Struggle for the health of the nation will resume

Although SAs health care spending is relatively high by international standards (7,7% of gross domestic product in 2006) it famously gets little bang for its buck, with health status indicators that lag far behind other countries that spend similar amounts on health care per capita. Part of the reason for this is that 56% of SA s annual health care spending (R100bn in 2006) occurs in the private sector, which services just a fifth of the population. Parliament will be considering the Medical Schemes Amendment Bill, the Medical Research Council Bill, the Medicines and Related Substances Bill, and the National Health Act Amendment Bill this year. The Medical Schemes Amendment Bill is perhaps the most important for the private health care industry as it will pave the way for the implementation of the Risk Equalisation Fund, says Jonathan Broomberg, head of strategy for Discovery Health. The funds intention is to level the playing field between medical schemes those with more young, healthy members will subsidise schemes with an older, sicker and costlier membership base. 

The health department is also heading for a busy year, as it must finalise work on the health care charter, agree on a method for benchmarking medicine prices with pharmaceutical firms, and resolve the dispute with pharmacists over the dispensing fees they can levy on medicines. It also needs to bring important aspects of the National Health Act into effect. Although the act was signed by President Thabo Mbeki in 2004, few of the enabling regulations have been written. These include drafting regulations for the certificate of need, a licensing system for health care establishments and doctors that has been fiercely opposed by the South African Medical Association, SAs largest umbrella body for doctors. Regulations are also needed to establish an Office of Standards Compliance in the department and set quality standards for equipment, premises, business practices and the manner in which patients are treated. 

The acts provisions on human stem cells and cloning also need regulations to replace the outdated Human Tissue Act. The Traditional Health Practitioners Bill now needs only Mbekis signature to become law. But again , the legislation will take effect only once enabling regulations have been promulgated. While debate on the policies that underpin the legislation may be over , as ever, the devil will be in the detail, and the government can expect intense debate when it publishes draft regulations for public comment. The private sector is also waiting to see whether Health Minister Manto TshabalalaMsimang regulates private hospital fees, as she has been threatening to do . If this happens, doctors and specialists may well be next. The health department is still working to restructure the Medicines Control Council, the body charged with overseeing clinical trials and ensuring that medicines are safe and effective. Industry is increasingly frustrated by the length of time the council takes to scrutinise proposed research and drugs and is hoping an overhaul will see the council get more resources. 

Arguably the most important development for the pharmaceutical manufacturing industry is the governments work on a new industrial policy, says Stavros Nicolaou, head of strategic trade for Aspen Pharmacare. The government has identified the sector as strategic to SA, and manufacturers are hoping to see measures to nurture scarce skills, create jobs and boost exports. Although the government is responsible for implementing SAs new AIDS plan, the health department is expected to play a leading role in ensuring targets are met: the plan aims to halve the number of new infections and provide treatment and support to 80% of those in need by 2011. Issues that need to be tackled include devising treatment guidelines, issuing a new AIDS drug tender, drafting a policy on male circumcision for HIV prevention, and improving its record-keeping systems . 

AIDS activists will be keeping an eye on progress in these areas, says Treatment Action Campaign spokesman Nathan Geffen. This year will be the litmus test of the governments commitment to the AIDS plan, he says.