HIV/AIDS crippling public health sector

With an increasing number of HIV/AIDS patients seeking health care from already over-stretched public sector facilities, the HIV/AIDS epidemic is undermining the quality of care in South Africa's health system.

According to The South African Health Review (SAHR) for 2002, published recently by the NGO Health Systems Trust (HST), HIV/AIDS is the "single most important" challenge to improving health care delivery in the country.

Health workers have borne the brunt of the disease as they began to feel the effects of the epidemic in their own ranks, the review found. Moreover, they were now required to implement new initiatives and policies without additional staff or training.

The review called for a "comprehensive human resource strategy" to address the impact of HIV/AIDS in terms of infected staff and staff burnout, and the large numbers of staff leaving to work overseas.

Clinical and management skills required to deal with other health issues, not just HIV/AIDS, were also lacking in the health system, the review noted.

The World Health Organisation ranked South Africa as having the ninth most serious tuberculosis (TB) epidemic in the world last year. Despite progress made to extend TB treatment, the cure rate for new patients in 2002 was 64 percent, far lower than the national target of 85 percent.

Sexually transmitted infections (STI) were also a major public health challenge and both the public and private sectors had yet to achieve the required levels of quality of care, the review said.

The HIV/AIDS epidemic also took its toll on the poorest households. A study of 728 AIDS-affected households in four provinces showed that 34 percent of monthly income was spent on healthcare (54 percent in rural areas).

"Many households had to dig deeper into their pockets for the care of their loved ones," Dr Patiswa Njongwe, chairwoman of the board of trustees of HST, said in the review.

Despite the government's reluctance to provide anti-AIDS drugs in the public sector, universal access to highly active antiretroviral therapy (HAART) would become an "inevitable reality in South Africa over the next three to seven years," the report predicted.

The review analysed the current status of the provision of antiretrovirals (ARVs) in South Africa and found that around 20,000 people of the estimated five million living with HIV/AIDS were receiving HAART.

But the lack of capacity and operational weakness currently undermines the health system's ability to deliver basic care. "Should universal access to HAART become a reality in SA, efforts must be made to ensure that the ARV programme does not steal resources from existing health interventions," the report warned.