Submission to the South African Human Rights Commission enquiry into access to health care services
This submission argues that there is a growing crisis of disease and ill health in South Africa that not only undermines the quality of life of millions of individuals, but also crucial programmes aimed at the reconstruction and development of the country. Much of this crisis could have been avoided. It results, in large part, from the failure of government to recognize the link between fundamental rights to dignity, equality and autonomy and the state’s constitutional obligations in respect of the right to have access to health care services.
In addition, government has on several key occasions failed to consider the implications of its economic policy for the right to health. The starkest example of this was the Growth, Employment and Redistribution (GEAR) strategy, which, at a critical point, led to a period of decreasing real per capita health expenditure. According to the DoH itself, real per capita expenditure declined from R928 in 1997/98 to R894 in 2000/2001 (in 2002 prices). We intend to lead evidence during the public hearings on what has actually occurred from this period.
This decrease caused significant damage to the DoH’s capacity to deliver quality health care. It also increased the dependence of those with some money on private health care, adding to inequalities. These errors are now being compounded: by a policy of contracting-in private sector “expertise” to manage aspects of the public sector, as well as moves to shift low-income earners from the public to the private health sectors. These measures exacerbate rather than address the underlying problems. The submission argues that rights violations lie at the heart of the problem – and that recognition and the discharging of the state’s positive duties in respect of health care access are central to the solution. To illustrate this argument the submission:
- briefly summarises some of the empirical information that has been gathered about health in South Africa;
- argues that an analysis of the relevant data, statistics, laws and court decisions will lead the SAHRC to concluding that defining the essential package of health services to all people in South Africa are – by law – entitled is both long overdue and urgent;
- concludes that only by engaging in such a process would it be possible to cost the health service accurately;
- argues that government has consistently and deliberately avoided developing and implementing a methodology for calculating the needs of the public health system – and that consequently public health care is chronically under-funded, resulting in government’s own policy framework and major objectives for health being undermined;
- unpacks the implications of the right of access to medicines – an integral aspect of the right to have access to health care services – for the review, development and implementation of the National Drug Policy and as an example of the level of national government planning, stewardship and service delivery demanded by the Constitution;
- draws attention to the poor governance of our health system and recommends that a range of health officials be subpoenaed by the SAHRC to account publicly at its hearings; and
- considers how the health sector should be regulated appropriately.