US embassy cable - 05PRETORIA3481

UNCLAS SECTION 01 OF 04 PRETORIA 003481 
 
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 KHILL 
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 DBIRX 
 
E.O. 12958:  N/A 
TAGS: ECON, KHIV, SOCI, TBIO, EAID, SF 
SUBJECT:  SOUTH AFRICA PUBLIC HEALTH AUGUST 26 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:  South African Government Continues Strong 
HIV/AIDS Spending Commitment; Government Issues Bid for Civil 
Servant Medical Care; Guns Significant Health Care Cost; Health 
Department Releases Human Resources Plan; Erratic Infant 
Formula Supply Pose HIV Transmission Problems; SA Private 
Hospitals Cheaper than U.S. and Australia; and Poverty and 
Gender Inequality Hamper South Africa's Response to HIV/AIDS. 
End Summary. 
 
South African Government Continues Strong HIV/AIDS Spending 
Commitment 
--------------------------------------------- ------------- 
 
2.  The 2005/6 National Budget shows a continuous commitment of 
the national government to increase AIDS spending through 
earmarked transfers to provinces and specific allocations to 
national departments.  Total HIV and AIDS budgets (including 
conditional grants, which are earmarked spending transferred to 
provinces) increased from R1.4 billion ($220 million using 6.4 
rands per dollar) in 2004/5 to R1.9 billion ($300 million) in 
2005/6, increasing in real terms by 36 percent.  Conditional 
grants continue to be a major source of HIV/AIDS funding for 
provinces. 
 
3.  Three government departments use HIV/AIDS funding.  The 
Health Department spends its funding on prevention, treatment, 
care and support interventions.  The Education Department uses 
HIV/AIDS funding for HIV/AIDS Life skills and prevention 
education in schools while the Department of Social Development 
spends its money on HIV/AIDS community and home-based care 
activities.  The Health Department remains the provider of most 
HIV/AIDS services.  The national HIV/AIDS Life skills program 
(managed by the Department of Education) is the slowest growing 
budget, declining by 3 percent in 2005/6 in real terms and by 1 
percent over the 2005/6-2007/8 medium term, reaching R152 
million ($24 million) by 2007/8.  The Social Development 
Community and Home Based Care Services grant (the Department of 
Social Development's HIV/AIDS contribution) recorded a real 
growth of 88 percent in the 2005/6 budget, and will increase by 
27 percent in real terms over the medium term reaching R195 
million ($30 million) by 2007/8.  The National Health HIV/AIDS 
budget increases by 38 percent in real terms in 2005/6, 
increasing 23 percent over the medium term to reach R2.1 
billion ($330 million) by 2007/8.  The South African government 
plans to spend R6.6 billion ($1 billion) over the medium term, 
of which 85 percent is allocated to the Health Department. 
These budget allocations exclude provincial discretionary 
allocations sourced from the provinces' own budgets.  The 
provincial health departments are allocating an additional R2.3 
billion ($360 million) from their own budgets, raising the 
total HIV/AIDS budget to R8 billion ($1.25 billion) over the 
medium term. 
 
4.  For implementation, monitoring and evaluation purposes, 
HIV/AIDS allocations between national and provincial 
departments indicate who is responsible for the bulk of 
implementation.  In 2005/6 53 percent of the total health 
HIV/AIDS spending was conditional grants sourced from the 
National Government and spent by provinces, increasing to 55 
percent by 2007/8.  The provinces contributed 30 percent of the 
total health HIV/AIDS budgets from their own discretionary 
budgets.  Spending at a national level decreases as a share of 
the total health HIV/AIDS budgets, from 17 percent in 2005/6 to 
15 percent in 2007/8.  Three provinces (Free State, Limpopo, 
and Northern Cape) do not add provincial funds to the HIV/AIDS 
conditional grants, with Kwa-Zulu Natal spending 54 percent and 
Guateng spending 57 percent of their total Health HIV/AIDS 
budget from provincial sources in 2005/6.  Some provinces do 
not report their discretionary spending on HIV/AIDS and 
official budget and expenditure documents do not disclose the 
amount of donor funding and how much was spent, making complete 
monitoring and evaluation of HIV/AIDS funding difficult. 
Source:  IDASA Budget Brief No. 156, August 5. 
 
