With the Ronald McDonald socks aside…How serious is Cyril about South Africans’ health?

Hours after former President Jacob Zuma’s resignation, President Cyril Ramaphosa was pictured walking and jogging along the Sea Point promenade.

It wasn’t the first time he’d been spotted doing this.

In January, East Londoners saw him walking along the beach … in Ronald McDonald socks. And on Tuesday morning, the country’s new president arrived at the Gugulethu Sports Complex at 5:30 am in an ANC track suit to lead a brisk 6km group walk to Athlone.

On that day he told journalists he usually walks 10km each morning and wants to inspire South Africans to live healthier lives.

But is he as serious about health issues on a policy level as he is about his personal health?

We look at the three health promises Ramaphosa made in his State of the Nation address: were they followed through in the budget and how likely are they to materalise?


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1. Promise: 2-million more people on ARVs

What Ramaphosa said:

“This year, we will take the next critical steps to eliminate HIV from our midst. By scaling up our testing and treating campaign, we will initiate an additional two million people on antiretroviral treatment by December 2020.”

What is it about?

South Africa has the world’s largest HIV treatment programme. According to the national health department, about 60% — or 4.2-million of the country’s just over 7 million HIV-infected people — are on lifelong antiretroviral (ARV) treatment. Although the bulk of these people receive treatment via the state, about 300 000 collect their pills from the private sector.

Approximately 12.6% of South Africans are HIV positive, Stats SA’s 2017 mid-year estimates found.

Since the country’s national HIV treatment programme was rolled out in 2004, life expectancy has increased from 54.9 years in 2002 to 64 in 2017, Stats SA data show. Experts agree that ARVs can at least be partly credited for this. Aids deaths have also decreased significantly: from 254 883 (41% of the total deaths in the country) in 2002 to 125 755 (25.03% of total deaths) in 2017, according to Stats SA.

Studies have shown that ARVs don’t only allow people with HIV to live longer, but that, when used correctly, they drugs decrease the amount of HIV in someone’s blood to such a low level that it becomes impossible for infected people to transmit the virus to others.


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Therefore, the more HIV-positive people we put on ARVs, the slower the virus is likely to spread, provided that those on ARVs use their pills correctly.

In September 2016, South Africa adopted a “test and treat” policy where anyone who tests HIV positive qualifies for free antiretroviral treatment. The ideal for the country would be to have every HIV-infected person on ARVs. But for that to happen, everyone who has contracted the virus, would need to know that they are infected. And, in 2016, about a quarter of people with HIV in the country, didn’t know they were HIV positive, health department statistics show.

The United Nations has set goals known as the 90-90-90 targets for countries like South Africa. By 2020, 90% of people need to know their HIV status, of those diagnosed with HIV infection, 90% would need to be on antiretroviral treatment, and of those on treatment 90% need to be virologically suppressed (have virus levels low enough so that they can’t transmit HIV).

It’s within this context that the president’s promise of putting 2-million more people on ARVs fits.


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What did the 2018 budget speech say about it?

The finance minister’s budget speech didn’t refer to this, but the government’s “2018 estimates of national expenditure” document shows that the health department aims to have 6-million people on ARVs by 2020/2021, which is more or less 2-million more than the current number on ARVs in the state sector (3.9-million).

An additional R1-billion will be allocated to the HIV and Aids, tuberculosis, and maternal and child health programme in 2020/21 for “the comprehensive HIV, Aids and TB grant for provinces” to provide ARVs to an estimated 6-million people. As a result of the extra allocation in 2020/21, funding for the grant increases by 11.6% per year, with a total budget of R66.4-billion between 2017/18 and 2020/21.

Overall, government will be spending R205 billion on health in 2018/19 growing to R240 billion by 2020/21.

Provision has also been made to increase funding for community health workers, who play an important part in ensuring that people take their treatment correctly.


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