People’s Power for Economic Freedom Table of Content
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- Definition of Primary Healthcare (PHC)
- Healthcare Status Quo in South Africa 2014 – a Comparative Analysis
- Escalating Health crisis
- Maternal and child mortality
- Structural healthcare deficiencies and impact
- On industrial chemicals in household and food products
- Clean, safe environments, free from noxious chemicals and pollutants
- EFF’s Healthcare Policy and Transformation Perspective
- Critique on National Health Insurance
- Health crisis: government in dilemma
CHAPTER 7 National Health Policy Discussion Document for the EFF National Health Policy Preface South Africa is plunging into a disease-ridden abyss, by design. To combat the destructive scourge of lack of access to healthcare system, the EFF will implement radical changes to the principles and foundations of Healthcare in South Africa, which urgently addresses the sources and causative factors in the promotion and progression of diseases in the population, while simultaneously instituting systems for ensuring effective and safe treatments for those individuals languishing in a diseased status. Our take is that good health on equal terms for the entire population based on the CUBAN model that emphasizes Prevention Over Cure should be the mantra.
In virtually every critical area of public health and medicine facing poor countries Cuba has achieved undeniable success, these include most prominently:
The raison d'etre of the health sciences as demonstrated in Cuba is the discovery of new knowledge and the use of that knowledge to improve health of all the people. Both the professional and commercial reward structures within the discipline insure that evidence of a major advance will attract further sustained attention and human development. Much as health facility infrastructure expansion is equally important to put emphasis not only on infrastructure, but also on preventative health system cannot be over-emphasized. From cradle, human being’s life evolves from birth, born in safe and clean environment, healthy food, clean playing and learning and provision of good medical support in case of illness until his grave. The draft healthcare policy is required amongst others, to develop a perspective on how to bridge the gap between the rich and poor; on food security; access to healthcare centers on a 24 hour, 7 days a week basis; exploration of alternative or traditional medicine and exploitation of the use of marijuana 'cannabinoids' for medical and commercial purposes; on HIV/Aids policy; develop a view on reasonable distance for patients to walk to clinics; EMS system impact on maternal deaths and infant mortality; the use of universal ambulances for pregnant women; compulsory labeling of GM products; develop a view on abortion; mental health and rehabilitation centers; a transgender perspective; HPV vaccination; cellular health medicine; retraining of doctors and health workers. These are areas of grave concern to the working class and the poor. A policy perspective of the EFF should be driven by a pro-poor paradigm and profoundly respond to these challenges. Definition of Primary Healthcare (PHC) Here, from a universal point of view, primary healthcare refers to the first line of health care that a patient receives, including the treatment of disease by regular medical visits, referral to more specialized care if needed and prevention by health education aimed at individuals, families and communities. “…essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and a cost that the community and country can afford to maintain… It forms an integral part of the country’s health system of which it is the central function and main focus, and of the social and economic development of the community. It is the first level of contact on individuals, the family and community…bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process”. Source: WHO and United Nations Children’s Fund, 1978 The deficiency of primary care for the African majority in South Africa during apartheid led to disproportionately high serious health problems in this population group, manifested in higher infant mortality rates and lower life expectancies compared to the white upper class. This is further exacerbated by related social determinants of health such as poverty, unemployment, gender based violence, corruption and poor planning, lack of basic infrastructure like water and sanitation, roads and transport, deterioration in health systems and lack of provision of basic quality services. As it will be illustrated below, the numbers are shocking: empirical and scientific research reveals that in the 1960s, the average life span was about 65 for white men and 72 for white women, but only 51 for black men and 59 for black women.3 While the post-apartheid government has since developed a model of primary-centered health care aimed at all South Africans, the political, economic and social legacy of apartheid continues to affect the quality of primary care in the nation today. Currently, primary healthcare in South Africa is challenged by two major problems, as supported by the evidence, which are rooted in the underlying socioeconomic inequalities that were implemented during the apartheid era: (1) the differential burden of disease and (2) the inequality between private and public health care. Access to primary healthcare is still, as it were in 1960s, defined on the same fault-lines in 2014, 20 years into democracy.
Primary healthcare has a unique history in South Africa, where efforts to provide holistic health care to rural communities began in the early 1940s. The racial bigotry and social inequalities brought by apartheid caused this progression in medical care to be reversed until South Africa’s liberation in 1994. Since then, the successive policy options have been attempted to adopt a health care system with its main focus on primary care and prevention. However, given the numerous and other economic and political issues the government faces, the establishment of a strong primary healthcare system has proven difficult yet unavoidable. Some of these issues include a two-tier healthcare system: public system that is mainly state funded which serves 86% of the population and privately owned healthcare system with only 16% of the population. Both tables below illustrate life expectancy at birth by race and sex between the year 1970 to 1980 and the life expectancy at birth by race between 1990, 2000 and 2010. They also make a comparative analysis, the huge decline in life expectancy of South Africans especially amongst blacks and Africans in particular.
