AIDS, Violence Burden Health Care in South Africa: Studies

South Africa's new government has the chance to turn around a public health system that has been plagued by poor leadership and management, according to a new series of articles in the Lancet medical journal.

The country's health care system is challenged by HIV/AIDS foremost, the articles said. About 17 percent of the global HIV/AIDS population lives in South Africa, and many of these patients are co-infected with TB, the authors said.

"Although South Africa is considered a middle-income country in terms of its economy, it has health outcomes that are worse than those in many lower-income countries," wrote South African doctors. "Failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies," researchers noted.

A lack of national coordination has led to health care disparities among South Africa's provinces. Western Cape had an 80 percent TB cure rate in 2007, compared to KwaZulu-Natal, where the rate was as low as 40 percent. The rate of death by violence in South Africa is five times the average for the world.

"Violence is profoundly gendered, with young men (ages 15-29 years) disproportionately engaged in violence both as victims and perpetrators," the researchers said. "Half the female victims of homicide are killed by their intimate male partners, and the country has an especially high rate of rape of women and girls."

"Both the private and public sectors are in trouble," said Health Minister Aaron Motsoaledi, who met with international experts on Monday, including some of the authors, to tackle the problems. "As government, we take responsibility of the mistakes, especially with regards to HIV/AIDS where wrong policies were adopted. However, some of the problems we have inherited from apartheid and colonialism."

The series was published Aug. 25 online ahead of print at the Lancet Web site: www.thelancet.com/journals/lancet/onlinefirst.

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