South Africa has the dubious distinction of having some of the worst health indicators in the world - a massive tuberculosis epidemic, the biggest HIV-positive population in the world, one of the worst rape rates and double the global average of violent deaths.
All these grim statistics, and more, are contained in a special edition of The Lancet, the respected UK-based medical journal, focusing on health in South Africa, that was launched in Johannesburg on Tuesday.
Written by a formidable panel of South African health experts, including Professors Salim Abdool Karim, Hoosen Coovadia, Di McIntyre, Bongani Mayosi and Mickey Chopra, chapter after chapter condemns the lack of political leadership over the past 15 years.
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But while former president Thabo Mbeki is roasted for his "bizarre" ideas on HIV and Aids, the authors hail President Jacob Zuma's election as offering a "window of opportunity" out of the mess.
A good starting point, they argue, is that South Africa could recommit to the Millennium Development Goals (MDGs), an eight-point development programme aimed at improving the lives of those most in need by 2015, adopted by the United Nations in 2000.
Five of the eight goals are health-related, and include the eradication of hunger and extreme poverty, gender equality, reduced maternal and child mortality and combat HIV and Aids and malaria.
Sadly, South Africa's child mortality, hunger and poverty rates have worsened since the government pledged itself to the MDGs.
It is one of only 12 countries in the world where the mortality rate for children has got worse since 1990, and South Africa has made no progress in reducing maternal mortality and insufficient progress in combating HIV and Aids.
HIV and Aids is the country's biggest health problem, but Mbeki's "bizarre and seemingly unshakeable belief that HIV did not cause Aids" resulted in hundreds of thousands of lives lost and a substantial burden of ill health.
Pregnant HIV-positive women are 10 times more likely to die in, or soon after, childbirth than HIV-negative women.
Infections, mostly HIV and Aids, cause 44 percent of maternal deaths.
The role of alcohol abuse is raised over and over throughout all the six chapters. It plays a major role in violence - including murder, rape and road accidents - as well as unsafe sex.
"Alcohol misuse, and in some parts of the country drug misuse, are major factors underlying homicides, intimate partner violence, rape, abuse of children, road deaths and other unintentional injuries," note the authors.
The death rate of South African women killed by their intimate partners is six times the world norm.
Child homicides are double those of other low income countries, with boys aged 10-14 most in danger of being killed.
More than a quarter of men (27.6 percent) admitted to having committed rape. In 2003 in Gauteng, 40 percent of rape victims were under the age of 18.
Almost four in 10 girls report experiencing sexual violence before the age of 18.
South Africa's road traffic death rate is also nearly double the global rate, and more than half of the pedestrians and almost half of the drivers involved in fatal accidents were drunk.
The authors are brutally frank about the failings of the public servants who are supposed to be running health services.
"Rudeness, arbitrary acts of unkindness, physical assault and neglect by nurses have been widely reported" during the post 1994-era, according to the authors of the report.
"Each year, an estimated 2 500 mothers die, 20 000 babies are stillborn, another 21 900 die before the age of one and an additional 52 600 die before their fifth birthday, most from preventable and treatable causes," according to authors Mickey Chopra and colleagues.
Unfortunately, "incompetence within the public sector is widespread" and political loyalty rather than the ability to deliver has been rewarded."
In order to properly deliver health care, the authors argue for a back-to-basics approach in which the health system is built from the bottom, with most resources going into developing a "comprehensive primary health care".
The authors support the establishment of a National Health Insurance scheme to address "gross inequities" in health care, including the fact that too many doctors and nurses are employed by private health (three quarters of GPs are in private health).
Finally, the "social determinants of health" need to be addressed, including "strengthening families, decreasing violence, changing the existing culture of men's behaviour towards women and children, creation of solutions to migrant labour and relief of poverty".
In addition, alcohol abuse, sexual violence, diet, physical activ ity and sanitation must be addressed. The list is formidable, but South Africa needs to get it right, because a sick nation cannot succeed. - Health-e News Service.
- This article was originally published on page 8 of Daily News on August 26, 2009
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