THE health ministry is pushing for the national health budget to be ring-fenced and is looking at the establishment of South African National Aids Council-type implementation bodies that function separately from the department and have oversight over all the role players.
Deputy Minister Molefi Sefularo also invited delegates at the tuberculosis meeting in Cape Town yesterday to think about how the health department could harness the expertise situated in many government-funded bodies such at the Medical Research Council, to address the health burden in South Africa.
Answering questions from the media, Sefularo said the Ukukuhlamba incident where children died after drinking contaminated tap water and receiving sub-optimal health care was an example of the "awkwardness where a subsidiary of government failed and the same department is called on to investigate the circumstances".
He said Sanac was a good example of a body that represented all the stakeholders and oversaw everybody "driving them towards a mandate to deliver".
Sefularo said the current Standards Office, which is situated in the department and responsible for, among others, the monitory of patient safety and quality of services was almost defunct and completely under-resourced.
He said that by ring fencing the health budget, there was a hope that "we would among others get more money for Aids and less Aids for the money".
He said there had been problems created by the system of "fiscal federalism" whereby the national government determines policy and it is left up to the provinces to determine how many resources they commit to a particular programme.
This has seen the TB control programme not receiving the priority it should in many provinces.
Sefularo was not prepared to commit to specific timelines, but said they wanted to see the ring fencing happening by the next budget cycle.
Responding to a presentation by Kevin de Cock of the Centres for Disease Control in Kenya, that serious research needed to go into the model of testing everyone for HIV and treating them with high-active antiretroviral therapy on diagnosis as a means of prevention, Sefularo said he was "broadly in support".
He said Health Minister Aaron Motsoaledi was on a fundraising drive with the goal to initiate people living with HIV onto ARVs at a much earlier cut-off than the current CD4 count of 200. Also, the ministry wanted to see HIV testing introduced as standard practice at all TB sites and TB testing at all HIV sites.
In a frank assessment of government's TB programme, Sefularo acknowledged that there had been very little progress with low treatment success rates, high default rates and death rates. He warned that the country was in danger of not meeting the millennium development goals as a result of these poor outcomes.
Sefularo said he felt "anxious and concerned" on learning that TB was the number one cause of death in eight of the nine provinces with 13 out of every 100 people in South Africa dying of the disease.
Under former health minister Manto Tshabalala-Msimang and her director-general Thami Mseleku, the health department resisted attempts to treat multidrug-resistant TB patients in community settings or to integrate HIV and TB services.
Yesterday Sefularo stated unequivocally that the two services had to be integrated and that they were preparing final guidelines, which rethink the current policy of hospitalising all MDR TB patients.
Research has shown that many TB infections are happening in the healthcare settings - with healthcare workers and people living with HIV at high risk. - Health-e News