Charl Swart (PhD Political Science, Post-Doctoral Fellow, School of Public Health, University of the Western Cape)
On the 7th of May 2014, South Africans took to the polls in the country’s 5th national democratic election. The African National Congress (ANC) recorded its 5th victory securing 62.15% of the national vote. The Democratic Alliance (DA) secured 22.23% of the national vote, the most ever by the party confirming further its status as the official opposition. Although the ANC secured substantially fewer seats in the National Assembly than in any previous term, the party still holds enough seats to continue its parliamentary dominance. Therefore, despite stronger opposition and a decline in votes, the ANC remains firmly in power. What, if any, are the implications of continued ANC dominance for health outcomes and the organization of the health sector in South Africa?
South Africa’s health indicators illustrate the enormous health challenges facing the country. The health challenges include a quadruple burden of disease as well as addressing the legacies of colonialism and apartheid. The first signs from the newly elected ANC have, thankfully, been positive. The highly respected Aaron Motsoaledi, under whose supervision the South African Anti-retroviral (ARV) programme has become the largest in the world, has been retained as the Minister of Health. The minister and government have stated their commitment to enlarging the ARV programme to eventually include 4.6 million people on treatment. Continuity in the top government health position and a commitment to the ARV programme is a great step forward considering the history of ‘AIDS-denialism’ under previous regimes.
Similarly the (previous) government had committed itself to combating the TB epidemic by dramatically scaling up the Xpert MTB/RIF diagnostics testing system to the largest of its kind in the world. In the same vein, government has taken decisive steps to combat the three other disease burdens, namely maternal and child mortality, non-communicable diseases and violence and injury. The increased government commitment to these elements comes in the wake of South Africa’s regression in MGDs 4 and 5. Political continuity is thus probably a good thing for the response to these challenges.
A further positive element for the health sector can be found in the continued government commitment to the National Development Plan (NDP) launched in 2011. The NDP includes a chapter dedicated to improving health and health systems in South Africa. However, the commitment to “radical socioeconomic transformation policies and programmes” captured under the NDP has been met with some concern due to the economic realities in South Africa. The proposed accelerated implementation of black economic empowerment, land reform and other forms of empowerment may further adversely affect the already struggling economy. Nevertheless, the commitment to a development plan, which includes a dedicated health focus, can be viewed as a positive step towards addressing South Africa’s health challenges.
The retention of the Minister of Health also bodes well for the implementation of the proposed National Health Insurance (NHI) introduced as a green paper late in 2011. Although the NHI has reached the pilot stage, there is still uncertainty about many aspects thereof. Despite this uncertainty, there is consensus that the South African health system is in need of restructuring. My greatest concern is that the government views the NHI as a catch-all concept for much needed health systems reform and in doing so fails to successfully implement the NHI.
A further positive health development has been the retention of Rob Davies as minister of the Department of Trade and Industry. His retention may facilitate the speedier creation of a South African IP policy, which could increase access to cheaper generic drugs.
Whether the developments highlighted will translate into concrete improvements for the health of South Africans remains to be seen. The government is however displaying a commitment to pro-actively taking on South Africa’s health problems on the levels of rhetoric, leadership, policy and programmes. This commitment is unfortunately not always clear-cut, as illustrated by the issues and problems confronting the NHI. The results of the recent elections, ministerial leadership continuity and continued commitment to improving the health system is, at the very least, a step in the right direction.