27 May 2004

Build a People's Health System:
People's Health Summit, East London
2 to 4 July 2004


  • Background
  • Details of the People's Health Summit
  • A Tale of Two Systems
  • Objectives of the People's Health Summit
  • International Solidarity
  • Agenda for the People's Health Summit

Background to the People's Health Summit

"I spent the whole day yesterday waiting at the clinic but I was sent home because my turn came too late, so I'm back today even earlier. Maybe someone will see me today, but I will have to come again tomorrow to the pharmacy. I expect to spend the whole week here. I have not been able to tell my work that I am sick yet."

"I came to the clinic at half-past three this morning. Because this is my first time at this clinic, I have to stand in a queue to get a card, then I have to join the main queue. I expect to be here the whole day."

These are the words of two patients in waiting rooms with hundreds of other people in public clinics in Cape Town. People wait from early in the morning so that they can be seen before the clinic closes in the afternoon. When they eventually get served, they are seen by a nurse, maybe a doctor, who is likely overworked, undertrained, underpaid, disillusioned and grumpy. If they receive a prescription, they then have to join a long queue for the pharmacy, or even come back the next day. Then instructions on how to use the medicines will be barked hastily to the patient. Often the pharmacy will not have the medicine. Often, the prescription will be for a sub-optimal treatment or paracetamol when something more relevant, such as fluconazole or acyclovir, is required. The situation is certainly not unique to Cape Town, which has some of the better public health facilities in the country. Everyday at almost every public clinic across the country, the same situation occurs.

Despite being a middle-income country, South Africa has health-indicators that are comparable to the world's least-developed countries. Life-expectancy is approximately 51 and will probably drop further in the next decade. The developing world average life-expectancy is over 64 (UNDP Human Development Report, 2003). In Khayelitsha, three public clinics (one could argue four) serve a population of about 500,000, but according to World Health Organisation standards, there should be ten clinics. To a large extent this is a legacy of Apartheid that has been exacerbated by the AIDS epidemic which would have been difficult to overcome even with the best efforts of government. But government has not committed sufficient resources or demonstrated sufficient political will to resolve South Africa's health crisis.

In May 1994, the ANC published A National Health Plan for South Africa. The report contained a noble vision for building a healthy country. It commited to the creation of a "single comprehensive, equitable and integrated National Health Service" (pg. 9) "All racial, ethnic, tribal and gender discrimination will be eradicated." (pg. 19) and "Health and health care like other social services, and particularly where they serve women and children, must not be allowed to suffer as a result of foreign debt or structural adjustment programmes" (pg. 19). Ten years later, this vision has faded; it must be recovered.

Details of the People's Health Summit

It is against this background that the TAC is co-hosting a People's Health Summit in East London from 2 to 4 July with nursing unions, SADNU and HOSPERSA, the Public Service Accountability Monitor (PSAM), the Eastern Cape Provincial Council of Churches (ECPCC) and the Rural Doctors Association of South Africa (RUDASA). The TAC hopes this conference will make a difference for two reasons: First, the delegates and speakers will primarily be nurses, doctors and public health system users who experience both its shortcomings and its positive qualities first-hand on a regular basis. Second, the purpose of the summit will be to mobilise an ongoing campaign driven by communities to address the problems of health-care in South Africa. Representatives from government, academia, labour, civil society, private medical care and business have also been invited to participate in the Summit. They have an essential role in resolving the crisis of South African health-care.

The antiretroviral treatment rollout, with its associated services (including VCT and a public education campaign) is the most important health intervention for reducing the impact of HIV. The rollout offers an opportunity to address many of the problems in the public health system and, if properly implemented, it will reduce the burden of disease on the system. But if the problems of underfunding, understaffing, overpricing of medicines by pharmaceutical companies, poor conditions of service for health-care workers, medicine shortages and derelict clinics are not addressed, the success of the rollout will be very limited. Therefore the TAC views the campaign for a People's Health Service as the logical continuation of our work of the last five years.

It is not coincidental that the summit is being held in the Eastern Cape. Indeed, it would be much more convenient and cheaper to hold the summit in Durban, Johannesburg or Cape Town. But the Eastern Cape has one of the most dysfunctional health systems in the country coupled with a civil service that is failing to deliver. Eastern Cape Health-care workers, patients and TAC members will comprise the bulk of the delegates. Testimonies from the frontline of the Eastern Cape health service will be heard and particular attention will be paid to addressing the problems of this province. Inequality in health-care expenditure, resources and facilities across provinces will also be examined at the summit.

A Tale of Two Systems

  • In 2001, there were approximately 7 million medical scheme beneficiaries, about 16% of the population. About 38 million South Africans either used the public health sector or paid for private health care out of pocket.

