More healhcare news snippets...

Motsoaledi unveils new plan for nurses

A 10-POINT plan to improve the nursing profession through education and training was recently agreed upon by the national Health Ministry and provincial MECs. Health Minister Aaron Motsoaledi, addressing a Nursing Education Association conference in Kempton Park, said the five-year plan included the strengthening of strategic leadership for better health outcomes and the implementation of a national health insurance system. Improving quality of care, revitalising health infrastructure, reviewing drug policy and strengthening research and development were part of the plan agreed upon. Motsoaledi said that also in the plan was the overhauling of the health system, and improving its management. He said improving human resources for health management, planning, development formed part of the planned priorities. The acceleration of the implementation of the national strategic plan for HIV with an increased focus on tuberculosis and other communicable diseases was also included. Mass mobilisations for better health for the population which included a strengthened response to improving the maternal and child health also made the list of priorities. Motsoaledi said the successful implementation of this programme of action required government to strengthen and extend its partnership with all stakeholders in South Africa and with its development partners. He said it was critical that academics, civil society, organised business, labour, and researchers in the country work with the government to turn the health system around and achieve better outcomes. Motsoaledi said discussions were underway between the department of Higher Education and Training, his department, the Council on Higher Education and Umalusi on the role of new quality councils in quality assurance of the diversity of health science offerings. From this discussion, Motsoaledi said, came an agreement between the Health Department and the department of Higher Education and Training on the need for a diversified nursing education and training system. The next step was to revitalise the nursing colleges sector. This followed a recognition that strengthening colleges would contribute to a vibrant nursing education and training system. Motsoaledi said what was needed was to work out how to retain nurse educators, encourage nurse education as a critical career path and more generally attract young people into the profession.

SAPA, 30 September 2009

Glimmer of hope

WHEN scientists identified HIV as the cause of AIDS more than 20 years ago, they predicted that a vaccine to prevent infection would be developed long before the drugs to treat the symptoms. The opposite happened. Today, millions of people around the world - and thousands of them in South Africa - depend on a cocktail of drugs to hold the disease in check. Despite the expenditure of years of effort and billions of dollars, research for a vaccine to prevent the infection proved fruitless. Four trials of separate vaccines failed to show a protective effect and there was even a suggestion they made certain people vulnerable. The positive finding from the world's largest vaccine trial in Thailand, announced last Thursday, is therefore significant on two counts. Firstly, it provides proof of concept that a vaccine can be developed. Researchers have a handle on the virus that they did not have before which should mean we can now look forward to further progress, though there is still a long way to go before scientists will be able to say when, or whether, a viable vaccine against HIV may be available. Secondly, it is a tribute to those scientists who persisted with the trial, in the face of sometimes bitter opposition from colleagues who accused them of wasting funds and even endangering lives. HIV is a diabolically clever virus that disables the very immune responses a vaccine needs to trigger in order to work. After the failure of the four trials, pessimism within the scientific community grew and some scientists predicted a vaccine would never be found. Meanwhile, some dissenting voices within the Aids community in South Africa and elsewhere in the world demanded the resources devoted to vaccine research be diverted to safer sex, condom distribution and other preventive measures. Drugs to treat HIV have been successful in converting a disease that was once a death sentence into a chronic condition. But no one has ever been cured of HIV. Preventing the infection remains the best strategy.

Editorial Comment: The Star, 30 September 2009

Access to AIDS drugs on the rise

LESS than half the adults and children needing antiretroviral treatment (ART) in sub-Saharan Africa - where two-thirds of all global HIV infections occur - are receiving it. This is despite the region showing the greatest gains worldwide in terms of access to the lifesaving drugs. According to a report released yesterday, 45 percent of HIV-positive pregnant women received the drugs needed to prevent them from passing the virus on to their baby, up from 35 percent the year before. The World Health Organisation (WHO), the United Nations Children's Fund and the Joint United Nations Programme on HIV/AIDS yesterday released Towards Universal Access - the third in a series of annual progress reports to monitor the health sector response to the HIV/AIDS epidemic. Around 2.9 million people in sub-Saharan Africa received ART in 2008 compared to about 2.1-million in 2007. ART coverage in the region was 44 percent in 2008, compared to 33 percent in 2007. Between 2007 and 2008, the estimated number of children in sub-Saharan Africa receiving ART rose from 158 000 to 225 000. Total coverage among children in the region is about 35 percent. The report shows that in South Africa, 458 951 people were estimated to be receiving ART in December 2007. This figure rose to 700 500 a year later, which means that just over half (53 percent) of those needing ART were accessing it - in both the public and private sector. Alternative sources indicated that the last reliable estimate of the number of people on ARVs in the public health system was about 450 000 as of July 2008. South Africa's Budget and Expenditure Monitoring Forum warned last week that six provinces might run out of antiretroviral drugs as a result of a shortfall of R1 billion. Some hospitals in the Free State have been without drugs for up to three weeks. The WHO put a positive spin on the report, stating that more than 4 million people in low- and middle-income countries were receiving ART at the close of 2008, representing a 36 percent increase in one year and a ten-fold increase over five years. WHO director-general Margaret Chan said the report showed tremendous progress in the global HIV/AIDS response, but that more had to be done. She said at least 5 million people living with HIV still did not have access to life-prolonging treatment and care and prevention services failed to reach many in need. Governments and international partners must accelerate their efforts to achieve universal access to treatment, she added. The report showed that prices of the most commonly used antiretroviral drugs had declined significantly in recent years, contributing to wider availability of treatment. The cost of most first-line regimens decreased by between 10 and 40 percent between 2006 and 2008. However, second-line regimens continue to be expensive. Despite recent progress, the report acknowledged that access to treatment services was falling far short of the need and that the global economic crisis had raised concerns about their sustainability. Many patients were being diagnosed at a late stage of disease progression, resulting in delayed initiation of ART and high rates of mortality in the first year of treatment, according to the report. Ninety-three percent of all countries that reported data across all regions provided free HIV testing through public sector health facilities in 2008. Nevertheless, the majority of those living with HIV remained unaware of their HIV status.

