Review NSP on the state of health in South Africa incorporating the Edition #4 – December 2017 A STATE of capture Why state capture is a fundamental health issue in SA +A worrying Global Aids & TB response + Spotlight on the eastern cape+ TB realities + Prep in South Africa In this issue THE STATE OF OUR RESPONSE FUNDING BY FAITH BROKEN BONES, BROKEN STATE Contents GLOBAL HIV & TB RESPONSE The state of the global HIV and TB response in December 2017 ...................................... www.spotlightnsp.co.za STATE CAPTURE Another World AIDS Day. What MARK HEYWOOD, SECTION27 @SpotlightNSP is the state of affairs in 2017? State capture threatens the right to health .......................................................... Spotlight nsp We ask a group of people who PEPFAR FALLOUT are at the coal face in different The news tells us that UFRIEDA HO, SPOTLIGHT guises, for their take on the Published jointly by the Treatment money for HIV is scarce and Funding by faith ................................................................................... response or non-response. 2 Action Campaign and SECTION27 diminishing. While many Burden of the generations Review Editors: Marcus Low & Anso Thom. Page 2 of these conversations SPOTLIGHT ON MECS FOR HEALTH: FREE STATE The Free State health system ......................................................................... NSP happen in boardrooms, the UFRIEDA HO, SPOTLIGHT Journalists: Ufrieda Ho, Ntiski Mpulo. is broken and people are 7 communities are the ones Heading for the rocks? ............................................................................. Photographers: Ntsiki Mpulo, Thom suffering and dying. In who face the brunt of it. We Pierce, Ufrieda Ho, Roger Sedres. this issue we revisit the FREE STATE HEALTH visit one in our backyard. Contributors: Mark Heywood, ReGenesis scandal with ANSO THOM, SPOTLIGHT 13 Broken bones, broken state Ufrieda Ho, Lotti Rutter, Nora Mathe, Page 13 an update and turn the 17 SPOTLIGHT ON THE Estimated epidemiological burden of TB in 2016 for 30 high TB burden countries, WHO regions and Ngqabutho Nceku Mpofu, Marije globally. Numbers in thousana ds. KWAZULU-NATAL HEALTH EASTERN CAPE spotlight on the dire state of ........................................................................ Versteeg-Mojanaga, Elin Hem Stenersen, POPULATION HIV-NEGATIVE TB MORTALITY HIV-POSITIVE TB MORTALITY INCIDENCE HIV-POSITIVE TB INCIDENCE the state of health in South Africa LOTTI RUTTER & NORA MATHE, TREATMENT ACTION CAMPAIGN incorporating the the orthopaedic services. Edition #16 – December 2016 BEST UNCERTAINTY BEST UNCERTAINTY BEST UNCERTAINTY BEST UNCERTAINTY Ntsiki Mpulo, Thuthukile Mbata, Professor ESTIMATE INTERVAL ESTIMATE INTERVAL ESTIMATE INTERVAL ESTIMATE INTERVAL Hospital horrors Angola 29 000 18 Page10–29 216.9 3.4–12 107 66–156 18 8.5–30 19 Quarraisha Abdool Karim, Nomnotho Bangladesh 163 000 66 43–94 0.18 0.09–0.30 360 262–474 0.50 0.25–0.84 ................................................................................... Ntsele, Vuyokazi Gonyela, Luvo Nelani, MOMENT OFBrazil 208 000 5.4 4.9–5.9 1.9 1.4–2.4 87 74–100 11 9.1–13 LIFE ESIDIMENI ARBITRATION TRUTH IN TBCambodia 16 000 3.2 2.1–4.4 0.45 0.29–0.66 54 35–78 1.3 0.85–1.9 NGQABUTHO NCEKU MPOFU, SECTION27 Zain Rizvi. & Joyrene Kramer. Central African Republic 5 000 2.7 1.5–4.2 2.5 1.3–4.0 19 12–27 6.2 3.3–9.9 143+ and counting? ............................................................................... China 1 404 000 50 34–70 1.8 0.7–3.4 895 766–1 030 11 6.9–15 21 Design: Karien van der Westhuizen, the Congo 5 000 3.1 1.7–4.8 2.1 1.1–3.4 19 12–28 5.1 2.6–8.4 earth is round DPR Korea 25 000 11 6.8–16 MILLIONS0.05 0.02–0.09 1OF30 113–148 0.28 0.14–0.46 EASTERN CAPE HEALTH DR Congo 79 000 53 31–80 8.5 4.0–15 254 165–363 20 13–29 MARIJE VERSTEEG-MOJANAGA, RURAL HEALTH ADVOCACY PROJECT Proofreading: Dave Buchanan. Ethiopia 102 000 26 16–37 TB4. 0 DEATHS2.7–5.4 182 128–245 14 9.6–19 c India 1 324 000 423 324–534 12 6.6–19 2 790 1 44 0–4 570 87 56–125 Priority-setting, social justice and human rights in the Eastern Cape ................................ Indonesia 261 000 110 75–152 13 6.2–23 1 020 660–1 460 45 21–78 25 Cover image: South Africans march on ELIN HEM STENERSEN, VOLUNTEER PHYSIOTHERAPIST, CANZIBE HOSPITAL Kenya 48 000 29 16–45 24 14–36 169 103–250 53 32–79 parliament in April 2017 to protest state Lesotho 2 000 1.1 0.56–1.8 5.2 3.3–7.7 16 10–23 12 7.3–17 Fifteen years without a wheelchair – who pays? .................................................... Liberia 5 000 2.8 1.6–4.2 0.96 0.60–1.4 14 9.2–20 2.2 1.4–3.2 capture and corruption. Story on page 7. Mozambique 29 000 22 13–33 33 20–48 159 103–227 72 46–104 NTSIKI MPULO, SECTION27 Myanmar 53 000 25 16–35 4.9 3.5–6.6 191 141–249 18 13–24 Two steps forward, three steps back 29 Namibia 2 000 0.75 0.48–1.1 0.87 0.61–1.2 11 8.5–14 4.2 2.7–6.0 Spotlight Nigeria 186 000 115 67–176 39 23–58 407 266–579 63 40–93 Lifesaving programme under threat support of isthe produced South African with the Pakistan 193 000 44 34–55 2.1 0.98–3.6 518 335–741 6.9 3.2–12 Philani Clinic – A timeline of failure ................................................................. Papua New Guinea 8 000 3.6 2.4–50 0.82 0.45–1.3 35 28–42 3.6 2.0–5.5 ............................................................... Development Fund. This province is always on Philippines 103 000 22 22–22 0.30 <0.01–2.6 573 321–895 6.0 2.5–11 35 Russian Federation 144 000 12 11–12 1.7 0.85–2.7 94 61–135 18 12–26 PrEP ............................................................... our radar. We reveal that all Sierra Leone 7 000 3.4 2.0–5.2 1.0 0.66–1.5 22 14–32 3.1 2.0–4.5 THUTHUKILE MBATHA, SECTION27 South Africa 56 000 23 17–29 101 67–142 438 304–595 258 176–355 EDITORIAL INDEPENDENCE is not well and below the Thailand 69 000 8.6 7.2–10 3.9 2.3–5.9 119 70–180 10 6.1–16 The state of PrEP access in SA 38 UR Tanzania 56 000 28 13–50 27 12–46 160 75–275 54 35–78 The opinions expressed in Spotlight do breathtaking natural beauty PROFESSOR QUARRAISHA ABDOOL KARIM, CAPRISA A high level ministerial Viet Nam 95 000 13 8.4–18 0.85 0.63–1.1 126 103–151 4.2 3.4–5.1 Zambia 17 000 4.8 2.8–7.3 12 7.9–18 62 40–89 36 23–52 41 not always reflect the views of TAC or there is a story of collapse and Age, gender and cycles of transmission ...................................................................... meeting took place in Moscow Zimbabwe 16 000 1.2 0.71–1.7 4.4 3.0–6.1 34 24–44 23 15–32 SECTION27. suffering and empty promises. High TB burden countries 4 710 000 1 130 998–1 270 317 268–369 9 060 7 450–10 800 866 755–986 43 where the delegates focused THUTHUKILE MBATHA, SECTION27 Africa 1 020 000 417 351–488 320 272–372 2 590 2 310–2 900 764 660–876 PrEP in higher-education institutions 44 Page 32 on TB and what needs to be The Americas 996 000 17 16–18 6.2 5.6–6.9 274 255–294 30 28–33 Eastern MediterranWeean unpack669 000 8 2the 69findings,–95 3.0 1 .8–4.5 766 573–985 9.9 5.9–15 NOMNOTHO NTSELE, STUDENT done to turn the tide. Read Europe 916 000 26 25–27 5.1 3.9–6.4 290 251–333 34 26–42 Why I take PrEP South-East Asia the numbers,1 950 000 652 from542–772 the35 25–46 4 670 3 190–6 440 163 120–211 Western Pacific 1 890 000 103 85–123 5.0 3.0–7.3 1 800 1 500–2 130 29 23–36 .............................................................. this report from the frontline. .................................................................................... GLOBAL latest7 4WHO40 000 1 3TB00 1report. 160–1 440 37 4It is32 5–427 10 400 8 770–12 200 1 030 915–1 150 SPOTLIGHT ON TB 47 Page 52 a Numbers shown to two significant figures if under 100 and to three significant figures otherwise. b a report that reveals that MARCUS LOW, SPOTLIGHT spotlight Deaths among HIV-positive TB cases are classified as HIV deaths according to ICD-10. c Estimatestoo of TB inc idmanyence and morta litpeopley for India are inter imare in natur estill, pending results from the national TB prevalence survey plann ed for 2018/2019. Moment of truth for global TB response ............................................................ dying of TB worldwide, and Who funds TB research?. The Treatment Action Campaign (TAC) specifically in South Africa. 1.7 million TB deaths in 2016 ....................................................................... 49 advocates for increased access to treatment, care and support services for Page 56 AIDS COUNCILS 50 people living with HIV, and campaigns to reduce new HIV infections. Learn more VUYOKAZI GONYELA, SECTION27 Let’s make AIDS councils work about the TAC’s work at www.tac.org.za. INTELLECTUAL PROPERTY 52 LUVO NELANI & ZAIN RIZVI, SECTION27 ..................................................................... 54 @TAC Overdue IP reform process crucial for healthcare in South Africa 56 58 ..................................