US embassy cable - 05PRETORIA946

UNCLAS SECTION 01 OF 05 PRETORIA 000946 
 
SIPDIS 
 
DEPT FOR AF/S; AF/EPS; AF/EPS/SDRIANO 
DEPT FOR S/OFFICE OF GLOBAL AIDS COORDINATOR 
STATE PLEASE PASS TO USAID FOR GLOBAL BUREAU APETERSON 
USAID ALSO FOR GH/OHA/CCARRINO AND RROGERS, AFR/SD/DOTT 
ALSO FOR AA/EGAT SIMMONS, AA/DCHA WINTER 
HHS FOR THE OFFICE OF THE SECRETARY,WSTEIGER AND NIH,HFRANCIS 
CDC FOR SBLOUNT AND EMCCRAY 
 
E.O.  12958: N/A 
TAGS: ECON, KHIV, SOCI, TBIO, EAID, SF 
SUBJECT:  SOUTH AFRICA PUBLIC HEALTH MARCH 4 ISSUE 
 
 
Summary 
------- 
 
1.  Summary.  Every two weeks, USEmbassy Pretoria publishes a 
public health newsletter highlighting South African health 
issues based on press reports and studies of South African 
researchers.  Comments and analysis do not necessarily reflect 
the opinion of the U.S. Government.  Topics of this week's 
newsletter cover:  Health funding increases 12 percent in 2005 
Budget; HIV spending increases by 30 percent; provincial health 
care spending up; Budget 2005's emphasis for poor; MRC study 
highlights AIDS impact on South African deaths; Stats SA 
releases mortality report; absenteeism costs South Africa R12 
Billion; FDA approves South African HIV/AIDS testing 
technology; Heart disease spreading in South Africa; Health 
Department ready to issue bids for AIDS drugs; and SANBS 
unveils new testing methods.  End Summary. 
 
Health Funding Increases 12 Percent in 2005 Budget; HIV 
Spending Increases by 30 Percent 
--------------------------------------------- ---------- 
 
2.  Consolidated national and provincial spending on health for 
fiscal year 2005/06 (beginning April 1) will reach R 48 billion 
($8.3 billion using 5.8 rands per dollar) compared to R42.5 
billion for FY2004/05, a 12.2 percent increase.  The Treasury 
Department puts the total budget for fighting AIDS during the 
next fiscal year at R4.3 billion ($740 million), a rise of 
about a billion rand over current spending and roughly six 
times South Africa's FY05 allocation from the President's 
Emergency Plan for AIDS Relief.  The National Treasury has 
allocated HIV/AIDS funds to three social sector departments: 
Health, Education, and Social Development.  The increase 
conforms to medium-term expenditure framework projections, and 
is planned to rise to R5.2 million by the 2007/08 financial 
year.  R1.8-billion of this year's amount is earmarked as 
conditional grants to the provinces in the fields of health, 
social development (which includes a R60 million increase in 
home-based care, to about R139 million) and education.  The 
education component includes a R137 million allocation for life- 
skills programs.  The Health Department faces several key 
challenges:  services, particularly for primary health care; 
programs for maternal and child health need expansion; 
infectious disease, chronic diseases and trauma need 
improvement; and quality of care also needs to be improved.  A 
total of R3.4 billion has been set aside for rehabilitating 59 
hospitals over the next three years.  Seventy seven percent of 
the Health Department's HIV/AIDS budget will be sent to 
provinces through conditional grants.  The remainder of the 
budget will be spent and transferred by the Department to non- 
profit institutions.  In real terms, the total Health HIV/AIDS 
budget has grown by 18 percent in 2005/06, from R1.2 billion in 
2004/05 to R1.5 billion in 2005/06.  Source:  Sapa, February 
24; IDASA HIV and AIDS Allocations:  A First Look at Budget 
2005, February 25. 
 
