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Progress report on promises made to improve South Africa’s health services

Over the last three years South Africa’s President Jacob Zuma has made several promises to improve health care in his annual state of the nation address. This includes fighting TB, improving life expectancy and reducing maternal, infant and under five mortality. Health and Medicine Editor Candice Bailey asked a panel of academics to assess whether the promises have been kept.

In 2013 the president spoke of integrating HIV and TB services because of the high co-infection between the two. Has this happened? Did it work?

Professor Jill Murray: The government has moved very well to integrate HIV and TB services. The latest figure from the South African Department of Health is that 73% of patients who have TB are also HIV positive.

Obviously problems arise in integrating these services. Both TB and HIV were previously stand-alone programmes and each had their own dedicated staff, budgets and sites. In combining the two there have been issues around upskilling the doctors and the nurses who are responsible for implementing the programmes at grass roots. They have also had to explain to patients why the programmes need to be joined. All of this takes time. But integrating the services is happening well across the country.

In 2015, he promised to implement TB programmes for prisoners, mine-workers and mining town communities. Has it happened?

Professor Jill Murray: Although these programmes have been slow to start - this is a conversation that has been happening for about seven or eight years - they have picked up pace recently and there is a big push for implementation over the coming year.

Various international donors are working the with governments of 10 Southern African countries and will be granting money for project implementation within the next month or so.

The programmes will be put in place across southern Africa as many of the region’s miners are migrants. It therefore doesn’t help to only implement programmes in South Africa. TB knows no borders. It is also important to note that the programmes will involve identifying former miners who have developed mine related diseases and helping them to access compensation.

Improving South Africa’s life expectancy from 60 years in 2012 to 63 by 2019 was on the top of the president’s agenda in 2014. Are we on track?

Professor Robert Pattinson: Yes, we are on track to meet and exceed this target. The 2013 Rapid Mortality Surveillance Report shows that the life expectancy at birth in 2013 was 62.2 years. This is broken down into 59.4 years for men and 65.1 years for women. One would reasonably expect the trend to continue. The major reason for this is the success of the HIV screening and treatment programme.

Zuma has pushed to further reduce child and maternal mortality by improving quality of care in the public sector. Is this happening?

Professor Robert Pattinson: Yes, the number of maternal and child deaths for each birth has been dropping rapidly. The maternal mortality ratio has dropped from 252 deaths for every 100 000 live births in 2009 to around 197 per 100 000 live births in 2012. In that four year period, there were 424 fewer maternal deaths. This averages 85 fewer deaths per year from 2009 to 2014.

The under 5 mortality rate has dropped to 41 deaths for every 1 000 births from 56 for every 1 000 births. Similarly, the infant mortality rate came down from 39 deaths for every 1 000 infants that were born to 29 for every 1 000 births. In terms of newborn deaths, in 2009, there were 14 deaths for every 1 000 births. This dropped to 11 by 2013, according to the latest statistics.

The major reason for these declines has been the success of the HIV screening and treatment programme. The programme would not be successful if the health care professionals were not providing quality of care in this programme. Unfortunately the reduction in child deaths seems to be levelling off.

In 2015 he also said that Ketlaphela, a state-owned pharmaceutical company, would start supplying antiretrovirals to the Department of Health. What’s happened?

Professor Fatima Suleman: The government’s Ketlaphela project is an ambitious one. If it is successful, it will mean that active pharmaceutical ingredients, which are in all drugs, will be manufactured in South Africa. This is good for two reasons. We will have our own antiretrovirals, malaria and tuberculosis drugs which will cut down costs, but it would also increase the country’s ability to supply increasing domestic and global demands for drugs.

But the project has been beset by teething problems. It was supposed to be up and running by 2015 but it has stalled because the preferred international technology and investment partner pulled out. The new plan, based on a report by Deloitte and Touche is to have the project running by 2017, with new investment and technology partners.

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