VZCZCXRO4519
RR RUEHDU RUEHJO RUEHMR
DE RUEHSA #0990/01 0690759
ZNR UUUUU ZZH
R 100759Z MAR 06
FM AMEMBASSY PRETORIA
TO RUEHC/SECSTATE WASHDC 2102
INFO RUCNSAD/SOUTHERN AFRICAN DEVELOPMENT COMMUNITY
RUCPDC/DEPT OF COMMERCE WASHDC
RUEATRS/DEPT OF TREASURY WASHDC
RUEAUSA/DEPT OF HHS WASHDC
RUEHPH/CDC ATLANTA GA 1054

UNCLAS SECTION 01 OF 04 PRETORIA 000990 
 
SIPDIS 
 
SIPDIS 
 
DEPT FOR AF/S; AF/EPS; AF/EPS/SDRIANO 
DEPT FOR S/OFFICE OF GLOBAL AIDS COORDINATOR 
STATE PLEASE PASS TO USAID FOR GLOBAL BUREAU KHILL 
USAID ALSO FOR GH/OHA/CCARRINO AND RROGERS, AFR/SD/DOTT 
ALSO FOR AA/EGAT SIMMONS, AA/DCHA WINTER 
HHS FOR THE OFFICE OF THE SECRETARY/WSTEIGER, NIH/HFRANCIS 
CDC FOR SBLOUNT AND DBIRX 
 
E.O.  12958: N/A 
TAGS: ECON KHIV SOCI TBIO EAID SF
SUBJECT:  SOUTH AFRICA PUBLIC HEALTH MARCH 10 2006 ISSUE 
 
Summary 
------- 
 
¶1.  Summary.  Every two weeks, Embassy Pretoria publishes a 
public health newsletter highlighting South African health 
issues based on press reports and studies of South African 
researchers.  Comments and analysis do not necessarily reflect 
the opinion of the U.S. Government.  Topics of this week's 
newsletter cover:  SA's Aid to Orphans; Health Department Cites 
HIV/AIDS Progress in South Africa; Health Department Plans to 
Improve HIV Data; South Africa's Contribution to UN AIDS 
Report; South Africa Silent on HIV/AIDS Airline Tax; Findings 
from the District Health Barometer; Health Inequalities between 
Khayelitsha and Cape Town Still Present; South Africa to 
Develop Vaccine Manufacturing Facility; and Firms Begin to Feel 
HIV/AIDS Impacts on Work Force.  End Summary. 
 
SA's Aid to Orphans 
------------------- 
 
¶2.  A Human Sciences Research Council (HSRC) report, "A 
situational analysis of orphans and vulnerable children (OVC) 
in four districts of South Africa" details the South African 
governmental policies aimed at vulnerable children.  The four- 
year study concentrated on the Free State and North West 
provinces, which have high HIV/AIDS prevalence rates. 
Insufficient capacity and inadequate resources are two of the 
most crucial challenges faced by the government dealing with an 
increasing number of OVC and high levels of poverty, said 
Donald Skinner, one of the authors of the HSRC study.  The 
foster care grant is currently $100 (R590) a month and is 
important to families (often grandparents) taking care of OVC 
who have no other source of income.  Foster parents or 
guardians can also apply for other grants such as care 
dependency and child support which amount to about $30 each. 
According to Selwyn Jehoma, acting Deputy Director-General of 
Social Security in the Department of Social Development, 
governmental strategies to increase the number of social 
workers and allow OVC in foster care to access grants have 
increased coverage.  The government adopted a policy to retain 
and recruit social workers by offering them higher salaries to 
address the problem of capacity.  All nine provinces are 
expected to almost double the number of social workers over the 
next two years.  In addition, by making it easier to access 
foster care grants, the foster care applicants have increased. 
In 2002, 150,000 children were registered under foster care, 
300,000 are currently registered.  The HSRC report points out 
that the government has begun a national action plan where fast 
track delivery of services is emphasized.  Government will 
focus on services such as access to birth certificates and 
identity documents, access to grants, protection from abuse and 
neglect as well as provision of psychosocial support and the 
monitoring of vulnerable households.  According to the UN 
Children's Fund (UNICEF), HIV/AIDS has orphaned more than a 
million children in South Africa.  Source:  HIV-AIDS, IOL, 
February 22. 
 
Health Department Cites HIV/AIDS Progress in South Africa 
--------------------------------------------- ------------ 
 
¶3.  According to Health Minister Manto Tshabalala-Msimang, 
South African HIV prevalence is no longer increasing as 
significantly as it was in the early 1990s.  The Minister cited 
as positive developments youth heeding prevention messages 
regarding abstinence, faithfulness and condom use.  Minister 
Tshabalala-Msimang stated that in order to mark 2006 as the 
 
