Right to access to care? Progress since 2007?

Right to access to care? Progress since 2007?

Early in the COVID-19 pandemic WHO’s @DrTedros  highlighted the problems of access to health services by millions of people living with NCDs+ in his tweet.  His tweet certainly mirrors what the SA NCDs Alliance and our allies have been saying since 2007 when the SA Human Rights Commission  (SAHRC) held its first public hearings into the right access to health services.
COVID-19 changed the parameters of vulnerability to include NCDs+, mental health, and reemphasised disability in all its shapes and forms.

SAHRC report 2007

15 years ago the primary focus was understandably on access to HIV/AIDS and TB services. It was the height of the communicable disease epidemic. And amidst our homegrown “AIDS-denialism”. It was also the midpoint of the Millenium Development Goals (MDGs) where vast amounts of funding were channelled into communicable diseases and maternal-child services. That pattern of expenditure and funding remains in place today.

Executive summary

The report’s executive summary is salutary: it fits today’s health service access issues in the COVID-19 pandemic. Just substitute NCDs+ for communicable diseases.  And, we have a similar complaint today.
The report’s opening quote is ironically, but not surprisingly, from The AIDS Law Project, the early version of Section 27:

“We don’t yet have a definition of essential health services. This means we don’t have a base line for the right to health and it is impossible to cost the health service and thereby determine objectively what can be

We still don’t have the definition. But HIV unlike NCDs+ is a  National Development Plan priority. As for the rest of the conclusions, they mostly are unmet PLWNCDs+  The main change to health services is that HIV/TB services dominate primary health care. We beg for evidence-based inclusion of NCDs + throughout the life-course. And, more not just a tack on to HIV, TB and STI services.

That is why we fight on.  Read the SAHRC 2007 report on access to health services SAHRC 2007Health Report

SA’s health data ranking

SA’s health data ranking

The SCORE for Health Data Technical Package represents the most comprehensive strategies and interventions for strengthening country health information systems. First launched in August 2020, it is a one-stop solution to improve the availability of timely, reliable and comparable health data to track progress towards the Triple Billion targets and health-related Sustainable Development Goals.

SCORE is the first time that all elements comprising an optimum health information system – Survey, Count, Optimize, Review, Enable – are captured in a single, harmonized package.

Download the South African report 2013-2018

Revise WHO biosimilar guidelines urgently

Third World Network asks African civil society organisation to support its letter to the Chair WHO Expert Committee on Biologic Standardisation (EBCS) to revise the WHO biosimilar guidelines. The South African NCDs Alliance has signed.
The content below is from TWN.


In 2014, WHA adopted the resolution on access to Access to biotherapeutic products including similar biotherapeutic products and ensuring their quality, safety and efficacy” (WHA 67.21).

It requests the Director-General: “to convene
t). the WHO Expert Committee on Biological Standardization to update the 2009 guidelines, taking into account the technological advances for the characterization of biotherapeutic products and considering national regulatory needs and capacities and to report on the update to the Executive Board
”. However, till date, the Secretariat has not updated the SBP Guideline.

WHO states that after the adoption of the  WHA resolution   “In April 2015, an informal consultation was organized during which participants from NRAs of both developing and developed countries, as well as from industry, recognized and agreed that the evaluation principles described in the Guidelines were still valid, valuable and applicable in facilitating the harmonization of SBP regulatory requirements globally. It was therefore concluded that there was no need to revise the main body of the existing Guidelines“.

This is a problematic approach and legally wrong. The resolution is clear and it asked the DG to convene the meeting of  WHO Expert Committee on Biological Standardization to update the Guideline and not to convene the meeting of  Expert Committee on Biological Standardization to decide whether to update or not. Further, the decision of  Member states cannot be overturned by the informal meeting of  National Regulatory Meetings. Further WHO has not published any verbatim records or minutes of the 2015 informal meeting. 

Systemic reform necessary to cure SA health system

Friday, October 19, 2018

Deputy President David Mabuza says nothing short of a systemic overhaul is required to pull the country’s ailing health system out of the status quo.

“We all agree that our health system is in crisis and needs urgent attention,” Mabuza said on Friday at the inaugural Presidential Health Summit.

Delegates ranging from government officials, academics, labour to social activists are gathering in Ekurhuleni, Gauteng, over the next two days to thrash out pressing matters beleaguering the country’s strained health system.

Where does it hurt?

Before any steps can be taken, Deputy President Mabuza said, the country must collectively get to the root cause of the crisis.

“According to the World Health Organisation (WHO), one of the six building blocks of a healthy and resilient healthcare system is the health workforce or human resources for health.

