As we celebrate our achievements of the first decade, we are dedicating ourselves within the health sector to ensuring that the fruits of the second decade exceed those of the first.
There are priorities from the first two terms of government that remain top of the agenda even now. These are programmes related to the goal of ensuring that all South Africans enjoy the fruits of our freedom and democracy.
We have achieved much in the past 10 years. Our major gains have been in relation to vaccine-preventable illnesses, better management of malaria, improved reproductive health services, a more focused approach to disability, reducing tobacco use and the gradual achievement of a truly comprehensive response to HIV and AIDS.
During the past 10 years this government has built more than 1 300 new clinics in under-served areas of our country, and we now have functioning health districts right across the country.
We undertook 966 hospital rehabilitation projects and built 18 entirely new hospitals.
We introduced a Patients' Rights Charter and saw provinces gradually initiate complaint systems, help desks and incentives for good service.
The reform of the medical aid legislation has resulted in a stabilisation of the financial situation of the medical aid schemes to the extent that there have been no bankruptcies in the past two years.
We are working on a Health Charter that will provide a framework for the interaction of the public and private health sectors, and which will also lay out the core values that the private health sector should seek to uphold, including the ownership of private health services, Black Economic Empowerment and how the public and private sectors should co-operate and complement each other.
Our country has also played a leading role in shaping the agenda of the Southern African Development Community, Africa and, more importantly, the World Health Organisation.
We have put the interests of South Africa, Africa and the developing world firmly to the fore, for example in advocating action to make medicines more affordable, to manage the brain drain of health workers from developing to developed countries and to promote a comprehensive approach to disease management.
On the home front, we have agreed one vision - an accessible, caring and high quality health system.
The new mission, which is how we hope to achieve this vision, is to improve health status through the prevention of disease and promotion of healthy lifestyles and to consistently improve the healthcare delivery system by focusing on access, equity, efficiency, quality and sustainability. To work toward our vision, we set priorities for the next five years and the top 10 of these are:
- Improve the governance and management of the national health system.
- Promote healthy lifestyles.
- Contribute towards human dignity by improving quality of care.
- Improve management of communicable diseases and non-communicable illnesses.
- Strengthen primary healthcare, emergency medical services and hospital service delivery systems.
- Strengthen support services.
- Human resource planning, development and management.
- Plan, budget and monitor and evaluate.
- Draft and implement health legislation.
- Strengthen international relations.
This list is not exhaustive but it represents those things that we must pay particular attention to among all the other things that we do every day.
We have combined the management of communicable diseases and non-communicable illnesses. Together with promoting healthy lifestyles, this priority constitutes the core business of the national health system.
We recognise the need to develop our mental health services and interventions to reduce non-natural causes of death. We are seeing an increase in non-natural causes of deaths. These are deaths from traffic accidents, homicides and suicides.
We need to better understand the psycho-social underpinnings of these issues and shape our interventions accordingly. The national school health policy, introduced last year, will assist in the early detection of learners who may be considered high risk in terms of suicide.
Non-communicable diseases, such as diabetes, hypertension, cancer and osteoporosis, are increasingly being recognised as global health problems. Many developing countries face a growing burden of chronic, non-communicable disease - and South Africa is one of them.
Our priority over the next five years, therefore, is to develop meaningful strategies for preventing these diseases that are difficult to live with and costly to manage. The strategies for prevention are the same for many non-communicable diseases - they centre on good diet, responsible alcohol consumption, regular exercise and avoiding tobacco use. The government is going provide a policy framework that will contribute to responsible alcohol consumption.
In the absence of a cure, our response to HIV and AIDS emphasises the centrality of prevention. We are intensifying our programme to encourage especially young people to abstain from sex and those who are sexually active to be faithful to one partner. We are proactively marketing the free high-quality male condoms and their distribution has increased by 80% over the past six years.
We are also implementing the programme to reduce the risk of mother to child transmission of HIV - the guidelines for this programme will soon be reviewed in line with the recommendations of the Medicines Control Council.
Our Comprehensive Plan for Management, Care and Treatment of HIV and AIDS also emphasises the strengthening of the national health system for it to sustain a series of interventions aimed at mitigating the impact of AIDS. We have a target of establishing a service point in each of our 53 districts within this financial year ending in March 2005, and a service point in every local municipality within five years.
We believe that this approach will enable all South Africans to have access to a comprehensive package of quality services irrespective of their geographical location within our vast country with a history of inequitable distribution of resources.
These services include a series of interventions aimed at prolonging the progression from HIV infection to development of AIDS-defining conditions and ensuring optimal health for people living with HIV and AIDS, including nutritional support, traditional medicine, treatment of opportunistic infections and antiretroviral therapy.
We are increasing our effort to combat tuberculosis, which remains the major challenge in the country. Our interventions are focused on better case management and providing support for those on TB treatment because TB is curable even in the presence of HIV.
Central to all these interventions is our health workers. Health is a labour intensive sector and we spend 60% of our budget on personnel. We are therefore determined to recruit and retain adequate numbers of health workers to provide quality services. We are intensifying our effort to improve their working conditions and ensure a fulfilling career growth within the health system.
There is so much to do. Dealing with all these health and social problems requires social mobilisation and involvement of all sectors of society. We must therefore commit ourselves as South Africans to working together to ensure a better life for all.
Let us bring dignity to our people through quality healthcare.
Dr Tshabalala-Msimang is the Minister of Health and a member of the ANC's National Executive Committee. This article first appeared on the ANC's website, ANC Today http://www.doh.gov.za/docs/strat-f.html
(Source: The Cape Times, 5 August 2004).
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