GOVERNMENT ISSUES BID FOR CIVIL SERVANT MEDICAL CARE 
--------------------------------------------- ------- 
 
5.  The South African government has finally issued its long- 
awaited tender for a new compulsory medical insurance plan for 
public servants.  The government intends for the new plan to 
simplify the provision of medical benefits to its employees, 
drive down costs, and increase the number of civil servants on 
medical insurance.  Eight contracts are available for bids, 
among them: an administrator, a clearing house to manage 
members' prescription medicines, two providers of primary 
health-care services, an HIV management company, a hospital 
service provider, a managed care organization and an IT firm. 
Bids have to be prepared by September 1, and the bid should be 
finalized by October 7.  Among the bid specifications are the 
equal weightings of 20 percent for price and empowerment 
status, in anticipation of which a number of black economic 
empowerment deals have been arranged.  From January 2006, all 
public servants will be required to join the Government 
Employees Medical Scheme, including those who already belong to 
a medical scheme, and those who have no medical insurance yet. 
Public-sector trade unions and the Congress of South African 
Trade Unions oppose the government insurance plan, arguing that 
it could have adverse implications for low-income workers that 
would amount to a change in conditions of service.  Among the 
top contenders for the scheme's administration contract are Old 
Mutual Healthcare, which announced an empowerment deal with 
Kwacha earlier this week, MxHealth, and SA's two biggest 
administrators, Discovery Health and Medscheme.  An estimated 
300,000 public servants' families are already covered under 
medical insurance plans and an additional 150,000 to 200,000 
families would eligible for coverage.  Source:  Business Day, 
August 18. 
 
GUNS SIGNIFICANT HEALTH CARE COST 
--------------------------------- 
 
6.  South Africa could be spending up to R200 million a year 
($31 million) just on treating people with serious abdominal 
gunshot wounds, according to researchers in the latest South 
African Medical Journal.  Dr Denis Allard, a surgeon at Cape 
Town's GF Jooste Hospital, and University of Cape Town 
professor of medicine Dr Vanessa Burch, assert that this amount 
does not include the cost of gunshot injuries to other parts of 
the body.  Their estimate is based on extrapolation from a 
study of wounds at GF Jooste, a state hospital on the violence- 
wracked Cape Flats.  They found that over a seven month period, 
surgeons at Jooste did an average of one emergency laparotomy - 
surgical entry into the abdominal cavity - a week for firearm 
injuries.  On average, each of the 21 patients treated at 
Jooste from admission to discharge cost the state health 
service about R10,269 ($1,600), 13 times the government's per 
capita health spending.  Source:  Sapa, August 18. 
 
HEALTH DEPARTMENT RELEASES HUMAN RESOURCES PLAN 
--------------------------------------------- -- 
 
7.  The Health Department's human resources plan has finally 
been released, and now further discussions are underway about 
how to ensure that the country has enough health workers to 
serve the nation.  The challenge of ensuring that the country 
has enough health staff to serve citizens properly has been 
complicated by the exodus of skilled staff to wealthy health 
systems, a "changing disease profile" and a lack of a 
"developmental approach" to HR planning and management, notes 
the plan.  By 2001, over 23,000 South African-born health 
professionals were working in Britain, U.S., Canada, Australia 
and New Zealand.  By March this year, the entire public sector 
was left with only 42,373 professional nurses, 7,784 doctors 
and 1,561 pharmacists.  The emergence of HIV, the persistence 
of tuberculosis (and complications such as multi-drug resistant 
TB), the re-emergence of diseases such as cholera and the 
increase in chronic "lifestyle" diseases such as diabetes have 
increased demands on the health sector.  The plan's admission 
that there has been a "lack of a developmental approach" refers 
mainly to the fact that training institutions have not kept 
pace with the demands of the population.  Between 1998 and 
2003, only 4,018 new professional nurses were trained.  This 
did not even keep up with population growth over the period. 
Yet, during the same time, the public health sector shifted 
care from hospitals to primary health clinics, meaning there 
was an even greater need for more nurses.  The plan itself 
concedes that proper management is a key problem.  South Africa 
spends 8.5 percent of its GDP on healthcare, which is a very 
substantial portion in global terms.  Treasury has also set 
aside about R4.6 billion ($720 million) for provinces to train 
and develop health professionals over the next three years. 
For the next two weeks, the health department will be briefing 
stakeholders including trade unions, professional bodies and 
training institutions.  Stakeholders have until 15 September to 
make written submissions on the plan.  By January, a program to 
develop national training standards for health workers is to be 
in place.  Source:  Health-e News, August 9 and Financial Mail, 
August 19. 
 