Anso Thom: Health-e News Service via The Star, 1 October 2009

Health gets fifth qualified audit in a row

AUDITOR-General Terence Nombembe has given the Department of Health a qualified audit for the 2008-09 fiscal year - for the fifth year in a row. His assessment of the department's financial management, contained in its annual report tabled in Parliament, once again highlights the department's failure to maintain proper oversight of both its own accounts and the conditional grants transferred to the provinces. There is growing concern in the government about the way health budgets are administered, with the Treasury complaining last month that provinces had wasted scarce funds on "frills" such as consultants, travel, food and cellphone allowances at the expense of essential items such as blood. The issue shot to prominence after the Free State said it had run out of money to pay for AIDS drugs last year, and placed a moratorium on starting new patients on treatment between November and March - a move AIDS activists say cost 30 lives a day. Last year conditional grants totalling R14bn were transferred to provincial health departments, which spent R75bn in the 2008-09 fiscal year. The grants are channelled from the national Treasury to the provinces via the national Health Department, and are earmarked for specific purposes, such as HIV/AIDS programmes. In terms of the Division of Revenue Act, the grants are supposed to be monitored by the national department, which then reports to Treasury. Nombembe said the national department failed to comply with the requirements of the act, as it did not monitor the conditional grants through quarterly visits and inspections to the provinces. The department also failed to evaluate provincial reports properly and to follow up on issues that such scrutiny might have thrown to light. Director-general of health Thami Mseleku acknowledged these issues in the department's annual report, saying it was hamstrung by its lack of capacity. But Nombembe also points a finger at provincial health departments, saying they hobbled the national department's ability to monitor the conditional grants by submitting monthly and quarterly financial performance reports late, or failing to submit them altogether. There were "significant inconsistencies" in the information supplied by the provinces to the national Health Department. Nombembe says he was unable to verify R29,7m in revenue the Health Department said it received from the Medicines Control Council, as the department did not have a proper system in place to match fees paid to applications to register new medicines. The department was also unable to verify R23,2m paid out for travel costs incurred by using the National Fleet Public Private Partnership project, as it did not have a system for reconciling payments with supporting documentation . The national Health Department's spokesman, Fidel Hadebe, said that a national strategy to "co-ordinate and assist" provinces was being developed. He said the department was dealing with the issues Nombembe raised and expected to have an unqualified audit next year. The Treasury's Kenneth Brown said there was a "concerted effort to bolster the administration of health". Provincial treasury officials have been seconded to provincial departments to try to improve their financial management, and plans are under way to set up a unit within the national Health Department to improve oversight of the provinces.

Tamar Kahn: The Weekender, 3 October 2009

Measles outbreak alert in Gauteng

GAUTENG has a measles outbreak, as there have been more than 400 confirmed cases of the illness since March. Dr Lucille Blumberg, a microbiologist and head of the epidemiology unit at the National Institute for Communicable Diseases, said the number of cases was much higher than in previous years. Last year, Blumberg had seen about 25 cases. The last outbreak to have occurred, she recalled, happened three or four years ago. Gauteng department of health and social development spokesman Mandla Sidu said that because so many were infected, it had become "necessary to go out on a massive scale" to address the issue. The department was today due to embark on a massive immunisation drive. This campaign will target children from the ages of six months up to primary and high schools learners. Health workers will be visiting clinics, schools and crèches throughout the province for immunisation. As another measure to ensure that the disease is contained, the department's outbreak response team has alerted all clinicians, both in the private and public sector, to be on the lookout for any signs and symptoms from patients who present themselves at health facilities. Infection control officers in all hospitals have also been requested to be on high surveillance for the disease and for ongoing public education to be provided through clinics. Health promoters dispatched throughout the province were also focusing on measles. Blumberg blamed the outbreak on parents' failure to vaccinate their children. The measles vaccination was part of a good national standard programme of immunisation, and was provided free at clinics, but mothers did not take their children for the vaccine, said Blumberg. She explained that it was safe and effective. With one vaccination, not 100 percent of people will get protection, but the second vaccination allows an improved response. Unfortunately, she said, a lot of mothers may go the first time, but not a lot will take them for the second vaccination. Some of this was due to parents either being apathetic, a misconception over the vaccination, or some parents just not thinking about it, she said. The recent outbreak had affected three different age groups: children under one year, teenagers and young adults.

Noor-Jehan Yoro Badat: The Star, 12 October 2009