“Over the past few months, there has been a serious outcry from all corners of our country about the shortages of the workforce in the public sector. Whereas the President has agreed to inject a certain number of the health workforce as part of his stimulus package, this is just but a temporary measure for immediate relief,” he said.

As part of the stimulus package, President Ramaphosa announced in September that Minister of Health and the National Health Council would immediately fill 2 200 critical medical posts, including nurses and interns. Funding would also be made available immediately to buy beds and linen.

On Friday, Mabuza said the summit had to come up with lasting solutions.

“The gross inequalities that have developed in the provision of human resources between the public and the private health sectors need to be faced head-on and resolved speedily,” he said.

The Deputy President said the country needed to urgently produce a national human resource operational plan that each level of health care can use in planning service provision.

The second major cause of problems in the provision of good quality healthcare, Mabuza said, is poor procurement or supply chain management systems that make it impossible to have adequate pharmaceuticals and other vital health commodities.

Although the country has essential medical equipment and medicine lists, which were accompanied by the delivery of chronic medicines distribution programme, challenges emanating from inadequate maintenance of equipment and stock-outs of medicines are still experienced.

“To ensure quality, safe and relevant technologies, we need to involve the end-users, primarily the health workers, in the procurement of equipment to ensure they can be used effectively and efficiently,” Mabuza said.

The Deputy President said the State needs to work with civil society groups to monitor the availability of medicines and other commodities in the healthcare system.

“The public needs to keep us on our toes to ensure that the population gets what is due to them.”

Health services provision is another area that requires urgent attention, Mabuza said, as this would ensure that every South African has access to care that is affordable.

“It must also be comprehensive and include preventive, curative, palliative, rehabilitative and health promotion services. At the moment, the primary health care component of our healthcare system is very weak and is found wanting.

“Our healthcare system is by and large curative, hospicentric and unable to provide comprehensive healthcare.”

Mabuza conceded that public facilities were congested, inappropriately staffed and plagued by long queues of patients, among them too many repeat visits.


With regards to the National Health Insurance (NHI) scheme, which is set to be phased in from 2019, the Deputy President said health facilities had to meet the set standards in order to be accredited.

Government is in the process of establishing learning centres to implement these standards.

“At facility level, we need to ensure that agreed quality standards are met in the provision of health care services. This must be supported by the recruitment and deployment of appropriately skilled personnel to ensure quality service delivery,” he said.

There is an urgent need to prioritise the development of new infrastructure in previously underserviced areas, and ensure that existing infrastructure is properly maintained to meet the required standards.

“The drastic shortage of appropriate infrastructure means that people with a mental health condition are often hospitalised in non-mental patient wards, and male and female patients are hospitalised in the same ward,” Mabuza lamented.

Funding and meeting infrastructure needs

In response to these challenges, the Deputy President said government must develop a consistent 10-year infrastructure plan, using identified and ring-fenced infrastructure resources that might benefit from the President Cyril Ramaphosa’s R400 billion infrastructure stimulus package.

“Our response to the health sector challenges will be incomplete if this summit does not provide targeted solutions to inadequate health systems financing and management,” he said.

The Deputy President said the financing of South Africa’s healthcare was inequitable across the board.

The private sector, he said, uses a higher proportion of the GDP but only serves only 16% of the population, when the public sector uses a lower proportion of the GDP, while it services 84% of South Africans.

“These inequities need to be identified and corrected in budget allocations.”

In an effort to address some of the challenges, the Office of the President will be re-costing health system funding “to provide more realistic figures on the cost of this health system and estimate a better model of allocation depending on the burden of disease per district”.

“The challenges in healthcare are also found in the private sector, although they vary in nature,” said Mabuza.

The private sector provision costs are unacceptably high and affordable only to a few, as proved by the Health Market Inquiry headed by former Chief Justice Sandile Ngcobo.

Mabuza bemoaned how most medical schemes were unsustainable, as they had high premiums that often increase faster than inflation.

“Medical scheme benefits are often exhausted before year-end, which forces patients to have no cover and many end up using the public health sector.”

He said challenges in both the public and private health sectors require a new approach to serve all South Africans.

“We need a publicly financed health system where services are provided by both the public and private facilities delivered according to improved standards of care. An integrated unitary health system under NHI does not negate the existence of medical schemes for those who desire additional care that complements services provided under NHI.”

He urged both the public and private arms of the sector to address the challenges in commissions over the next two days.

“We must work on a system based on solidarity to give all of our people the best that we can offer as a nation. It is within our power to make quality health care accessible to all.

