Human Rights Approach Key to Fixing Health Care
BYLINE: Molefi Sefularo
In 2006, President Thabo Mbeki awarded Dr Ivan Toms the Order of the Baobab in recognition of his "outstanding contribution to the struggle against apartheid and sexual discrimination".
Part of the citation read: "Toms is a remarkable individual who has always had the courage of his convictions. He could easily have lived the life of privilege and comfort, but opted instead to reflect the realities of the country and to take a bold stand against the injustices he witnessed."
Toms observed what went on around him, applied the human rights value test and decided that as far as health and human rights were concerned, he could not remain clinically detached from the condition of his fellow human beings.
He was driven by the struggle for human rights, which he regarded as a condition for the attainment of true health for the downtrodden masses of South Africa.
Across the country, many who shared Toms's dream of a people's health service worked hard to introduce primary health care principles, policies, values and laws into the South African health system. Well before they were formally known as such, we pursued what are now universally recognised as Millennium Development Goals, colloquially known as the MDGs.
With MDG 1, which calls for the eradication of extreme poverty and hunger, we managed to reduce the number of children under five with severe malnutrition from 88 971 in 2001 to 30 082 in 2005.
My sense is that this progress was a result of many interventions beyond the health sector. Among others, the improvement in social security grants, which include the child support grant, would have improved the ability of families to access food and nutrition at household level.
With MDG 4, which calls for the reduction of under-five child mortality by two thirds between 1990 and 2015, there was a slight decrease from 59.4 to 57.6 between 1998 and 2005, a modest promise towards the goal of the national target of 20 in 1 000 live births.
Our performance on the MDG 5, which calls on nations and governments to reduce by three quarters the maternal mortality ratio between 1990 and 2015, turned out to be a huge disappointment, a harbinger of other major failures in the ability of the South African health system to protect women against preventable pregnancy-related death. Instead of decreasing, the maternal mortality ratio increased from 81 in 1997 to 147 in 2004.
What went wrong?
What happened to Toms's dream of a people's health?
How is it possible that we can see this tragic and scandalous state of the health of the nation?
My own proposition is that our failure to make the expected progress towards the Millennium Development Goals is mainly because of our collective failure to pursue seriously the right to health within the framework of the Bill of Rights as given in chapter two of the constitution.
More specifically, we have failed to fight fully for and protect the right to health care, food, water and social security.
Alongside the post-liberation conspicuous consumption of the new elite, we see an increasing number of women dying in pregnancy or during or after giving birth.
As we described the problem of tuberculosis in South Africa in 1981, the problem we are confronted with is "consumption in the land of plenty".
In addition to the national failure to make the expected progress towards the Millennium Development Goals that are so critical to the fight against disease, disability or premature death, we have seen a prolonged period of strife and work avoidance over HIV and Aids in our country.
In this unfortunate period in the history of our young nation, we saw acute tragedies like the death of children from klebsiella in the neonatal unit of the Pelonomi Hospital in Mangaung, Free State, failed incubators in Frere Hospital, East London, and acute gastro-intestinal infection in the Eastern Cape's Ukahlamba District. …