ERRATIC INFANT FORMULA SUPPLY POSES HIV TRANSMISSION PROBLEMS 
--------------------------------------------- ---------------- 
 
8.  The Health Department met with representatives of Nestle, 
an international food and beverage company, to discuss 
shortages of the infant formula, Nan Pelargon, provided by the 
state to the babies of HIV positive mothers.  The company is to 
provide a full report to the South African government on how it 
is addressing the erratic supply of infant formula to public 
health facilities.  The company holds a government tender for 
providing infant formula to 2,525 sites countrywide for the 
national prevention of the vertical HIV transmission of HIV 
program.  Exclusive formula feeding reduces the risk of 
transmission via breast milk by one-third, and women enrolling 
in the program are advised to bottle-feed.  But the shortfall 
in supplying the formula could jeopardize the vertical 
transmission campaign.  According to Nestle, the shortages were 
partly due to a 20 per cent increase in demand for the formula 
in 2004, which had been exacerbated by a strike at production 
facilities.  In a statement the company said:  "In order to 
address the shortage, we have reopened our Bethal factory and 
have commissioned our Brazilian market to assist us to meet our 
backlog and current needs.  The supply will improve over the 
coming weeks and should gradually normalize as of October." 
Source:  IRIN News, August 19. 
 
SA HOSPITALS CHEAPER THAN U.S. AND AUSTRALIA 
-------------------------------------------- 
 
9.  According to a study sponsored by the Hospital Association 
of South Africa, private hospitals in South Africa perform much 
of their surgery better, faster and cheaper than those 
hospitals in Australia and the United States.  The report shows 
that South Africa is up to 50 percent cheaper than the US and 
Australia with regard to procedures requiring hospitalization. 
On average, the private hospital industry invests R8 billion 
($1.3 billion) in health-care technology annually, about 45.7 
percent of the sector's revenue.  According to the study, the 
average combined cost of hospital and surgical fees, drug and 
surgical equipment for an uncomplicated Caesarean section in a 
private hospital in South Africa is about R15,431 ($2400), 
almost half the R29,445 ($4600) in Australia and a quarter of 
the R58,602 ($9200) cost in the U.S.  The cost of a colonoscopy 
in a private South African hospital, R3,458 ($540), is one- 
third less than the cost of the identical procedure in 
Australia, R5,305 ($830), and 30 percent of the U.S. cost of 
R11,760 ($1800).  A tonsillectomy performed in South Africa is 
between 53 percent and 58 percent cheaper than in Australia and 
less than 10 percent of the U.S. cost.  A hip replacement is 77 
percent cheaper than in Australia and 58 percent cheaper than 
in the U.S.  A vasectomy costs R3,883 ($610), which is 10 
percent of the R39,900 ($6200) charged in the U.S.  The length 
of time a patient spends in South Africa's private hospitals is 
among the lowest worldwide.  The average stay for an 
uncomplicated Caesarean section is four days in a private 
hospital in South Africa, compared with 3.38 days in the U.S. 
and 5.9 days in Australia.  Patients who undergo a 
straightforward hip replacement in South Africa's private 
hospitals spend an average of 5.58 days in hospital, while the 
length of stay for the identical procedure in the U.S. and 
Australia is 4.59 and 9.5 respectively.  Source:  Sapa and Mail 
& Guardian, August 15. 
 
POVERTY AND GENDER INEQUALITY HAMPER SOUTH AFRICA'S RESPONSE TO 
HIV/AIDS 
--------------------------------------------- ------------------ 
 
10.  Speaking at a recent HIV/AIDS forum organized by the 
HIV/AIDS networking organization, HIVAN, and the World Council 
of Religion and Peace (WCRP), Hoosen Coovadia, Professor of 
HIV/AIDS Research at the Nelson Mandela Medical School of the 
University of KwaZulu-Natal (KZN), asserted high unemployment 
rates, poverty and lack of access to basic services is such a 
problem in South Africa that enough resources could not be 
utilized to control the HIV/AIDS pandemic.  He noted that 
recent statistics released by the national Department of 
Health, showing that HIV prevalence in South Africa had risen 
from 26.5 percent in 2002 to 29.5 percent in 2004, indicated 
that there was "something terribly wrong with this country's 
HIV/AIDS program.  Nevertheless, Coovadia acknowledged the 
country's success in implementing one of the most extensive 
prevention of mother-to-child transmission (PMTCT) programs in 
the world, and enrolling more than 50,000 people in the 
national treatment plan.  He called on researchers to pay 
greater attention to the link between HIV/AIDS and gender, and 
to remember that women were at higher risk of infection. 
Approximately 25 percent of South African women are raped or 
suffer domestic violence.  According to Cookie Edwards, 
provincial coordinator of the KZN Network of Violence Against 
Women, HIV/AIDS and the abuse of women were often regarded as 
unrelated.  Discussants at the forum also asserted that the 
country's fight against HIV/AIDS relied heavily on medical and 
technical solutions, while largely ignoring social factors, 
such as behavior, beliefs, traditions and inter-personal 
relationships.  Source:  PlusNews, August 18. 
 
TEITELBAUM