already up and running. At present, about 700 South Africans who cannot afford medical aid are receiving ARV treatment through a number of research projects, according to a recent ARV conference organised by the Treatment Action Campaign (TAC). Although modest, the projects - all located either in the Western Cape, KwaZulu-Natal and Gauteng - have already learnt some important lessons. The Western Cape is the most advanced, with seven ARV projects treating over 500 people. The Khayelitsha programme, started in May 2001 by Medicins sans Frontieres (MSF) and supported by the provincial administration, is the biggest and oldest public health ARV programme in the country. One of the most striking things about the Khayelitsha project is that it is utilising very cheap generic ARV drugs imported from Brazil which cost R10 per patient per day. It has been given permission to do so - in terms of what is called a Section 21 exemption - by the Medicines Control Council. We have over 300 patients on anti-retrovirals, and this has completely changed the attitude of health workers. They now see they can do something for people with AIDS, says Dr Fareed Abdullah, Deputy Director General of special health projects in the provincial administration. We have found that counselling is an essential part of treatment if we are to ensure that people adhere to their treatment, Abdullah told the TAC conference. Dr Lorna Jenkins from an ARV research project run at Chris Hani-Baragwanath Hospital in Gauteng, says her best advice is don't rush to start. It is better to wait until your patients are well educated about the programme and you have thorough medical information about them, said Jenkins. Identifying those in need of ARV treatment is not always easy, given that people often deny that they have HIV. In South Africa, tuberculosis and HIV often go hand in hand. For example, in 2001 in KwaZulu-Natal 64.6% of the province's 65 654 TB patients were also HIV positive, according to the University of Natal's Professor Slim Abdool Karim. Nationally, 47.6% of TB patients were HIV positive. There are about 4.7 million people living with HIV in the country, said Karim. How do we find those in need of treatment? One efficient way to people through existing TB treatment programmes. The care infrastructure for TB already exists and there is a high co-infection rate of TB and HIV. In addition, experience from other countries shows us that co-infected patients have a high mortality rate, he said. But while TB programmes might be a good way to find the people who need AIDS treatment, Karim warns that running TB and ARV treatment concurrently will not be easy. While these small projects have uncovered a number of important issues, as Karim says, there is a policy vacuum and a leadership vacuum. Government needs to step in and guide the process if there is to be equal access to anti-retroviral treatment countrywide, rather than small research-driven projects set up here and there.(Source: Kerry Cullinan, Health-e, 28-01-2003)

Private patients swell public hospitals coffers

Although *Mrs Maharaj doesnt have a medical aid, she didnt want to go to a public hospital when she needed a hysterectomy. But when she called a private clinic, they told her the procedure would cost R20 000. Then she heard about Folateng, and there she was charged R11 000 for the hysterectomy.

Members of Medical schemes have to be more vigilant

Members of medical schemes have to be more vigilant to protect their interests against the rogues that seem to hover like vultures over the troubled industry. The uncovering of major corporate governance failures at Publiserve, the 9000-member medical scheme administered by Metropolitan Health, has been the most visible example yet of how things can go horribly wrong when members' interests are not taken seriously by trustees. All the members were left in the lurch when the scheme went into voluntary liquidation in May last year. It took a commission of inquiry, which has uncovered evidence of irregularities, to force Metropolitan to guarantee the outstanding claims of members to the tune of R10 million. More damning, however, is Metropolitan's failure to take action against anyone fingered by the commission. If it were not for the actions of the Council of Medical Schemes, some of those implicated may have walked away without being held accountable.

Private healthcare 'will soon be beyond reach'

The private healthcare sector was hurtling towards breaking point, where it would become impossible for the average family to afford medical cover, according to Gerrie van Zyl, the chief executive of Healthbridge. A three-person household taking home R10 000 after tax, at an average salary growth of 9 percent, would have to spend all their earnings on contributions towards a medical aid scheme by 2018, if the current pace of medical inflation (23 percent) continued, Van Zyl said. This kind of family was the bread and butter of most medical schemes, he added. Using the same assumptions, they could end up spending at least 20 percent of their earnings on medical AIDS by 2004, growing to 30 percent by 2007. There were two main drivers of medical costs - administration and clinical costs, Van Zyl said at the National Healthcare Structure Symposium in Midrand. Both relied on the efficient flow of accurate information when decisions were made on which treatment a patient needed. The Internet had managed to slash costs for hospitals and general practitioners by using real-time information to process claims, validate a member's benefits and submit electronic remittance advice, he added. Medical inflation has skyrocketed since the 1990s. In most organisations, health costs escalated from under 4 percent of the payroll in 1985 to between 14 and 20 percent in 2001, according to Agatha Pretorius, the managing director of Occupational Care South Africa. Employers, healthcare funders and care providers would have to create a partnership of co-operative risk sharing to clamp down on escalating health costs and safeguard the general well being of employees. Steve Jooste, a consultant for Medscheme, said pressures had created an environment where unrestricted use and cost of resources could no longer be subsidised by contribution increases. This would usher in a new era, which would be dominated by the identification, evaluation and management of financial and clinical risks. (Source: Business Report, 30 January 2002)