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
· 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
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
· The public has fewer medicines on the chronic medication
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
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.