South Africa Medically Speaking

Among other issues highlighted in the The Lancet online on August 25, 2009, are the following (for the full article, click on the link at the end of the article):

Since 1994, average life expectancy in South Africa has dropped by almost 20 years, mainly because of the rise in HIV-related mortality. Average life expectance at birth is only 50 years for men and 54 years for women.

South Africa has 0,7% of the world's population, but carries 17% of the global HIV burden. HIV prevalence seems to have reached a plateau, but there are 5,5 million South Africans living with HIV/Aids.

The overall injury death rate is 157.8 per 100,000, twice the global average. Road carnage plays a significant part: there are about 16,000 road traffic accident deaths every year. Around 7% of all deaths are alcohol-related.

The homicide rate is five times the global average: 38.6 per 100,000 people, with the highest rate among men aged 15 to 29 years. Still, the female homicide rate is six times the global average, and half of these women are killed by their partners.

It is estimated that a woman is killed by her partner every six hours in South Africa.

Although South Africa and the then minister of health, Manto Tshabalala-Msimang, were signitories of the Millennium Development Goals, which were particularly focused on child and maternal mortality, our children continue to be victims. Far from reaching goals set then, South Africa has gone backward: it is one of only 12 countries in the world where infant mortality has risen since 1990. Every year, 23,000 babies are stillborn, and almost 75,000 children die in SA – 23 000 in their first four weeks of life. 12% of our children under 5 are underweight. Each year 37 200 children could be saved through improving coverage of the prevention of mother-to-child HIV transmission and safer infant feeding practices.

There are 4.9 physicians, nurses and midwives per 1,000 South Africans, double the World Health Organisation standard of 2.5, but most South Africans are still under-served: medical staff are clustered in urban areas. Not only that, but 79% of doctors in South Africa work in the private sector, where 60% of health spending happens, but which is accessible to just 14% of SA citizens.

Depending on what province they live in, only 9% to 28% of South Africans are covered by medical schemes.

Though the state's focus on health is significant, comprising 10,8% of total goverment spend, the price the population pays for mismanagement is dire: if the policy of free antiretroviral therapy provision in public health services had been adopted in 2003, 330,000 lives could have been saved between then and now.

the burden of TB has more than doubled since the year 2001. KwaZulu Natal is the hardest hit with an HIV prevalence of 39,1% and a TB notification rate of 1,066 per 100,000 people.

Find more at the Lancet