April 8, 2005

If you compare what the ANC wanted to give the people in the Freedom Charter, what they promise the people in the Constitution, what they try give with the best intentions of a hard-working Department, and what the people actually receive in terms of health care in the Public Sector, you must see that there is a huge contradiction. You have to admit something is seriously wrong with our health policy.

Nothing is wrong with the amount of money dedicated to heath care; much is wrong with the way it is spent. For 10 years the IFP has offered the same solutions:

Simplify and clarify political and financial accountability and responsibility 
Let Provincial and Local Governments make decisions, control funds and choose priorities. Keep them accountable and have a zero tolerance policy on fraud and corruption

All Provinces now belong to the ANC. From your own MECs and Administrative Heads come the following views, for which you should praise them as foxes and promote them, not punish them for speaking forthrightly:

KZN has a better, more efficient and cost-effective laboratory service than the rest of the country. When you force them to become part of the National Health Laboratory Service they will become less effective and more costly. 
Eastern Cape consistently has rollovers on conditional grants. Give them greater autonomy and accountability and they will spend the money more effectively. 
The Western Cape, under its previous Provincial Government, whether DA or NNP was a fox, not a hedgehog. It started to provide Anti-retrovirals using donor funding and is now way ahead of the rest of the country in having patients on anti-retrovirals.

Most that comes from central government is obstructive. In its obsession with equal services government is providing lesser services, particularly to the poor.

As if that is not enough, laws are protecting private medical schemes and pharmaceutical manufacturers though regulations intended to reduce the costs of medicines to consumers.

Although most Provinces are spending between R800 and R1200 per capita on health care, infant mortality is increasing, aids infection and deaths are increasing, TB and drug-resistant TB are increasing and only life-expectancy is decreasing. In the private sector, too many people are paying more for health care not less, more to medical schemes, more to hospitals and more for medicines.

What have all of government's well meaning regulations achieved? Squabbles between government and the private sector, between the High Court and the Cape Court and privately between hospitals, medical schemes, pharmaceutical manufacturers and pharmacists.

No matter which way the judgement of the Constitutional Court goes on pharmacy mark up of R26 or 26%, consumers will pay more for medicines.

Currently with the new law in operation:

The public pays (and that includes us) the difference between generics and patent medicines 
The public pays an administration fee of R17 to pharmacists for every item purchased 
The public pays a levy on medicine to the medical schemes 
The public has fewer medicines on the chronic medication list.

By contrast, medical schemes are saving on all these items and yet increasing fees to members. If the law is struck down, only the administration fee to pharmacists will change, but pharmacies will add to the public's burden with a high mark up, loading the cost of more expensive medicines.

Meantime pharmacy manufacturers have had prices fixed at a margin above the level of their best discount previously given for bulk buying. No wonder they are happy with price fixing and opposing those taking the government to court.

The IFP has always offered a different solution. We would like to uplift the public service by contracting the private sector to work for the poor and ensuring that minimum standards are maintained. Where medicines are concerned, fix only the maximum price, and enforce transparency, but encourage discounting and competition. Ensure that all buyers receive the same discount for similar quantities.

Where pharmacies are concerned put a reasonable cap on the mark up, but allow competition on prices and let any store sell medicines through a pharmacist. With medical schemes, require all working persons to be on a medical scheme, with a low-cost government scheme as an option. Ensure that all schemes provide a minimum benefit.

Where hospitals are concerned, legislate for transparency with regards to medical devices (it is a puzzle why this has not yet been done), contract hospitals to provide services per day or per capita to registered, government-funded patients.

The greatest burden on public hospitals is HIV and TB. The IFP suggests many changes to the way those diseases are handled.

To tackle Aids we cannot do more of the same. We cannot accept 1700 new infections daily; or accept that 50% of our youth under 15 will die of HIV before the age of 45. We must do something dramatic to make a major difference on people's attitudes and to focus the minds of the youth on the dangers of STDs and HIV.

The IFP would like to change the focus of rights from the right to privacy to the right of non-discrimination. No person should lose a job because they have HIV or receive a lesser chronic medical benefit. If they die of HIV they must receive full death benefit and full life payout, if they test HIV negative when they apply for the life-insurance, but die because of HIV. The excessive focus on privacy leads to people not wanting other people to know their status and not wanting government to know their status. It adds to the culture of denial and gives them the sense that HIV is something to be ashamed of. We must have more testing and more openness, so that HIV is regarded as common-place as TB, diabetes or hypertension.

The IFP regards testing as so important, that we recommend mandatory premarital testing for HIV, not so that government knows who is or is not positive, but so that at a time when men and women want to conceive children they should know one-another's status. There are many women in the gallery who must surely know how vulnerable they are in sexual relations and how it would help them if government takes responsibility for the testing of themselves and their partners.


Dr Ruth Rabinowitz - 082 579 3698
IFP Spokesperson for Health.