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CSU 55/2009: SOUTH AFRICA ACCEPTS CRITICAL FINDINGS IN LANCET ARTICLES
This article, and the Lancet series, speak for themselves. They have been a
long time in coming.
Full text of the Lancet series is at
http://www.thelancet.com/series/health-in-south-africa
Good reading.
BD
From The New York Times, 24 August 2009
JOHANNESBURG — Leading South African scientists challenged the governing
party on Monday to break with its deeply flawed record on AIDS and public
health, spurring the country’s new health minister to say that he and his
party shared their diagnosis of systemic problems and were determined to
repair them.
Scientists called on South Africa to improve its flawed health system. The
decision by the health minister, Dr. Aaron Motsoaledi, to embrace the often
withering assessment of his party’s failings, laid out in six papers
published online Monday by The Lancet, a medical journal based in London,
provided a strong signal that the governing party’s new leadership intended
to shake up a badly managed health system.
It was also evidence that the long often strained relationship between the
government and the country’s senior medical researchers, who at times saw
their cutting-edge scientific findings ignored by their political leaders,
could be coming to an end.
“We do take responsibility for what has happened and responsibility for how
we move forward,” said Dr. Motsoaledi, who took charge of the Health
Ministry in May.
He also said, “I am feeling quite at home and comfortable with this Lancet
report.”
South Africa, still struggling to overcome the legacy of the racist
apartheid system, has H.I.V. and tuberculosis epidemics that are among the
world’s worst. The rate at which women here are killed by intimate partners
is six times the global average.
It is also one of only a dozen nations in the world where child mortality
has risen since 1990 — a period when many countries, including African ones
far poorer than South Africa, have seen significant declines. South Africa,
which delayed carrying out dual drug therapies proved to prevent the
transmission of H.I.V. from mother to baby, could save some 37,000
children’s lives a year by 2015 by broadening the provision of such
therapies, the researchers estimated.Dr. Motsoaledi vowed Monday that he
was committed to eradicating such deaths. “If others can do it, why can’t
South Africa?” he asked.
The team of Lancet authors — public health doctors, epidemiologists, health
economists and other researchers from South Africa — said the April
elections that brought the new leadership of the governing African National
Congress to power offered an opportunity for change.
The party has run the country since apartheid ended 15 years ago, but the
new president, Jacob Zuma, had for years been at odds with his predecessor,
Thabo Mbeki, and has pledged a new direction. South Africa’s approach to
AIDS and health began to shift significantly last year after Mr. Mbeki was
forced out of office by his own party and Barbara Hogan was named health
minister.
The current government “has the mandate and potential to address the public
health emergencies facing the country,” the authors wrote, adding, “Will
they do so, or will another opportunity and many more lives be lost?”
The scientists described the calamitous and now familiar consequences of
what they called Mr. Mbeki’s “bizarre and seemingly unshakable belief that
H.I.V. did not cause AIDS.” But they went further to detail the management
failures of his health minister, Manto Tshabalala-Msimang, that too often
crippled the quality of services even after good policies were adopted.
“South Africa is this great paradox of excellent policies,” said one of the
main authors, Prof. Salim S. Abdool Karim, who leads the Durban-based
Center for the AIDS Program of Research in South Africa. “The problem is
they can’t implement them.”
In The Lancet, the authors decried what they described as “a stubborn
tendency to retain incompetent senior staff and leaders, including (until
recently) the former minister of health. As a result, for many years,
loyalty — rather than an ability to deliver — has been rewarded in the
public sector.”
The authors of the papers prescribed what they considered an affordable
agenda to improve the health system, including a more strategic effort to
prevent the further spread of H.I.V.
The potential to contain the AIDS epidemic “was irretrievably lost,” they
wrote.
South Africa, with less than 1 percent of the world’s population, now bears
17 percent of the world’s burden of H.I.V. infection. It has more
H.I.V.-infected people than any other nation.
Expanding efforts to prevent mothers from infecting their babies and to
discourage people from having multiple sexual partners, as well as moving
urgently to routinely offer circumcision to men — a relatively simple
surgical procedure proved here in South Africa to more than halve their
risk of infection — could help the government achieve its goal of halving
new infections.
But doing so will be no easy task. Dr. Motsoaledi, asked when South Africa
would adopt a policy to promote circumcision, said that before moving
forward the country still needed to consult leaders of various ethnic
groups. Some of them practice circumcision, while the Zulu, the country’s
largest ethnic group, do not. The World Health Organization recommended
circumcision more than two years ago as an effective H.I.V. prevention
method.
Still, there is no question that the tone of the debate between the
government on one side, and scientists and advocates on the other, has lost
the contentious edge that often characterized it during the Mbeki era.
Dr. Motsoaledi noted Monday that he had been classmates with Dr. Karim at
the University of Natal’s medical school in the early 1980s. Dr. Motsoaledi
and Dr. Karim were both students of another of the report’s authors, Hoosen
M. Coovadia, a pediatrician and professor of H.I.V./AIDS at the University
of KwaZulu-Natal.
“I’m quite happy and excited about this gathering and the report,” Dr.
Motsoaledi said.
Professor Coovadia repaid the compliment, saying, “I’m so pleased we’ve
reached a moment when we’re all going to work together.”