Table A. Source: Census, May 06, 1980 The discrepancy in life expectancy more than just a consequence of racially exclusive apartheid society, it is a function of economics. Under apartheid control, the South African health care system was strikingly differentiated between racial groups and severe inequality between whites and blacks emerged. The most significant change with apartheid was the deregulation of public health care. By removing public health care, the private sector expanded, which made health care more expensive and prevented Africans and black people from being able to afford such care; this in turn added to their ability to attain health care. Table B. Source: StatSA 2013 In contrast to the table A, while life expectancy of African male grew from 48.9 to 52.1 and from 53.3 to 59.1 for female, between 1970 and 1980, however, there has been a marked decline, generally among Africans between 1990 and 2010 and beyond, life expectancy fell below 50.0 among black males. This decline in life expectancy is due to various socio-economic determinants of health and ill health such as poverty, unemployment, environmental pollution, lifestyles; HIV & TB related illnesses, etc. South Africa in is dire need for a game-changing healthcare policy based on curative interventions in order to turn the trend upward. To this end, the proposed universal coverage National Health Insurance (NHI) serves as a necessary antidote and policy intervention and alters health service philosophy and structural outlook significantly. The apartheid, capitalist model of deregulation of the primary healthcare led in the proliferation of private medical care institutions and pharmaceutical drugs companies which are the typical target and beneficiaries of the prevailing South African health system interventions. While these components contribute in the provision of healthcare and can improve the quality of life in the short term for assisting sick or injured individuals, they do not extend their services to all South Africans regardless of their economic status and positions in society. According to this data, life expectancy in general seem be increasing for all racial categories with slight increase for Africans. Comparatively, judging by the years increase of table B and C, life expectancy for Africans has slightly increased however, between white and African it remain poles apart with no prospects of narrowing of the gap anytime soon. Even Health department own data indicates that there is an increase in overall life expectancy from 57.1 years in 2009 to 61.1 years in 2012, there is no indication to explain the actual increase in subsequent years (2013-2014). Due to lack of data, it can only be assumed that the 61.1 remain the projection for this period. It cannot be argued that life expectancy is increasing for an average working class person. It would seem that, a modest increase in life expectancy among Africans has been enhanced not by the reduction in the burden of diseases or changes in the determinants of health but by the provision of ARVs. Life expectancy has increased disproportionately between main racial categories and the Africans are at the bottom of this life prolongation. Escalating Health crisis Escalating Health crisis is linked directly to several overt and inescapable factors include among others:
The escalation of health crisis in SA can best be shown or illustrated by means of the extent of and the amount of challenges in maternal and child mortality rate and the spread of HIV epidemic. Maternal and child mortality
attributed to malnutrition. This will need a complete restructuring of primary healthcare system by introducing home-based midwives services for data compilation and opportunity to improve coverage and quality of maternal and child health services through reaching learners in schools, reaching households through regular visits by healthcare workers and clinical specialists. This includes the expansion of healthcare provision to rural areas within the NHI framework. HIV & AIDS The scale of HIV epidemic infections remains huge and more HIV-positive people live in South Africa. SA has the smallest population compared and measured against those of China, India and Nigeria. Further, SA has the biggest HIV prevalence than Lesotho, Swaziland, Mozambique, Namibia and Zimbabwe combined. Government has introduced various intervention programmes like PMTCT, and massive roll-out of ARVs from 2009. The ARV program is entirely funded from the national fiscus, which is good. At present the HIV programme consumes just under 10% of government’s total health expenditure and about 0.82% of the GDP. However, this massive roll-out of ARVs is not without challenges. In the majority of cases, ARVs are mainly imported from multinational pharmaceutical companies often bought with exorbitant amount of money resulting in massive loss of revenue; there have been reports of antiretroviral stock-outs; the collapsing of many public health systems, corruption in procurement of medicines supply and service delivery threatens the expansion of continued successful treatment programmes and the fight against HIV/AIDS.
Rampant corruption endemic throughout South African political, social and economic structures, resulting in the massive diverting of resources and opportunities towards the benefit of those that already have significant resources, to the crippling detriment of vulnerable groups, and the alienated and impoverished masses is the chief culprit in our the fight against health injustices in this country. South Africa faces many structural challenges among which is the decades where ‘poverty within black communities is being mainstreamed thus making poverty a permanent feature and social determinant of health. Poor nutrition (malnutrition) and poverty in black communities is not only a health issue but also a social and economic construct of apartheid colonialism. On food security The decimation of food diversity and food security, destruction of the nutritional quality of foods, bad food production practices and proliferation of incorporated hazardous substances, compounded by the massive and sinister infiltration of health-destroying Genetically Modified Organisms and the increasing reliance of GMO crops in agriculture on extremely dangerous and environmentally destructive poisons in their growth and production. We are currently witnessing the beginning phases of the destruction of human health arising from these factors, and this rate of chronic disease prevalence will become explosive until the South African socio-economic systems collapse. Collapse of South African food growing systems and community-based farming, resulting in marginalised people being forced into a state of increasing poverty, food-insecurity, propelling them to consume hazardous commercial foods in a desperate effort to preserve life. This loss of food security is leading to rapid decline in national health status. Proliferation of scientifically proven problematic, dangerous and hazardous chemicals and substances throughout the growing, manufacture and production of food and food products, Pharma-drugs, vaccinations and synthetic vitamins, commercial products, “nutritional” products, construction industry materials, mining environment, and most “modern” socio-economic environments, which are causing the massive spike in a wide range of acute and chronic disease.