  • In 1997, per capita health care spending for medical aid beneficiaries was 4.5 times public sector users. In 2002/3, it was more than 7 times greater.

  • Number of active doctors in 1999: Private: 20,782; Public: 8,587

  • Number of active dentists in 1999: Private: 4,116; Public: 271

  • Number of pharmacists in 1999: Private: 8,891; Public: 1,011

  • Percentage of registered nurses and midwives in the public sector: approximately 66%

(Sources: South African Health Review 2002 and Human Resources for Health: A National Strategy, 1999)

Private sector users are increasingly paying more for fewer services. Anglo American's Clem Sunter, was quoted by ThisDay as saying at the recent Board of Health Care Funders' Annual General Meeting that private health-care in South Africa is exclusive and efficient. We agree with Sunter that it is exclusive, but it is also very inefficient. Certainly the experiences of the patients quoted at the top of this statement are not a feature of the private health care system. Waiting lists, where they exist, are short and world-class treatment is available for serious ailments, for those who can pay. But the private health-care system is characterised by over-servicing, excessively high medicine and theatre prices and perverse incentives. Receiving quality treatment for sexually transmitted infections and HIV in the private sector is a hit-and-miss affair with many doctors being insufficiently trained to deal appropriately with these diseases.

Objectives of the People's Health Summit

The People's Health Summit will focus on the following key issues:

  • Assess the antiretroviral treatment rollout;

  • Identify how to build greater involvement of communities with the delivery of health services, with emphasis on the antiretroviral rollout;

  • Ensure that national, provincial and local governments comply with their constitutional obligations to ensure that all people in South Africa have access to health care services that respect their autonomy and dignity;

  • Highlight the health inequities between the public and private sectors, between rural and urban areas, and between provinces; and

  • Examine the Eastern Cape's dysfunctional public health-care system.

International Solidarity

Poor, dysfunctional health systems are a problem throughout Southern Africa. We believe that all SADC countries can learn from each other's experiences. Furthermore, as the world becomes more globalised and labour becomes more mobile, the problems of health-care services throughout the region have become interlinked. Therefore, the TAC is inviting representatives from the Pan African Treatment Access Movement to participate in the summit. Speakers from international organisations, such as the World Health Organisation, have also been invited.

Draft Agenda for the People's Health Summit

Friday 2 July

13:00 - 17:30 Registration
Speeches by leaders focussing on the inequities and shortcomings of the South African health-care system, how they can be overcome and how voluntary counselling and testing coupled with the antiretroviral rollout can be used to improve the public health-care system. A presentation of a vision of a unified public and private health-care system will be made. Health-care workers and people with HIV will give testimony on their experiences. The evening will end with a memorial for people who have died of HIV/AIDS.

Saturday 3 July

Presentations by health-care workers and activists on the state of the antiretroviral rollout. Discussion on what needs to be done to improve the rollout and the tasks ahead for civil society, labour, business and government. Issues covered will include developing a nurse-driven rollout where the main service points for treatment are at primary health clinic level, the role of treatment literacy, need for better communication on the state of the programme, routine voluntary counselling and testing, improving registration speed for essential medicines and continued pharmaceutical company over-pricing.

11:30-11:45 Tea

Presentations by health-care workers and activists on the problems in the health system and what needs to be addressed. Particular focus on staff shortages and conditions of service in the public health system and how the private sector needs to be reformed, as well as how inequalities between provinces and urban and rural areas need to be addressed. Particular emphasis will be placed on the problems faced in the Eastern Cape.

13:00-14:00 Lunch


Delegates will break into commissions which will develop resolutions on the following issues:

  • Unfair Rationing: Attracting Health-Care Workers to the Public Health System: Addressing Conditions of Service
  • Private Sector: Reforming an Inefficient and Exclusive Service
  • Challenge of Workplace Programmes, Especially the Mines
  • Patient Preparation for Antiretroviral Treatment
  • Antiretrovirals for Children
  • Mobilising Communities for Antiretroviral Treatment and Making the Antiretroviral Rollout Work at Clinic Level
  • Antiretrovirals in the Developing World: Making 3 by 5 a Reality (Tea will be served during commissions)

(Dinner on 3 July is not part of the conference.)

20:00-22:00 Voluntary Informations Sessions Presented by Invited Organisations

Sunday 4 July

8:30 -11:00: RESOLUTIONS
Resolutions from commissions will be presented, discussed, debated and adopted.

11:00-11:30 Tea

11:30-12:30 CLOSING
Stirring presentations from well-known speakers on the need for sustained community activism to build better health care systems globally and the need for international solidarity.

(Lunch on 4 July is not part of the conference.)