CSU 55/2009: SOUTH AFRICA ACCEPTS CRITICAL FINDINGS IN LANCET ARTICLES
| Friday, 11th of September 2009 |
 |
 |
This article, and the Lancet series, speak for themselves. They have been a
long time in coming.
Full text of the Lancet series is at
http://www.thelancet.com/series/health-in-south-africa
Good reading.
BD
From The New York Times, 24 August 2009
JOHANNESBURG — Leading South African scientists challenged the governing
party on Monday to break with its deeply flawed record on AIDS and public
health, spurring the country’s new health minister to say that he and his
party shared their diagnosis of systemic problems and were determined to
repair them.
Scientists called on South Africa to improve its flawed health system. The
decision by the health minister, Dr. Aaron Motsoaledi, to embrace the often
withering assessment of his party’s failings, laid out in six papers
published online Monday by The Lancet, a medical journal based in London,
provided a strong signal that the governing party’s new leadership intended
to shake up a badly managed health system.
It was also evidence that the long often strained relationship between the
government and the country’s senior medical researchers, who at times saw
their cutting-edge scientific findings ignored by their political leaders,
could be coming to an end.
“We do take responsibility for what has happened and responsibility for how
we move forward,” said Dr. Motsoaledi, who took charge of the Health
Ministry in May.
He also said, “I am feeling quite at home and comfortable with this Lancet
report.”
South Africa, still struggling to overcome the legacy of the racist
apartheid system, has H.I.V. and tuberculosis epidemics that are among the
world’s worst. The rate at which women here are killed by intimate partners
is six times the global average.
It is also one of only a dozen nations in the world where child mortality
has risen since 1990 — a period when many countries, including African ones
far poorer than South Africa, have seen significant declines. South Africa,
which delayed carrying out dual drug therapies proved to prevent the
transmission of H.I.V. from mother to baby, could save some 37,000
children’s lives a year by 2015 by broadening the provision of such
therapies, the researchers estimated.Dr. Motsoaledi vowed Monday that he
was committed to eradicating such deaths. “If others can do it, why can’t
South Africa?” he asked.
The team of Lancet authors — public health doctors, epidemiologists, health
economists and other researchers from South Africa — said the April
elections that brought the new leadership of the governing African National
Congress to power offered an opportunity for change.
The party has run the country since apartheid ended 15 years ago, but the
new president, Jacob Zuma, had for years been at odds with his predecessor,
Thabo Mbeki, and has pledged a new direction. South Africa’s approach to
AIDS and health began to shift significantly last year after Mr. Mbeki was
forced out of office by his own party and Barbara Hogan was named health
minister.
The current government “has the mandate and potential to address the public
health emergencies facing the country,” the authors wrote, adding, “Will
they do so, or will another opportunity and many more lives be lost?”
The scientists described the calamitous and now familiar consequences of
what they called Mr. Mbeki’s “bizarre and seemingly unshakable belief that
H.I.V. did not cause AIDS.” But they went further to detail the management
failures of his health minister, Manto Tshabalala-Msimang, that too often
crippled the quality of services even after good policies were adopted.
“South Africa is this great paradox of excellent policies,” said one of the
main authors, Prof. Salim S. Abdool Karim, who leads the Durban-based
Center for the AIDS Program of Research in South Africa. “The problem is
they can’t implement them.”
In The Lancet, the authors decried what they described as “a stubborn
tendency to retain incompetent senior staff and leaders, including (until
recently) the former minister of health. As a result, for many years,
loyalty — rather than an ability to deliver — has been rewarded in the
public sector.”
The authors of the papers prescribed what they considered an affordable
agenda to improve the health system, including a more strategic effort to
prevent the further spread of H.I.V.
The potential to contain the AIDS epidemic “was irretrievably lost,” they
wrote.
South Africa, with less than 1 percent of the world’s population, now bears
17 percent of the world’s burden of H.I.V. infection. It has more
H.I.V.-infected people than any other nation.
Expanding efforts to prevent mothers from infecting their babies and to
discourage people from having multiple sexual partners, as well as moving
urgently to routinely offer circumcision to men — a relatively simple
surgical procedure proved here in South Africa to more than halve their
risk of infection — could help the government achieve its goal of halving
new infections.
But doing so will be no easy task. Dr. Motsoaledi, asked when South Africa
would adopt a policy to promote circumcision, said that before moving
forward the country still needed to consult leaders of various ethnic
groups. Some of them practice circumcision, while the Zulu, the country’s
largest ethnic group, do not. The World Health Organization recommended
circumcision more than two years ago as an effective H.I.V. prevention
method.
Still, there is no question that the tone of the debate between the
government on one side, and scientists and advocates on the other, has lost
the contentious edge that often characterized it during the Mbeki era.
Dr. Motsoaledi noted Monday that he had been classmates with Dr. Karim at
the University of Natal’s medical school in the early 1980s. Dr. Motsoaledi
and Dr. Karim were both students of another of the report’s authors, Hoosen
M. Coovadia, a pediatrician and professor of H.I.V./AIDS at the University
of KwaZulu-Natal.
“I’m quite happy and excited about this gathering and the report,” Dr.
Motsoaledi said.
Professor Coovadia repaid the compliment, saying, “I’m so pleased we’ve
reached a moment when we’re all going to work together.”
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