More healthcare news snippets ...

More funds for health

THE government has pumped more funds into improving public healthcare. Finance Minister Pravin Gordhan told MPs during his medium-term budget policy statement in Parliament yesterday that public health expenditure was set to rise from R90 billion this year to R115bn in 2012/13. He said that initiatives to strengthen public health services were important in laying the foundation for a National Health Insurance system.

The Treasury has also made significant additions to the government's budget for HIV/AIDS programmes in anticipation of meeting its target of providing treatment to 80% of those in need by 2011. Gordhan announced an extra R900m for providing AIDS drugs in state health facilities for the rest of this fiscal year. The money will help meet the R1bn shortfall acknowledged last month by Health Minister Aaron Motsoaledi. The Treasury declined to comment on progress in securing more donor funding for AIDS drugs, but director for health policy, Mark Bletcher, said the R900m was a very substantial allocation which would go a long way to addressing the shortfall.

The Treasury has also added R5,4bn to the HIV/AIDS conditional grant over the medium-term, given an expected rise in demand for AIDS drugs. An extra R1,2bn is allocated in 2010-11, R1,8bn in 2011-12 and R2,4bn in 2012-13, taking the total allocations to R5,5bn, R6,4bn and R7,3bn respectively. The Treasury said treatment uptake would soon exceed more than 300 000 entrants per year and by the end of March 2010 more than 900 000 people would be receiving antiretroviral treatment. Earlier yesterday the Minister said government was looking at making a considerable saving by introducing a new approach to the procurement of ARVs.

Sibusiso Ngalwa: The Star, 28 October 2009
Tamar Kahn: Business Day, 28 October 2009

Cutting the cost of HIV treatment

WITH hundreds of thousands of new AIDS patients expected to sign up for treatment in the next three years, the government is intent on finding ways to slash the cost of providing care. SA has one of the world's worst HIV/AIDS epidemics, with 5,4- million people infected with the virus. Based on current demand, the government expects to be providing AIDS drugs to 900 000 people by the end of March next wear. The Department of Health is finalising new guidelines that will see patients starting treatment earlier. It is also considering whether to provide more patients with an expensive drug, tenofovir, which has fewer side effects than the much cheaper and more commonly prescribed stavudine. The price tags for personnel, laboratory tests and drugs are all under the microscope. Finance Minister Pravin Gordhan hinted at the potential savings to be made earlier this week, when he released his midterm budget. He said that if a different approach were used, government could get the drugs at one sixth of the cost, which would free up money for other priorities, he said. Industry sources and analysts are sceptical that costs could be reduced so much, but it is clear SA could be getting its AIDS drugs much cheaper than it does through the R3,6bn tender it awarded last June. A rough calculation based on the Clinton Foundation AIDS Initiative's August price list, making allowances for VAT, transport costs, warehousing and distribution, shows SA is paying 27% more for efavirenz than it could be, and double its rate for tenofovir. These are the two most expensive drugs provided at state facilities. Efavirenz is prescribed to most adults as first-line therapy, along with stavudine and lamivudine. Patients who get dangerous side-effects from stavudine are switched to tenofovir. President of the Southern African HIV/AIDS Clinicians' Society Dr Francois Venter said D4T (stavudine) was one of the biggest obstacles to providing ARVs at primary level as it had a host of side-effects. He said if it could be replaced with tenofovir, it would be a huge step forward, and the only obstacle appeared to be cost. Aspen Pharmacare, which won 60% of the AIDS drug tender, said its prices are higher than the Clinton Foundation's because of the high cost of imported active pharmaceutical ingredients, and because it did not have the licence to produce generic tenofovir or efavirenz when the tender was issued. Aspen is waiting for its application to the Medicines Control Council to register generic tenofovir, without which it cannot distribute the drug in SA. The Health Department's Yogan Pillay said the government was looking at ways to reduce the cost of its HIV/AIDS programmes. Officials are exploring "task- shifting" - training nurses to provide services traditionally performed by doctors - and talking to the National Health Laboratory Services about cutting the cost of the regular blood tests required to monitor AIDS patients' progress. But most significantly for the industry, the department is also talking to its suppliers about how to cut medicine prices, including those in the current contract, which expires in May. Pillay said that one of the biggest challenges facing local drug companies was that 70% of their prices came from the active pharmaceutical ingredient, which was imported. He said the government could look at buying them in bulk, or SA could produce them in the country in the state or private sector or in a public-private partnership. The Department of Trade and Industry has set up a task team to investigate the feasibility of establishing a local active pharmaceutical ingredient industry. Pillay said alongside that, the department had started discussions with the Clinton Foundation and compared prices and found that in some areas it could make savings. He said the department had also started to think about how it could do the next tender differently. The AIDS Law Project's Jonathan Berger said the government was not legally obliged to use the tender system and could procure drugs via the Clinton Foundation if it chose to. He said the constitution required processes that were fair, equitable, transparent, competitive and cost- effective. The legal framework to give effect to this did not necessarily require a tender process, he said, but the government would probably want to give local companies a chance to at least match or better the Clinton Foundation."