3.  Comment.  The budget speech by Trevor Manuel, Finance 
Minister made no mention of HIV/AIDS problems facing South 
Africa.  Health Minister Tshabalala-Msimang cited TB, HIV/AIDS, 
diabetes, hypertension and cancer as the main health challenges 
facing South Africa and the Department plans to promote health 
promotion campaigns focusing on the major factors underlying 
the high burden of these diseases along with promotion of 
healthy lifestyles.  During a press briefing on February 18, 
the Health Minister said the department did not have reliable 
figures as to how many people were on ARV treatment or how many 
had dropped out.  In several recent press interviews, Dr. 
Nomonde Xundu, the new Chief Director for the HIV and AIDS, TB 
and STI's Department of Health cluster, also refused to discuss 
actual targets or numbers of people on treatment.  Provincial 
government statistics collected by the AIDS Law Project shows 
23,000 patients on anti retroviral treatment nationally, short 
of the government's goal of 53,000 patients by the end of March 
2005 and the Treasury Department's Estimates of National 
Expenditure 2005 mention that 28,786 people are on ARV 
treatment.  Budget 2005 makes no direct resource allocation 
specifically for the ARV treatment program.  Budget 2004 
estimated that R600 million will be spent on the ARV program in 
2005/06, but Budget 2005 has not indicated if this estimate is 
still operative and how it would be adjusted to meet increased 
need and demand for treatment. End comment. 
 
Provincial Health Care Spending Up 
---------------------------------- 
 
4. Consolidated provincial health expenditure is budgeted at 
R45.8 billion ($7.8 billion), rising to R49.9 billion in 
2006/07 and R53.5 billion by 2007/08.  A detailed provincial 
breakdown will be available in the intergovernmental fiscal 
review, released after the Budget Review, but Mark Bletcher, 
Treasury's Health Director indicated that significantly more 
money for health would be available for Limpopo and KwaZulu 
Natal provinces.  An additional R600 million is allocated to 
the national Health Department over the next three years to 
improve its management of the hospital revitalization program, 
which is funded through conditional grants.  (Conditional 
grants are funds that must be spent on a designated purpose.) 
Source:  Business Day, February 24. 
 
Budget 2005's Emphasis for Poor 
------------------------------- 
 
5.  A priority over the decade ahead will be to ensure that a 
caring and competently managed health service is available in 
every community, Finance minister Trevor Manuel told Parliament 
during his presentation of the 2005 budget.  A large portion of 
the Budget was allocated to government expenditure and tax 
changes designed to benefit the poor.  Tax changes to medical 
scheme contributions, more money for primary health care and 
tertiary hospitals, increases in taxes of tobacco and alcohol 
products are some of the varied highlights in Budget 2005. 
Manuel announced a change to the tax treatment of medical 
scheme contributions, which will have the effect of reducing 
the cost of medical scheme membership to lower income families. 
The present allowance for two-thirds of a medical scheme 
contribution to be paid tax-free will be replaced by a capped 
tax deduction, having the effect of limiting the tax loss 
associated with more expensive medical scheme options, while 
increasing its monetary benefit to lower income taxpayers, 
thereby enabling more people to afford medical aid.  These 
changes will take effect in 2006:  (1) the Budget makes 
available funds to enable provinces to fulfill their 
responsibility for primary health services formerly provided by 
non-metropolitan municipalities, and an additional R180 million 
a year for tertiary health services; (2) Old age, disability 
and care dependency grants will increase by R40, to 780 per 
month, foster care grants by R30 to R560 per month and child 
support grants by R10 to R180 per month; (3) the Budget also 
provides for improved salaries for social workers; (4) the 
Budget allocates R2 billion and R1.7 billion to municipal and 
sanitation infrastructure in the comprehensive housing 
strategy.  As in previous years, taxes on alcohol and tobacco 
were increased, raising R1.6 billion in additional revenue.  In 
keeping with these health-related fiscal measures, Manuel 
announced the abolishment of excise duties on sun protection 
products at a cost of R10 million a year.  Source:  Health E 
News, March 1. 
 
MRC Study Highlights AIDS Impact on South African Deaths 
--------------------------------------------- ----------- 
 
6.  "Identifying deaths from AIDS in South Africa", published 
in the journal AIDS by Medical Research Council (MRC) and 
University of Cape Town (UCT) researchers, confirms that there 
has been a massive increase in AIDS deaths in South Africa. 
The researchers found that 61 percent of the estimated 153,000 
AIDS deaths in 2000 were misclassified, described instead as 
deaths due to TB, pneumonia or meningitis.  The researchers 
compared the 1996 and 2000 death rates for 22 conditions and 
found that death rates for nine of them rose in tandem with 
recorded AIDS deaths, showing the same distinct age and gender 
pattern.  The nine conditions were TB, pneumonia, other 
respiratory diseases, diarrhea, meningitis, gastroenteritis, 
other infectious and parasitic diseases, deficiency anemia and 
protein malnutrition.  There was a disproportionate number of 
deaths among young children, sexually active young men and 
women, with the peak death rate for women (30-34) coning about 
five years before the peak for men (35-39).  The study shows 
that HIV had become the largest cause of death in women by 2001 
and that a pattern of mortality had emerged in which young 
adults (aged 15-49) were dying in increasingly large numbers 
relative to the rest of the population.  MRC and UCT released 
this study before Statistics SA released its mortality report. 
Source:  Business Day and Financial Mail, February 1; Health E- 
News, February 22; Sunday Times, February 27. 
 
