The life expectancy of South Africans has increased by six years since 2009, but recent health gains could be lost if the management of services is not improved.
This is according to an expert panel’s review of the state of South Africa’s health, published today (30 November) in the prestigious The Lancet journal.
Co-author Professor Salim Abdool Karim described the 10 percent increase in life expectancy from the age of 54 to 60 in three short years as “absolutely stunning”.
The main reason for the dramatic increase in life expectancy has been the massive expansion of the country’s HIV treatment programme, now reaching around 1.8 million people.
“Three years ago, we had a doom-and-gloom situation where all our data showed we were moving in the wrong direction. This increase in life expectancy, in which each of the over fifty million people will live an extra six years on average, will be of amazing benefit to society,” said Professor Abdool Karim, vice-chancellor of the University of KwaZulu-Natal and head of the Centre for the AIDS Programme of Research in South Africa.
The same expert panel led a comprehensive examination of health care in South Africa in 2009, which was also published in The Lancet. It concluded that “leadership, accountability and investment” was needed to address “four colliding epidemics”: HIV and TB; chronic diseases, high maternal and child mortality, and violence and injury-related deaths.
Today’s review praises the “effective leadership” of Health Minister Dr Aaron Motsoaledi and his senior staff for “radical policy changes”, particularly in HIV management.
By 2010, virtually all pregnant women were tested for HIV and 85 percent of all health facilities provided prevention of mother-to-child HIV transmission programmes. This has led to a dramatic drop in babies being born with HIV, from some 30% ten years ago to a mere 2.7 percent last year.
But the review warns that the health bureaucracy has been “slow to change”. Abdool Karim said the country was at a “tipping point”, and that human resource weaknesses in the health sector could “make the country slide back from recent gains”.
“Reports of antiretroviral drug stock-outs in provinces are very concerning because they could lead to large numbers of patients stopping their medicines, resulting in drug-resistant HIV,” said Abdool Karim. “We have already walked that road with TB, where we have seen the emergence of extensively drug-resistant TB, which has a very high mortality rate.”
In 2010, the country had the third highest number of patients with multi-drug-resistant TB in the world (5 402 patients), according to the review.
While there has been little change in the death rate for chronic diseases, government had recently committed itself to new targets, including less salt and alcohol consumption, which should see a reduction in these deaths.
Homicides, traffic deaths and injury-related violence have all fallen in the past decade. But the review notes that there have been few “infrastructural responses to prioritise injury prevention issues such as inter-personal violence, violence against women and girls, male youth violence, child and youth safety and traffic safety”.
However, government is paying more attention to gun control, alcohol and drug abuse, which are significant factors in interpersonal violence and traffic accidents.
“Undeniably, much remains to be done to improve the health and living conditions of large sections of the population. However, for the first time in two decades, this progress instils a basis for hope,” said Professor Bongani Mayosi of the University of Cape Town, who headed the review group.
Other authors were Dr Joy Lawn, Dr Ashley van Niekerk, Dr Debbie Bradshaw and Professor Hoosen Coovadia.