The Weekender, 31 October 2009

AIDS a massive threat - Zuma

IN THE most emphatic acknowledgement yet by a president that HIV/AIDS posed a massive threat to the nation, Jacob Zuma yesterday called for mass mobilisation against the pandemic which is killing more and more South Africans, particularly the young. Zuma moved to put the AIDS denialism of former president Thabo Mbeki firmly in the past when he addressed the National Council of Provinces yesterday. Ironically, and no doubt intentionally, Zuma chose to stress the seriousness of the HIV/AIDS crisis in the chamber where Mbeki first articulated his view that HIV did not cause AIDS almost 10 years ago. In a sombre warning, Zuma told MPs and premiers that SA was in danger of the number of deaths each year outstripping the number of births and "if we do not respond with urgency and resolve, we may well find our vision of a thriving nation slipping from our grasp". Recent statistics from the Department of Health, Human Sciences Research Council, Medical Research Council, Statistics SA and other sources "paint a disturbing picture of the health of our nation", Zuma said:

• Nearly six out of 10 deaths during 2006 were of people younger than 50.
• The number of deaths registered in 2008 jumped to 756 000, up from 573 000 the previous year, when just more than a million births were registered (1 205 111).
• The Independent Electoral Commission had to remove 396 336 names of deceased people from the voters roll in September 2008 and August this year.
• The average life expectancy of South African men in 2006 was 51 years, while in Senegal it was 60 and in Algeria 70.
• Some studies suggested that more than half - 57 percent - of deaths of children under five in 2007 were due to HIV.

Zuma said these were some of the chilling statistics that demonstrated the devastating impact that HIV and AIDS was having on the nation and that not even the youngest were spared. Some studies suggest that 57% of the deaths of children under the age of five during 2007 were as a result of HIV. The President said the situation was aggravated by the high tuberculosis prevalence. The co-infection rate between HIV and TB had now reached a staggering 73%, Zuma said. He added that while SA did have a comprehensive strategy to combat the disease and though SA had the largest antiretroviral programme in the world, we were not yet winning this battle. Zuma, in what was a clear reference to the AIDS sceptics, said the disease should be treated like any other and "there should be no shame, no discrimination, no recriminations. We must break the stigma surrounding AIDS". The Treatment Action Campaign, which fought for government provision of antiretroviral drugs and was at loggerheads with Mbeki and Tshabalala-Msimang because of their denialist views, hailed Zuma's speech as a "breath of fresh air". TAC general secretary Vuyiseka Dubula said this was a sign of political will in this administration to fight the epidemic as well as TB.

Wyndham Hartley: Business Day, 30 October 2009
Carien du Plessis: The Star, 30 October 2009
Nkululeko Ncana: The Times, 30 October 2009

A breath of fresh air

IN CASE anyone was in any doubt, the HIV/AIDS pandemic is here, and it is still wreaking havoc. That, at least, is the message that came out loud and clear from the statistics and other information released by President Jacob Zuma last week. He sounded a grim warning that we are not winning the war against the catastrophic impact of HIV/AIDS despite having the world's largest antiretroviral programme. These statistics are chilling, with Zuma cautioning that there is a real danger of deaths in South Africa soon overtaking the number of births. The number of deaths registered last year jumped to 756 000, up from 573 000 in 2007. Just 1.2 million births were registered during this period. He further observed that the Independent Electoral Commission had to remove 396 336 deceased voters from the voters roll during September last year and August this year. What was even more disturbing, Zuma said, was the number of young women who were dying in the prime of their life. In 2006, life expectancy at birth for South African men was estimated to be 51 years. By contrast, life expectancy in Algeria was 70 years, and 60 in Senegal. These are some of the chilling statistics that demonstrate the devastating impact that HIV and AIDS is having on our nation. To underscore this tale of woe, studies suggest that up to 57 percent of deaths of South African children are due to AIDS. The good news is that Zuma has pledged the government's determination to confront the scourge head-on. For instance, the SA National AIDS Council will develop a set of measures to boost the programmes already in place. The acknowledgement by Zuma that SA needs to make the fight against AIDS a top government priority is a welcome change from a decade of AIDS denialism that characterised the Thabo Mbeki administration. It is a breath of fresh air.

Editorial Comment: The Star, 2 November 2009

Is your doctor the real deal?

THE South African Medical Association (Sama) has urged the public to verify that their doctor is registered prior to consultation. Sama issued a warning against bogus doctors at a recent National Council meeting. Sama chairman Dr Norman Mabasa called on members of the community to be vigilant about bogus doctors claiming to be trained medical practitioners, providing medical treatment to the unsuspecting public and in some cases embarking upon activities that brought the name of the medical profession into disrepute. He said these so-called doctors often advertised their services by way of leaflets and via advertisements on street corners, offering very attractive medical solutions to all types of ailments. Sama said members of the public should contact the Health Professional Council of South Africa (HPCSA) if they had any doubts about their doctors. Doctors who were practising without being registered should be reported to the police.

SAPA, 3 November 2009

Vaccine ordered for return of swine flu

THE Health Department is to order a million doses of swine flu vaccine, which it hopes will arrive by early next year. The second wave of the virus is expected to hit South Africa before winter. Health Minister Aaron Motsoaledi's spokesman, Fidel Hadebe, said the vaccine would be used mainly on priority groups such as pregnant women and health workers at the front line of the fight against the virus. He could not say exactly when the vaccine would be readily available because of the high demand for it worldwide. The department is negotiating with at least three international companies for the vaccine. Hadebe would not say how much the vaccine will cost. Though the number of swine flu infections has decreased significantly in the past three weeks, the Health Department has issued a health warning to people travelling to the northern hemisphere. On Sunday, a 28-year-old pregnant woman from Dubai was admitted to the intensive care unit of a Western Cape hospital with swine flu. About 91 people have died from swine flu in South Africa, and almost 6 000 worldwide.

Nkosana Lekotjolo: The Times, 4 November 2009