STATS SA Releases Mortality Report 
---------------------------------- 
7.  Statistics SA released "Mortality and Causes of Death in 
South Africa", a study of approximately 3 million death 
notification forms received by the Department of Home Affairs 
between 1997 and 2002, and noted that South African adult death 
rate increased by 62 percent over the five-year period, from 
272,221 in 1997 to 441,029 in 2002.  Tuberculosis, influenza, 
pneumonia and strokes are the leading causes of death.  Pali 
Lehohla, Stats SA's chief, said that the data provided indirect 
evidence that the HIV epidemic is raising the mortality levels 
of adults, but that the death notification forms did not allow 
one to determine HIV infection or AIDS-related mortality.  The 
report also found that the proportion of deaths in the age 
group 20 to 49 was increasing and the proportion of deaths of 
females was increasing relative to the total.  HIV dropped in 
the ranks of the underlying causes of death when comparing 1999 
to 2001, a period in which deaths from TB and influenza 
increased by more than 50 percent.  In 1997, TB accounted for 
25,640 deaths, rising to 56,985 in 2001.  Influenza and 
pneumonia deaths rose from 24,698 to 55,115 during the same 
period.  Deaths specifically attributed on death notification 
forms to HIV fell by 10 percent to 9,000, pushing HIV out of 
the top 10 causes of death in 2001.  Representatives from Stats 
SA acknowledge that analyzing death notification forms does not 
give a true reflection of HIV fatalities given that most HIV 
deaths are due to other opportunistic infections.  David 
Bourne, an epidemiologist with the University of Cape Town, 
noted that the HIV status of the deceased must be known if 
accurate HIV death statistics can be discovered from death 
notification forms, which is almost impossible given the vast 
majority of South Africans not able to afford private health 
care.  In addition, he stated that HIV deaths are severely 
undercounted for reasons of confidentiality and prevention of 
stigmatization.  He argued that the Stats SA analysis 
demonstrates the high costs of AIDS in South Africa and that 
the debate should feature delivery of health interventions 
rather than the statistics.  Source:  Sunday Times, February 20 
and 27; Sunday Independent, February 20; Business Day, February 
21; Health Systems Trust News, February 23. 
 
Absenteeism Costs South Africa R12 Billion 
------------------------------------------ 
 
8.  According to a study commissioned by AIC Insurance, 
absenteeism costs South Africa R12 billion per year, of which 
roughly R1.8 to R2.2 billion can be attributed to the effects 
of HIV/AIDS.  Companies were losing as much as a month's work 
each year for each employee with advanced HIV/AIDS.  The study 
showed that the absenteeism rate for people living with 
HIV/AIDS was three times higher than that of people not 
infected with the virus.  People with HIV/AIDS were absent 32 
days per year on average.  The data are predominantly from 60 
companies in the motor and textile manufacturing industry in 
the Eastern Cape.  Source:  Business Report, February 9. 
 
FDA Approves South African HIV/AIDS Testing Technology 
--------------------------------------------- --------- 
 
9.  The U.S. Food and Drug Administration approved a South 
African AIDS technology that reduces the cost of monitoring 
immune levels in AIDS patients.  Dr. Deborah Glencross 
developed a new approach to CD4 testing that provides a 70-80 
percent cost savings over the traditional HIV testing methods. 
Glencross developed a simpler method of counting CD4 cells, 
called "PanLeucogating" or "PLG CD4" test, which reduces the 
number of steps involved in counting CD4 cells and is accurate 
on blood samples up to five days old.  The PLG CD4 test uses 
the white cell count as the reference point, a parameter that 
is generally stable.  Traditionally, CD4 cells are referenced 
to total lymphocytes, a subset of white cells, which is 
notoriously unreliable and several additional tests are needed 
for quality control, adding substantially to costs.  The PLG 
CD4 needs one quality control test, compared to up to five 
tests required by the conventional CD4 testing methods. 
Beckman Coulter, an international biomedical testing system 
manufacturer, obtained the exclusive license for the technology 
and arranged the process for FDA approval.  Source:  Sunday 
Independent, February 13. 
 
