19 April 2013

South Africa: Address By Cosatu General Secretary, Zwelinzima Vavi, At TAC Congress

press release

I bring you revolutionary greetings from 2.2 million members of COSATU. You are holding this important congress in the year when your organisation will be celebrating 15 years of existence, 15 years in the trenches with COSATU and other progressive formations to battle for transformation of the health sector to serve the majority our people.

In particular you have been in the forefront of the campaign against the scourge of HIV and AIDS which is devouring mainly working class families, and leaving many children orphaned and destitute. You have fought the powerful, both in the state and the private sector, and you have won.

You used a combination of mass mobilisation and the courts to force government to fulfil its responsibilities to honour HIV-positive pregnant mothers’ right to get drugs to prevent mother-to-child-transmission.

But when government was doing the right thing, challenging pharmaceutical companies to make HIV drugs access, you supported, it in a show of principle - providing support where necessary and criticising where things were going wrong. You did not despair in your struggle for the right to treatment for HIV-positive people despite being labelled "running dogs of big pharmaceutical companies" by Matthias Rath who promoted his nutritional products and rubbished ARVs as being toxic.

Through your campaign, which was supported by COSATU and other progressive formations, AIDS-denialism in the country became history. Government is rolling out ARVs massively and children born from HIV-positive parents are given a second chance. When you celebrate your 15 years of existence, you will be counting as one of your victories the rolling out of a Fixed Dose Combination antiretroviral pill that combines 3 drugs into one, launched recently by Comrade Minister Aaron Motswaledi.

Government has decided to build a state-owned pharmaceutical company to manufacture ARV ingredients. Although we have issues about the state equity in the proposed company, this is certainly a step in the right direction.

Government has designated some pharmaceutical products for local procurement, to build the pharmaceutical sector in the country. In the process, the struggle for quality health care is also supporting efforts for industrialisation and the creation of decent work.

The national HIV prevalence amongst 15-49 years pregnant women attending their first antenatal care in the clinics in South Africa dropped by 0.7% to 29.5% in 2011 from the 2010 figure. Despite tremendous progress being made to improve the quality of health care provision and to stem the tide of HIV infections, there are still huge challenges. The national HIV prevalence among general adult population aged 15-49, was still high in 2011, at about 17% since 2005. Furthermore, there about 5.6m South Africans were HIV positive and the estimated number of new infections was 1.43% in 2011 compared to 1.63% in 2008.

Recent statistics from Statistics South Africa on mortality in 2010 reveal that TB remains the number one cause of deaths in the country, followed by influenza and pneumonia. HIV is number seven. But we know that TB and pneumonia are opportunistic infections linked to HIV. While the report shows that deaths due to TB, influenza and pneumonia decreased by 10% or more between 2009 and 2010, the number of deaths due to HIV diseases increased by 3.0% between 2009 and 2010.

COSATU held its successful 11th National Congress in September 2012 where we analysed our socioeconomic progress since the 1994 democratic breakthrough. Our analysis was based on the demands of the Freedom Charter. On health it states that "A preventive health scheme shall be run by the state; free medical care and hospitalisation shall be provided for all, with special care for mothers and young children".

The RDP calls for the creation of single national health system, driven by the primary health care approach. Furthermore, the entire health system is supposed to be located within the context of rising standards of living through improved wages and income-earning opportunities, improved sanitation, water supply, energy sources, and accommodation. All these provisions ensure that material conditions exist to shift the national health system from the catastrophically expensive curative mode to the preventive mode.

In 2010 we reported that maternal mortality had increased between 1997 and 2005 from 81 per 100,000 to 600, yet the Millennium Development Goal target is 38! Child mortality has been on the decline, but remains high at 68 per 1000 live births. Yet a comparable country, Brazil, has reduced this figure from 58 in 1990 to 22 in 2007. There are 1000 AIDS-related deaths per day (and another 1,450 people becoming HIV infected each day). 70% of the case load in the public health system is now taken up by HIV/AIDS cases, which reduces the capacity to treat other medical conditions. Moreover, while we seem unable to treat more than half the 800 000 needing ARV treatment - people already HIV infected who will reach full-blown AIDS - that number is going to rise to 5.5 million within five years.

South Africa is one of the 22 ‘High Burden Countries’ that contribute approximately 80% of the global burden of all TB cases, the seventh highest TB incidence in the world. Unfortunately the incidence of TB has increased during the past ten years, parallel to the increase in the estimated prevalence of HIV in the adult population. This has resulted in an increasing recognition of the problems posed to public health by TB. Generally TB control is facing major challenges. Co-infection with Mycobacterium Tuberculosis and HIV (TB/HIV), and multi-drug-resistant (MDR) and extensively drug resistant (XDR) tuberculosis in all regions, make prevention and control activities more complex and demanding.

In terms of health insurance, almost 25% of South African households have at least one member who belongs to a medical aid, only 17% of individuals have medical aid coverage and 90% of households do not belong to a medical aid scheme because they do not have money to pay for it. Only 9% of the African population belong to a medical aid scheme whilst 74% of the white population do. This reflects in the imbalance in terms of life expectancy. A white person born in 2009 expects to live for 71 years, whereas an African born in the same year expects to live for 48 years. This means that white people expect to live 23 years more than Africans. These facts had not changed by 2011.

At an institutional level, we reported that there is a disconnection between national policy and the allocation of resources. Management information systems are insufficient for decision-making, and decision-making powers are generally incorrectly located (a hospital CEO doesn’t meaningfully control staff, budget or procurement). Furthermore, there is under-regulation of the private health sector and over-concentration of resources in the hands of the private healthcare providers.

An important policy development in the health sector is the Department of Health’s 10-Point Plan, which COSATU welcomed and supported. One of our proposals is for government to regulate the private healthcare sector. Government has since moved in this direction to initiate a process to review the fees that are charged in private healthcare facilities and by private healthcare practitioners and has moved to initiate a process to review the pricing of medicines.

The most encouraging part on healthcare is the implementation of the NHI, which is now in a pilot stage. In conclusion, as a tribute to the work TAC and other NGOs are doing in the struggle to create a better life for our people, I want to quote what I said to the 13th SACP Congress about you:

"The vast majority of organisations that have gained footholds in townships and villages across the country are a reflection of the fact that the neoliberal onslaught has not gone unchallenged. These organisations that are engaged in mass struggles, through marches, on various issues such as unemployment, housing, water, sanitation and education, health, HIV/AIDS, domestic violence including rape cannot be dismissed as imperialist inventions that seek to muscle the ANC government out of power. It is not the Free Market Foundation or AfriForum that are engaged in popular mobilisation around the demands of the Freedom Charter. These organisations that COSATU passionately works with are engaged in popular mobilisation around the demands of the Freedom Charter.

"These are organisations that challenge the state’s blatant and murderous refusal to grant people living with AIDS the crucial treatment to prolong their lives. These are organisations that recently exposed a calamity where our children in Limpopo had no textbooks for six months. Many of these movements are soundboards for the working class’ frustrations with a commodified citizenship where access to basic needs is meditated through the market and money. Many of these organisations constitute bulwarks against state privatisation in the fields of education, health and education. Many are also symbol of the disenchantment of the poor and their patience with a slim state, which allows capital to trample on their chests without any genuine intervention. Many of these organisations are not in a war to save a minority from what liberals call a Tyranny of the Majority; they are instead in battlefields to annihilate the Tyranny of the Market".

I wish you a fruitful congress.

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