| When the HIV / AIDS pandemic hit South Africa | | | | other activist groups won a significant |
| with what seemed to be catastrophic force in | | | | constitutional court ruling to force the |
| the mid-1990s, the country's health care | | | | government to provide life-saving drugs to |
| system was already under severe pressure. | | | | pregnant women and newborn babies. That, and |
| Following the end of apartheid in 1994, the | | | | other cases, compelled the government to take |
| health system was in the process of being | | | | a different view. Now, even though President |
| transformed from one that focused on the | | | | Mbeki has not unequivocally acknowledged that |
| needs of whites to one that met the needs of | | | | HIV causes AIDS, and Tshabalala-Msimang |
| the entire population. AIDS made that | | | | frequently causes controversy about |
| transformation even more difficult. A decade | | | | appropriate responses to the disease, South |
| on there are indications that South Africa is | | | | Africa has implemented a major program to |
| beginning to recover. | | | | combat AIDS. Anti-retroviral drugs (ARVs), |
| | | | considered the most effective treatment in |
| It was the screening of pregnant black women | | | | fighting AIDS, are a major component of the |
| by the South African public health care | | | | program. |
| system in the mid-to-late1990s that revealed | | | | |
| a sudden and dramatic increase in prevalence | | | | "Well, the way we view the ARV rollout is |
| of HIV, the virus that causes AIDS. A few | | | | that we recognize that South Africa has one |
| years earlier, because of the poor health | | | | of the biggest, if not the biggest treatment |
| care available to black South Africans under | | | | program of any country in the world. We have |
| apartheid, many of those women would probably | | | | gone from nothing to 110,000 people in the |
| not have been covered by the public health | | | | public sector in the space of two-and-a-half |
| care net. | | | | years, and we have to recognize and commend |
| | | | doctors and nurses and health care workers, |
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| | | | accomplishment," he noted. |
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| But with the end of apartheid, health care, | | | | patients, or in programs run by churches and |
| like so many other public services, was | | | | other non-governmental organizations. But in |
| expanded to reach all the country's citizens. | | | | its widely respected statistical model on the |
| Whites-only hospitals were opened to all, | | | | disease, the South African Actuarial Society |
| and a network of more than 1,000 walk-in | | | | estimates that as many as 500,000 South |
| clinics was set up throughout the country. | | | | Africans currently have full-blown AIDS and |
| Programs to tackle basic health issues in the | | | | require treatment. |
| black community were established. | | | | |
| | | | Dr. Letitia Rispel of the Human Sciences |
| But then, HIV / AIDS hit. South Africa had a | | | | Research Council in Pretoria, says that the |
| prevalence rate that would soon become one of | | | | public health system is also slowly tackling |
| the worst in the world. The burden on the | | | | other major health issues, such as measles |
| health care system was almost overwhelming. | | | | outbreaks, which are now isolated and |
| | | | infrequent. |
| To make the situation worse, many seasoned, | | | | |
| mostly white, health care professionals opted | | | | "I used to work in the Western Cape, one of |
| to take a government buyout offer aimed at | | | | the problems that used to be there, neo-natal |
| reducing excess support and administration | | | | syphilis which is a particular syndrome when |
| personnel. | | | | the mother has had untreated syphilis the |
| | | | baby suffers from - some instances these |
| Mark Hayward, of the Aids Law Project at | | | | children had to be in an incubator in an - it |
| Johannesburg's Witwatersrand University, says | | | | is [now] a rare occurrence to see that in |
| the loss of trained medical personnel had | | | | South Africa," said Dr. Rispel. |
| far-reaching consequences. | | | | |
| | | | But Rispel says that major challenges still |
| "The HIV epidemic tests the country's health | | | | remain. Since South Africa was welcomed back |
| system in very significant ways," said Mr. | | | | into the international community in 1994, the |
| Hayward. "It puts additional strain on | | | | country's health professionals are in demand |
| people who work in the health system, on | | | | in the oil-rich countries of the Middle East |
| doctors and nurses, because of the additional | | | | and in those of European Union. Many leave |
| burden of patients, people who are being | | | | and few return. |
| admitted to hospitals with opportunistic | | | | |
| infections associated with HIV." | | | | And most those who remain are reluctant to |
| | | | work in rural and impoverished areas where |
| And after President Thabo Mbeki came to | | | | the need is greatest. Rispel notes that |
| office in 1999, the practical difficulties of | | | | Gauteng, the richest province with 19 percent |
| responding to the pandemic were exacerbated | | | | the population has 3,000 doctors in the |
| when he questioned the causal link between | | | | public health sector. Limpopo, the poorest |
| HIV and AIDS. Hayward says Mr. Mbeki's | | | | of the eleven provinces and with 12 percent |
| unorthodox views on AIDS went unchallenged by | | | | of the population, employs just 300. |
| members of his cabinet, including Health | | | | |
| Minister Manto Tshabalala-Msimang, which was | | | | Both Hayward and Rispel says the government |
| particularly damaging. He says the effects | | | | must develop policies that will encourage |
| of Mr. Mbeki's beliefs are still being felt. | | | | health professionals to stay in South Africa |
| | | | and also to work in rural areas. |
| "I think what worries me and what worries | | | | |
| many of us in the [AIDS activist group the] | | | | Hayward argues that despite some positive |
| Treatment Action Campaign, is that there is | | | | developments, the crisis in South Africa's |
| also a crisis of senior management and of | | | | health system demands an urgent shift in |
| political management of the health system -- | | | | focus by political leaders, notably Health |
| particularly South Africa's Minister of | | | | Minister Tshabalala-Msimang. Rispel too |
| Health who frequently seems to prefer to deny | | | | urges urgent attention from government |
| there are serious problems rather than admit | | | | leaders to challenges in the health system. |
| to the problems and find a consensus on how | | | | But she also argues that the advances made in |
| those problems can be solved," he added. | | | | a decade of huge demand and much controversy |
| | | | point to a growing strength within the health |
| In 2003, the Treatment Action Campaign and | | | | system that bodes well for the future. |