An HIV/Aids education billboard in South Africa's northernmost Limpopo Province. (Photo Courtesy Chris Kirchhoff/MediaClubSA)

Respected medical journal, the Lancet, has published a special series of articles assessing the challenges of the South African health system. HIV and Tuberculosis, plus a lack of progress in achieving the health-related MDGs are shown to be two of the biggest health threats in the country.

The Lancet South Africa edition consists of six critical articles written by South African health experts and what has emerged is that South Africa has "four colliding epidemics". Professor Salim Abdool Karim of the University of KwaZulu-Natal, is one of the authors.

"We're dealing with this cocktail of the four colliding epidemics: the epidemic of problems in maternal, newborn and child health where South Africa has 2 - 3 times greater levels of global burden, which is higher than the average for comparable countries. As far as non-communicable diseases are concerned, again, South Africa has a disproportionate part of the global burden. In HIV we have about 23 times the global burden of HIV and if you look at violence and injury, similarly, we have high levels of injury and homicide", said one of the authors, Professor Salim Abdool Karim of the University of KwaZulu-Natal.

In 2007, South Africa, with just 0.7% of the world's population accounted for 17% of the global HIV epidemic and one of the world's worst TB epidemics. The country is one of only 12 countries in the world that have seen child mortality increase since 1990, largely due to AIDS. No improvement has been made to reduce maternal mortality. Reducing HIV infections, maternal mortality and the deaths of children under the age of five are some of the United Nations' Millennium Development Goals, which South Africa is a signatory to. Health Minister Dr Aaron Motsoaledi, acknowledged that the country is far from reaching the goals that it aspires to.

"It is evident that all is not right with the health system and health outcomes in our country. All commentators on our health outcomes appear to agree that we will not be able to meet the Millennium Development Goals by 2015. I will not disagree with this analysis", he said.

But the inadequacies of the health system and deaths that occur as a result are due to "reasons that can be avoided", said Professor Jerry Coovadia, another author in the series of articles.

"Basically, clinical care is often poor. Administrative management is very often poor and the community should be able to demand that 'I don't want that quality of health service. I don't want rudeness and I don't want waiting. I want proper care for my kids'. That is missing from the community. Those are key avoidable causes of deaths and dysfunction in the health services", said Coovadia.

"Lack of managerial skills within health institutions; delayed response to quality improvement requirements; the inability of individuals to take responsibility for their actions; poor disciplinary procedures and corruption; significant problems in clinical areas related to training and poor attitudes of staff; inadequate staffing levels in all areas and a spending discrepancy between the public and the private health sectors are some of the issues bedeviling the health system", according to the report.

Health Minister, Dr Aaron Motsoaledi welcomed the Lancet South Africa edition and said he hoped that "it will provide practical solutions to some of the health challenges" the country is grappling with.