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Comments with the Lancet South Africa series


In the first Comment with the Series, Lancet Editor Dr Richard Horton and Senior Executive Editor Dr Sabine Kleinert discuss three new strategies that SA's Health Minister Aaron Motsoaledi needs to address to effect real change. First, establish a dedicated and strengthened health workforce for the public sector; second, ensure health for all through an affordable national health insurance system; and third, give leadership and managerial positions to those who are most competent and who are not afraid of being held accountable.

Dr Horton and Dr Kleinert conclude: "The South African people have shown extraordinary resilience during difficult times. The current leaders have survived apartheid, and often imprisonment, to fight for the future of their country. Civil society, with its strong voice, has brought about many important changes in health. South Africa is a young democracy with pride and hope, and above all with high expectations for a fair, equitable, and peaceful society. Its people deserve a healthy future."

Lancet Press Office T) +44 (0) 20 7424 4949 E)

In the second Comment, Dr Wieland Gevers, Academy of Science of South Africa (ASSAf), Pretoria, SA, discusses how the serious decline in clinical research activity and capacity has prompted the Academy of Science of South Africa (ASSAf) to launch a consensus study designed to make recommendations on reinvigoration of clinical research in the country. He concludes: "The ASSAf consensus study is expected to address [many] relevant questions, in a report that will need careful consideration by the different key policy makers and interested parties who have allowed a core asset to be seriously damaged and distorted in recent years. A coordinated plan to reinvigorate clinical research in South Africa is thus urgently needed."

Dr Wieland Gevers, Academy of Science of South Africa (ASSAf), Pretoria, SA T) +27 (0) 21-686 4450 E)

The third Comment discusses health inequities in SA and is written by Dr Gavin Mooney, University of Cape Town, Cape Town, Western Cape, SA and Dr Lucy Gilson, University of Cape Town, Cape Town, Western Cape, SA and London School of Hygiene and Tropical Medicine, UK. According to Statistics South Africa, in 2001 'the 10% of the population in the lowest income decile shared R1·1 billion, whereas the 10% of the population in the highest income decile shared R381 billion'. In 2001, the Gini coefficient (the closer to 1, the greater the inequality) was 0·77 for South Africa, making the country one of the most unequal societies in the world.

The authors conclude: "How can the effect of the global financial crisis on health inequities in South Africa be reduced? The adoption of similar policies of going into deficit, as in several other industrialised countries, seems the best route. The South African economy, however, is less resilient than its counterparts elsewhere. What the country needs more than anything are jobs, and the outcome of the debate between the left and the right in South African politics on this issue will greatly affect health inequity."

Dr Gavin Mooney, University of Cape Town, Cape Town, Western Cape, SA (currently based in Australia) T) +61 8 9339 0803 E)

In the fourth Comment, Nathan Geffen, Treatment Action Campaign, Cape Town, SA, discusses the importance of scientists and activists working together. He talks of the importance of technical improvements, eg, integrating care for tuberculosis and HIV, better monitoring and evaluation of the programme for mother-to-child transmission prevention, early infant diagnosis and treatment, replacement of suboptimum antiretroviral drug regimens, shifting tasks from nurses to the army of community health workers that has been created in response to the HIV epidemic, reducing wasted expenditure in the public health system, and finding ways to share its burden of patients with the private system.

He concludes: "Whether or not activists can be galvanised into responding to these critical challenges is unclear; so far the challenge has not been met... It would be a great pity if the full potential of these opportunities is not realised."

Nathan Geffen, Treatment Action Campaign, Cape Town, SA T) +27 84 542 6322 E)

Traditional health practitioners are discussed in the fifth Comment, by Dr Karl Peltzer

Human Sciences Research Council, Pretoria, SA, and University of the Free State, Bloemfontein, SA. He concludes: "South Africa has made important steps towards inclusion of traditional care into the national health-care system by a traditional medicine directorate within the Department of Health, a traditional medicine research institute, postgraduate education in herbal science, and a draft policy for the institutionalisation of African traditional medicine, including a national institute. However, it seems that traditional medicine and allopathy will remain fairly separate and parallel in South Africa. Yet there should be limited cooperation between the two when appropriate."

Dr Karl Peltzer, Human Sciences Research Council, Pretoria, SA; and University of the Free State, Bloemfontein, SA T) +27-12-3022637 E)

The final Comment in the Series is by Dr Nelson Sewankambo and Dr Achilles Katamba, Makerere University, Uganda. They conclude on the importance of climate change, saying: "An important omission in the Series is climate change and its risks to human health. No African country has completed comprehensive assessments on climate change, and yet climate change will probably have adverse effects on health outcomes and thus exacerbate health inequities. WHO in 2008 placed climate change and health firmly on the health sector agenda. The time is now for African countries to act."

Dr Nelson Sewankambo, Makerere University, Uganda E)


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