Health care

Poverty, Aids, TB, malaria

Aids and other poverty-related diseases like tuberculosis and cholera are placing a tremendous strain on South Africa's health care system, eroding attempts to improve the general health of South Africa's people.

HIV/Aids poses the biggest threat by far, with an estimated six million South Africans expected to die from Aids-related diseases over the next 10 years. Based on the Department of Health’s national ante-natal survey, involving anonymous testing of pregnant women at state health facilities, an estimated 4.5-million South Africans were living with HIV in the year 2000.

Government agencies, as well as myriad non-governmental organisations, have risen to this challenge, mounting tremendous efforts to create awareness around HIV/Aids, promote behaviour change, and provide medical, social and economic assistance to those affected by the epidemic.

See: HIV/Aids in South Africa

Poverty and unemployment
High levels of poverty (71% in rural areas and 50% overall) and unemployment (at least 38%) make it difficult for most people to pay for health services, which places immense strain on the public health sector.

There have been significant improvements in some areas of basic health care delivery, such as ante-natal care, combating acute childhood illnesses, and managing to administer DOTS (directly observed treatment strategy) to combat tuberculosis in 80% of clinics.

But the challenges in primary health clinics are still enormous. Many clinics still lack basic equipment, drugs, tests for HIV and essentials like piped water, telephone access and reliable electricity supplies.

There has been a real increase in funding for public hospitals, which consume two-thirds of the health budget, but most of this money has gone towards better salaries, and our state hospitals, under growing pressure to accommodate people dying of Aids-related illnesses, are more overstretched and cash-strapped than ever.

Tuberculosis
The high rate of tuberculosis infection is another pressing health problem. South Africa is one of 22 countries around the world with the highest infection rates of TB.

The implementation of DOTS (directly observed treatment strategy) - where health workers monitor and observe TB patients taking their medication - in most clinics around the country has made significant inroads into controlling the disease.

However, the spread of HIV has been accompanied by an upward swing in the TB epidemic. More than half of the country's TB cases are HIV-related. People with HIV are far more susceptible to TB infection, and less able to fight it off.

Malaria
The prevalence of malaria in South Africa has increased steadily from the mid-1980s, with a rapid increase since 1996. In 2000 around 62 000 South Africans contracted malaria, and 423 died of the disease.

However, malaria occurs only on the fringes of the country, affecting the three north-eastern provinces: KwaZulu-Natal, Mpumalanga and Limpopo. Malaria transmission occurs seasonally, with peak rates of infection occurring in April and declining by June.

Reasons for the spread of malaria over the past decade include drug resistance, increased cross-border travel between South Africa and Mozambique, the spread of HIV, and reductions in DDT spraying.

Government efforts to curb malaria with the reintroduction of DDT spraying - 1.1 million households were sprayed last year - and distribution of bed nets are paying off, however, and the number of malaria cases in the northern parts of KwaZulu-Natal has been reduced by 70%.