For all compounds, products and substances graded as Hazardous or Toxic, usage, application or inclusion must be prohibited. A legislation prohibiting production of these materials should be passed. This would apply to compounds and substances such as Mercury, Aluminium, Glyphosate, and 2,4D, and any other substances scheduled as dangerous to human and environmental health. The EFF will develop and research a comprehensive schedule will be developed into an operational dossier by the relevant department and will remain current and relevant with its research and selection systems. This Schedule will control and direct all substances and compounds which are used throughout the Food and Medical production, manufacturing, preparation and delivery systems, products and methods. Every manufacturer, grower and producer will comply with the stipulations relating to the substances and compounds detailed in the schedule. Alternative policy: Clean, safe environments, free from noxious chemicals and pollutants: Sound agricultural practices which minimize the usage of dangerous agri-chemicals, and the re-establishment of non-GMO organic (traditional) food growing as the national standard. For all compounds, products and substances graded and scheduled as GRAS (Generally Regarded as Safe), usage is not restricted and all products or formulations containing only these classifications are approved subject only to formal submission and accreditation of the formulation and constituents, and related disclosures to the EFF Central Licensing Authority. EFF’s Healthcare Policy and Transformation Perspective The overall national objective of the EFF public health policy is to create societal and environmental conditions in South African society so that the entire population can enjoy good health on equal terms. The speedy promulgation of the NHI into a Bill will create conditions for the universal access to basic, free and affordable healthcare system. EFF will ensure that the NHI is underpinned by:
EFF considers the unconditional discontinuation of 60 percent GDP share spent on private health sector that ostensibly serves only 16 percent of the population not just unfair, but unjust. In 2003/2004 financial year government officials reported the private health sector spent R43 billion on 6.9 million people while the public health sector spent R33.2 billion for 37.9 million people. It is only through halting the process of further privatization of public health facilities and for greater controls of already established private health sector that these imbalances in resource allocations; gross-inequalities and injustice can stop. Critique on National Health Insurance The proposed NHI, like ObamaCare, is hugely problematic under the current political and economic frameworks, as it creates platforms for uncontrolled fiscal drain through back-room deals with Pharma-drug companies, which operate outside of the laws of the country, and create for themselves a legal status of zero liability for any harm inflicted on the population, and zero accountability for the usefulness, safety or efficacy of any of their products or instituted methods. Health crisis: government in dilemma Any further delays in the implementation of NHI albeit with its current over-zealous with its set objectives, which remain unrealistic bold step is taken to dismantle fundamental structural deficiencies of the Health system. During the last two decades, government‘s budgets for health care have been marginally increasing but decreasing in real money. In addition, the biggest share of the budget is also focused on funding private healthcare sector. Most of government health budget go to urban areas especially cities for salaries and costs on low quality infrastructure maintenance, while the poor in the rural areas receives little (if any). Very few hospitals and healthcare facilities were built during the same period under government initiatives. Health care services are left in the hands of private sector beyond the reach and affordability of ordinary people. As a result, commercialization and commodification of health services has been viewed according to ability to pay and not according to the people’s needs. The risk of neo-colonial plundering of our National resources is massive, and the basic paradigms of the envisaged NHI have to diametrically change to reflect a minimum 50% focus on preventative health maintenance, which does NOT imply mass vaccination programmes, such as is being touted currently. Vaccinations contain problematic substances that lead to future health challenges, and the entire system of conferring immunity needs to be revisited and reinvented. There are viable homeopathic options at 10% of the cost of hypodermic vaccinations, with none of the hazardous side-effects of main-stream injectable products. Genuine disease prevention programmes can only validly be considered that incorporate sound access to increased nutritional substances in order to build strong immune systems. This is not achievable through pharma-drug interventions, and nor is it intended to be. Pharm-drug systems only profit from disease, not health, and therefore an impassable conflict of interest exists in calling on these same organisations to resolve or reduce endemic levels of disease in South Africa. Without a stringent policy of enforcing accountability, safety, efficacy and affordability, any future effort to implement an effective health-care system is likewise doomed to failure, and the national population remain victim of intentionally-manufactured debilitating diseases, and the economy and society will remain entrapped in a cycle of disease-creation, disease-maintenance and massive fiscal drain. Africa and South Africa cannot afford the financial burden of maintaining chronic diseases that are deviously and intentionally caused through the agricultural-food-pharma-drug (“healthcare”) transnational syndicates – this trap has been specifically designed since the 1960s by American cartels to economically enslave global nations, and they intend to perfect their strategies and implementation before 2020.
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