What now, South Africa?

Abstract

In Cape Town, South Africa, over 400 delegates at the Countdown to 2015 conference about Millennium Development Goals 4 and 5 (maternal, newborn, and child survival, together with reproductive health) were treated to a warm address by Gertrude Mongella, president of the Pan-African Parliament. “We have done something, but we could do more—that is my message”, she said. By stark contrast, Mantombazana Tshabalala-Msimang, minister of health for South Africa, seemed to challenge the experts by dismissing their findings in the Countdown report 2008 as flawed. She claimed that the figures largely ignored the contribution of social determinants of health, and asserted that the 1990 baseline data, gathered during apartheid, were unsound because they excluded the indigenous population. But she provided no evidence to back up her assertions. Indeed, she tacitly acknowledged failings of South Africa's health system by raising the issue of developed countries' recruitment of skilled health workers—the very ones who would have provided care for mothers and their children, she said. Yet South Africa is well above the Countdown benchmark for such personnel. She followed with statements of success—increased spending on health (from R264 million in 2001–02 to R2 billion in 2007–08), a reduction in HIV infection in pregnant women who visit health facilities, 408 000 people on antiretrovirals, and an average immunisation rate of 85%. What she failed to do was openly concede failures, address the concerns set out in the Countdown report, or look for ways to improve health care for women and children. There were few signs of commitment to take action, other than to mention a need to strengthen health systems. How is she proposing to do this? She could follow Tanzania's example by committing about US$11 per head of population to health and to develop systems essential to the continuum of care. South Africa, of all African countries, is in the best position to devote more funds to its health programmes. What is lacking is political will. What is needed is less defensiveness and more action. South Africa should be looking forward, not back.