15 years after liberation from apartheid, South Africans are facing new challenges for which the highest calibre of leadership, vision, and commitment is needed. The country is facing a paradox of poor health outcomes despite high health expenditures and many supportive programmes. Many avoidable factors are identified which account for this contradiction. The impact of the unprecedented HIV/AIDS epidemic has been immense. Substantial increases in mortality and morbidity are threatening to overwhelm the health system and undermine the potential of SA to attain the Millennium Development Goals (MDGs). However, this Lancet Series has identified several examples of leadership and innovation that point towards a different future scenario. The authors discuss the type of vision, and priority actions needed to achieve such a change. The final paper is contributed to by all authors in the Series.
The authors give to call to action comprising a wide-ranging package of measures* which the South African Government should consider for implementation. Restating SA's commitment to attain the MDGs is highlighted as a good beginning. The authors say: "A concerted effort is especially needed to reduce the number of new HIV infections. The HIV/AIDS emergency, however, should not overshadow the urgency of taking bold steps to tackle alcohol consumption, or behaviours associated with the growing prevalence of non-communicable diseases."
Universities, training institutions, health councils, researchers, and civil society must all play their part. The authors say: "A continuing engagement across government is needed to tackle these broad social determinants of health and encourage all sectors to review their policies from a health perspective. Some important public policies and regulations can be directly enacted by the Ministry of Health, such as alcohol control, food safety and labelling, broadened scope of professional practice, and circumcision of men. But fundamental shifts are needed to form a macroeconomic policy that is focused on redistributive growth, which has been successfully implemented in diverse countries such as Brazil, Cuba, and Sweden, rather than on economic growth alone. Despite enthusiastic support from the international community and the abundance of resources compared with most other decolonising nations, progress in South Africa since the end of apartheid has faltered because of serious failures of leadership."
The authors conclude: "We still have time to change the health trajectory of the country, and even meet the MDGs. The South African Government, installed in April, 2009, has the mandate and potential to address the public health emergencies facing the country—will they do so or will another opportunity and many more lives be lost?"
Professor Hoosen Coovadia, Director:HIV Management,University of the Witwatersrand, Johannesburg; and Victor Daitz Professor of HIV/AIDS Research, University of Kwazulu-Natal, Durban, SA T) +27 31 261 8840 E) hcoovadia@rhru.co.za
Professor Salim S. Abdool Karim, Pro Vice-Chancellor (Research), University of KwaZulu-Natal and Director: CAPRISA - Centre for the AIDS Programme of Research in South Africa T) +27-31-2604550 E) karims1@ukzn.ac.za
Full paper 6: http://press.thelancet.com/saser6.pdf
Note to editors: *see panel 1, p85 and panel 2, p86 for more details
Journal
The Lancet