“As we enhance collaboration in our entire health system, we need to build coordinated, integrated and shared health information systems.”

Checka Impilo

Mabuza used the summit to launch Checka Impilo, a national wellness campaign that focuses on testing and treating people who have HIV, TB, sexually transmitted infections and non-communicable diseases (NCDs) such as diabetes and hypertension.

The campaign will focus on the provision of comprehensive health and wellness services targeted at men, adolescent girls and young women, as well as key and vulnerable population groups.

The success of the campaign, Mabuza said, depends on coordinated collaboration among all social partners in respect to planning, implementation and monitoring.

Checka Impilo is a call to action for South Africans to move from a curative response to health to preventative approaches and the adoption of healthy lifestyles.

The campaign will focus on increased information, education and communication activities, promotion of HIV testing, widespread distribution of condoms, and provision of pre- and post-exposure prophylaxis against HIV.

“All of us must, therefore, go out in great numbers to test for HIV and screen for STIs, TB and NCDs such as diabetes and hypertension.

“Within 24 months of this campaign, we must have found and put two million more people on ARVs. We must also have found and put at least 80 000 more people with TB on anti-TB treatment. We must also have identified thousands more with diabetes, high blood pressure and cancer, and put them on treatment,” Mabuza said. – SAnews.gov.za

Poor management blamed for bulk of drug stock outs

Health Minister Dr Aaron Motsoaledi has blamed manufacturers for shortages of medicines including HIV and tuberculosis drugs, but a civil society coalition has alleged 80%of stock outs are due to poor management.

Community members have also complained about medicine stock outs.
In the Stop the Stock Outs Project’s latest survey, more than 40 percent of health facilities reported having experienced a HIV, TB drug stock out: Joe Gqabi and Alfred Nzo districts, Eastern Cape; Bojanala District, North West; Nkangala and Gert Sibande districts, Mpumalanga; and Lejweleputswa and Fezile Dabi districts, Free State.
According to Motsoaledi, recent reports by Times Live and eNCA regarding alleged widespread drug shortages promoted the minister’s early return last week from the World Health Organisation’s on-going, annual World Health Assembly in Geneva.

At a Pretoria press conference yesterday, Motsoaledi widespread shortages of drugs including the country’s three-in-one antiretroviral (ARVs) fixed-dose combination (FDC).

“The FDC is our flagship programme and we do everything in our power to protect it,” Motsoaledi said in a statement. “To make sure that there are not problems in this very important programme, we even implemented the practice of a national buffer stock whereby 10 percent of all the FDCs we provide are strategically stockpiled with a service provider in a warehouse.”

Motsoaledi also added that the county source the combination ARV from three different suppliers to guard against supplier problems affecting supply.

“At no stage did we have a shortage of FDC in the country,” he added.

As of September 2015, about 119,000 patients had been started on the FDC.

One in five facilities have experienced stock outs

The department recently released a list of at least 40 medications  -(comment by Vicki Pinkney-Atkinson  many of these critical for the treatment of NCDs, morphine and mental health medication)– that were running short at provincial depots nationwide. The department attributed the bulk of shortages to supplier constrained and shortages of the pharmaceutical ingredients used to make the drugs.

Stock outs of medicines are indicative of a bigger problem related to the management and accountability in a health system”

Comprised of civil groups including Medicines Sans Frontières, the Treatment Action Campaign and the Southern African HIV Clinicians Society, the Stop Stock Outs Project (SSP) collects stock out reports from health workers and clinics nationwide.

The group recently surveyed more than 2,500 of the country’s 3,732 health facilities. According to the research to be presented at the upcoming SA AIDS Conference, one in five facilities reported experiencing an ARV or TB medication stock out.

According to a SSP statement released yesterday, management or logistical challenges between medicine depots and clinics caused 80% of stock outs.

However, the group noted that patients were turned away without any medication in only 20 percent of cases.

“Supply of medicine to clinics and hospitals is the basic pillar to any public health system and stock outs of medicines are indicative of a bigger problem related to the management and accountability in a health system,” said SSP’s Dr Karl Le Roux in the statement.

The findings show an improvement over the group’s previous survey in which about one in four facilities reported stock outs.

However, >40% of health facilities in seven districts reported at least one HIV and TB drug stock outs. These districts include the Eastern Cape’s Joe Gqabi and Alfred Nzo as well as the Free State’s Lejweleputswa and Fezile Dabi districts. – Health-e News

Do you know of a stock out?

Email the Department of Health

or Stop Stock Outs sms or What’s App 084.855.7867 or email
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