Saturday, 18 October 2014

Healthcare in South Africa

South Africa needs a national health service. Do you agree? #MSBlog #MSResearch

"In response to some of the comments yesterday I have to stand up for people living with MS in South Africa and defend their right to treatment. Although the vast majority of MSers in South Africa will be of European descent we are beginning to see increasing number of black Africans with MS (“black African” refers to indigenous people who speak an African language). Why? An interesting point and worthy of a separate post in the future. But as we begin to see the murmurings of an mini-epidemic of MS in the black South African population we need to study it as it provides an opportunity to study the environmental changes that are obviously so critical for the development of MS and possibly other putative autoimmune diseases. The average person living in South Africa white, black, Asian or of mixed ancestory cannot afford to pay for MS DMTs out of their own pockets. Even the lucky few South African MSers with private health insurance who have access to high-cost DMTs are still burdened by exorbitant co-, or top-up, payments. The essential MS DMT list is not for them, but all the MSers who simply can't afford DMTs privately or who can't access them via the South African state healthcare system. Most of us who write on this blog are in favour of a socialist healthcare system as we believe in the principle that healthcare is a basic human right; this principle extends beyond the borders of the UK. It warms my heart to note that South Africa is trying to create an NHS. May be would should change our blog byline to 'Championing MSers no matter where you live'?"

Karoo, South Africa

"If you are interested in reading more about the challenges facing South Africa the following special report in the New England Journal of Medicine captures the problems. Please note apartheid ended 20 years ago and it is time to move beyond that era. People living with MS in South Africa shouldn't be burdened with apartheid's legacy, they deserve access to DMTs as much as anyone else living with this disease in other parts of the world."

Bongani & Benatar. Health and Health Care in South Africa — 20 Years after Mandela. N Engl J Med 2014; 371:1344-1353.

Excerpts:

... Beyond the elimination of legislated racial policies, advances in South Africa during the past 20 years include substantial economic growth, an expansion of the black African middle class, and a greatly increased number of social grants to the very poorest and unemployed.  Social grants have reduced absolute poverty, but 45% of the population still lives on approximately $2 per day (the upper limit for the definition of poverty). More than 10 million people live on less than $1 per day — the so-called food poverty line below which people are unable to purchase enough food for an adequate diet. Even at an income of $4 per day, the quality of life would not be remotely near the level that the majority of South Africans had hoped for after the end of apartheid. Relative poverty has become worse, with the Gini coefficient increasing from 0.6 in 1995 to almost 0.7 in 2009......

..... The top 10% of South Africans earn 58% of the total annual national income, whereas the bottom 70% combined earn a mere 17%. These disparities, the widest in the world, are associated with diseases of poverty. The persistence of such disparities is incompatible with improvements in population health........

....... South Africa, with 0.7% of the world's population, accounts for 17% of the global burden of human immunodeficiency virus (HIV) infection.....

...... South Africa has one of the worst tuberculosis epidemics in the world. Driven in recent decades by the spread of HIV infection, the incidence of tuberculosis increased from 300 per 100,000 people in the early 1990s to more than 600 per 100,000 in the early 2000s and to more than 950 per 100,000 in 2012....

...... Multidrug-resistant (MDR) tuberculosis accounts for 1.8% of all new cases of tuberculosis and 6.7% of retreatment cases. Since a study involving patients with extensively drug-resistant (XDR) tuberculosis in rural South Africa made international headlines, South Africa reports the most XDR tuberculosis cases in the world. Annual notifications increased from 298 in 2005 to 1545 in 2012,...

..... Annual per capita expenditure on health ranges from $1,400 in the private sector to approximately $140 in the public sector, and disparities in the provision of health care continue to widen... 

..... The national public health sector, staffed by some 30% of the doctors in the country, remains the sole provider of health care for more than 40 million people who are uninsured and who constitute approximately 84% of the national population......

...... Approximately 16% of South Africans (8 million people) have private health insurance that provides access to health care from the remaining 70% of doctors who work full-time in the private sector......

...... Up to 25% of uninsured people pay out of pocket for private-sector care. In recent years, permission for senior full-time staff in the public sector to spend a limited proportion of their time working in the private sector has diluted their public-service activities.......

....... Many of the state hospitals are in a state of crisis, with much of the public health care infrastructure run down and dysfunctional as a result of underfunding, mismanagement, and neglect. This has been most visible in the Eastern Cape province but is also striking in other regions......

..... The number of graduating doctors increased by 18% between 2000 and 2012, with a shift from gender parity to more women, more black Africans and persons of mixed ancestry, and fewer whites and Indians.... 

....... South Africa and eight other sub-Saharan African countries have lost more than $2 billion (in U.S. dollars) in investment from the emigration of domestically trained doctors to Australia, Canada, the United Kingdom, and the United States. South Africa incurs the highest costs for medical education and the greatest lost returns on investment for all doctors currently working in such destination countries. Previous studies indicate that up to 30% of South African doctors have emigrated and that 58% were intending to emigrate to Western countries.......

....... Working toward the goal of national health insurance to provide more equitable access to high-quality individual health services has reemerged as a popular notion, and a draft plan has been developed.... 

...... At a time characterized by local and global crises that engender much despondency, and when it seems that we are probably collectively unable to recognize the dire nature of our mutual predicament, it is appropriate to recollect how President Nelson Mandela's attitude of magnanimity and reconciliation (despite 27 years in prison) spearheaded peaceful progress toward a new South Africa.... 

4 comments:

  1. "..we are beginning to see increasing number of black Africans with MS...."

    Virus? Infection? the same happened in the Faroe Islands.

    Citations from a lot of sources on the internet (Google is your friend):

    "...Among native resident Faroese the first instance of symptom onset was in 1943...."

    "...We believe the source of MS on the Faroes was their occupation by British troops for 5 years in World War II. We think they introduced a widespread, specific, persistent (but unknown) infection.."

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  2. I quite agree, hence my comment yesterday about 1) not all white South Africans are rich 2) it doesn't just affect white South Africans and 3)MS drugs are not exactly cheap. I supported the anti-aparthied struggles in the 1980s (in the UK) and have watched as SA has evolved thereafter.
    Yes, it would be fantastic if SA had an NHS and yes, apartheid ended along time ago, South Africa has done well with its peace and reconciliation work (and has shown the world how to forgive) so no need for comments about "apartheid medication". It is a relatively young democracy and there are huge disparities but how many societies are so perfect, that brickbats can be thrown at others?

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  3. Prof G,

    There's an element of rose tinted glasses with your SA post. See wikipedia:


    Crime is a prominent issue in South Africa. South Africa has a very high rate of murders, assaults, rapes (adult, child and infant), and other crimes compared to most countries. Most emigrants from South Africa state that crime was a big factor in their decision to leave.

    South Africa is a rich country e.g. Gold and diamonds etc. However, as with many African countries wealth never finds its way to the general public. Until the violence and corruption can be sorted out, professional like you will continue to leave. I don't think they'll be much change in our lifetimes.

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    Replies
    1. Crikey I must be missing something but where exactly was Prof G's post rose tinted? Please explain. And I don't mean by just pointing to wiki.

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