Heart Disease Spreading in South Africa 
--------------------------------------- 
 
10.  The Medical Research Council (MRC) is finalizing two 
research proposals that would identify and manage risks of 
heart disease among South Africans.  The first is a three-to- 
six month study testing the feasibility of evaluating risk 
factors for heart disease among black, coloured and Indian 
South Africans.  The second proposal would look at a much 
larger sample over a longer period of time (three years). 
South Africa has had one of the highest incidences of heart 
disease among the Indian population in the 1970s and 1980s, 
among coloureds during the 1980s and 90s and now heart disease 
is growing in importance among black South Africans.  During 
2000, 12 percent of the 500,000 deaths in South Africa were 
from heart disease.  Another 8 percent of deaths were caused by 
strokes.  Approximately 25 percent of the South African 
population suffers from hypertension and about 20 percent is 
obese.  Ten years ago, estimates of the cost of heart treatment 
on the economy were R4 billion per year; recent estimates reach 
R10 billion per year.  At Chris Hani-Baragwanath Hospital in 
Johannesburg, over half of the patients experiencing heart 
attacks are black.  Source:  Pretoria News, February 17. 
 
Health Department Ready to Issue Bids for AIDS Drugs 
--------------------------------------------- ------- 
 
11.  Health Minister Manto Tshabalala-Msimang announced that 
the government completed its negotiations with drug companies 
to supply anti-retroviral drugs in state hospitals and will 
issue tenders shortly.  Facing the world's biggest HIV caseload 
with more than five million people infected with the virus that 
causes AIDS, South Africa launched a program in late 2003 to 
provide life-prolonging anti-retrovirals free to the public. 
But the state tender for the drugs has long been delayed and 
the government has been criticized for dragging its feet in 
rolling out the program. Tshabalala-Msimang said lack of 
capacity and infrastructure in the public health care system 
had stalled distribution of interim drug supplies. The bid, 
initially expected to be granted in August 2004, would be 
awarded shortly.  The government last year short-listed eight 
drug companies to supply the medicines.  Source:  Business Day, 
February 18. 
 
12.  Comment.  A February 1 article in Financial Mail suggests 
that the main reason for the bid delays lies in application of 
the Department of Trade and Industry's (DTI) regulations that 
state that any government or parastatal contract with an 
imported content of $10 million or more is subject to the 
National Industrial Participation (NIP) program, which requires 
a thirty percent reinvestment back into South Africa. 
Provincial health departments have been bypassing the state 
tender process and procured AIDS drugs directly from 
pharmaceutical companies on short-term contracts.  The drug bid 
is different from most state bids, where the government is 
negotiating prices with the short-listed firms instead of the 
companies submitting closed bids.   No additional comments were 
forthcoming from the Department of Health regarding the 
application of the NIP program's reinvestment regulations on 
the drug bid.  End comment. 
 
SANBS Unveils New Testing Methods 
--------------------------------- 
 
13.  The new method of testing whether donated blood is safe 
will be based on whether a donor has a transmissible infection, 
and not on race, according to the Department of Health.  Based 
on the goal of keeping blood supplies as safe as possible, the 
first-time donor will donate for the purpose of screening for 
transmissible diseases.  The plasma will be quarantined and 
only issued after the donor has donated for a second time and 
is shown to be free of infectious diseases.  Disease-free blood 
after a third donation places a donor in a low risk category. 
Those who have donated more than seven units of blood in the 
previous 24 months are regarded as very low risk and their 
donations can be used for all types of treatment.  Blood from 
all the three risk groups will be tested for diseases after 
every donation.  In addition, a Nucleic Acid Technology (NAT) 
screening of all donations will be introduced which reduces the 
current window period in the transfusion service.  On average, 
in the low-risk group, zero to nine donations per 100,000 
tested positive for HIV; in the high-risk group, between 200 
and 3,000 donations per 100,000 tested positive.  The new model 
was developed after it became publicly known that blood 
donations from black people were treated as high risk based on 
HIV/AIDS prevalence statistics.  Health Minister Manto 
Tshabalala-Msimang ordered the South African National Blood 
 
SIPDIS 
Service (SANBS) find another way of making sure blood was safe 
and a committee consisting of representatives of both parties 
was given until the end of January to find an alternative.  The 
new model will be implemented within six months.  Source: 
Sapa, February 15; The Star, February 16. 
 
FRAZER