SIPDIS 
year of accelerated HIV and AIDS prevention, government will 
intensify its interventions targeted at particular risk groups 
including people between ages of 25 to 29 years.  She also 
cited the need to intensify interventions aimed at improving 
the socio-economic status of women, people living in informal 
settlements and other vulnerable groups.  Through the 
implementation of the Comprehensive Plan for HIV/AIDS, there 
are now service points in every health district for the 
provision of a range of interventions including prevention, 
nutrition, management of opportunistic infections and 
antiretroviral treatment.  The HIV/AIDS budget allocation spent 
by the Health Department increased from R264-million in 2001 to 
R1.5-billion in 2005.  More than R3.4 billion will be spent on 
antiretroviral drugs for the next three years.  The number of 
health facilities providing voluntary counseling and testing 
 
PRETORIA 00000990  002 OF 004 
 
 
increased from 1,500 in 2002/03 to more than 3,700 in 2004/05 
with the numbers of people using them increasing from 691,000 
in 2002/03 to more than 1.3 million in 2004/05.  As of now, the 
available data includes:  accumulative number of patients 
assessed; accumulative number of patients initiated on 
treatment; CD4 counts and viral loads; and the number of 
accredited health facilities.  Source:  SAPA, HIV/AIDS, IOL, 
March 2; The Star and Pretoria News, March 3. 
 
Health Department Plans to Improve HIV Data 
------------------------------------------- 
 
¶4.  Dr. Nomonde Qundu, the Health Department's head of 
HIV/AIDS, announced implementation plans for a nationwide 
monitoring system for HIV patients by the end of 2006.  Lack of 
data makes it difficult for the Department to determine how 
many patients have dropped out of the antiretroviral program, 
how many have died, or how many have had to change drugs 
because of side effects.  Pilot patient monitoring systems 
operate in Free State, Mpumalanga, Limpopo, Eastern Cape and 
Gauteng provinces and staff are being trained to expand the 
program.  Source:  Business Day, March 3. 
 
South Africa's Contribution to UN AIDS Report 
--------------------------------------------- 
 
¶5.  The Health Department is preparing a status report on its 
HIV/AIDS treatment plans as a contribution to a larger United 
Nations AIDS report.  Few civil organizations had responded to 
the Department's request for comments to the initial draft of 
the report.  Representatives from these civil organizations 
(such as Treatment Action Campaign, Cosatu and AIDS Law 
Project) objected to relying on the South African National AIDS 
Council (SANAC) for information.  SANAC cancelled its December 
meeting that was supposed to discuss the first draft.  In 
addition, SANAC relied only on questionnaires distributed to 
members for input to the draft.  Source:  City Press, March 5. 
 
South Africa Silent on HIV/AIDS Airline Tax 
------------------------------------------- 
 
¶6.  As of yet, National Treasury has yet to decide whether it 
will impose a new AIDS and poverty tax initially proposed by 
France and Britain to raise money for developing countries so 
that they can meet Millennium Development Goals.  Spokesmen for 
the Department of Transport announced that the South African 
government would contribute to the international fund, but 
would follow the International Civil Aviation Organization 
guidance regarding the tax imposition.  Source:  Business Day, 
February 27, Sunday Independent, March 5. 
 
Findings from the District Health Barometer 
------------------------------------------- 
 
¶7.  The District Health Barometer publishes health statistics 
of the country's 53 health districts.  The Barometer was 
complied by the Health Systems Trust (HST), based on statistics 
supplied by the districts themselves.  HST researchers caution 
that not all the figures are reliable as some districts are not 
yet keeping accurate records. 
Ekurhuleni Metro on Gauteng's East Rand spends more per person 
on primary healthcare services than other health district in 
the country, but Ekurhuleni scores low in some key health 
services.  While Ekurhuleni spent R389 ($65) per person, the 
Gert Sibande (Ermelo) district in Mpumalanga spent R42 ($7) per 
person on primary health care, according to figures for 2001 
(the latest year that these statistics are available).  Despite 
relatively high health expenditures, Ekurhuleni scores low in 
key service provision areas.  Only 15% of women attending 
antenatal clinics in Ekurhuleni in 2004 were tested for HIV. 
This contrasts sharply with the Western Cape and KwaZulu-Natal, 
where most health districts test over 80% of pregnant women. 
Ekurhuleni also had the lowest caesarean birth rate of the 
metropolitan areas (13.9%), two points lower than the 
internationally recommended rate of 16%.  The most caesareans 
were performed in KwaZulu's eThekwini metropolitan area 
(Durban) at 27.2%, a number that is high but could be related 
to the HIV epidemic in the province.  Caesareans decrease the 
likelihood of mother passing HIV to their babies.  All the 
rural districts in the Eastern Cape and Limpopo provinces have 
low caesarean section rates of close to 10% or below, probably 
 
PRETORIA 00000990  003 OF 004 
 
 
reflecting poor quality of maternity services. 
 
¶8.  Another indicator of maternal services is the stillbirth 
rate, or the number of full-term babies per 1000 that are born 
dead.  Developed countries have a stillbirth rate of about 10 
per 1000 births (1%).  Some districts report high stillbirth 
rates, with the highest rates reported in urban areas.  The 
worst reported rate in South Africa is the West Rand in 
Gauteng, where 68 babies per 1000 were born dead in 2004. 
Poorer rural areas in Limpopo (Vhembe and Mopani) have the 
lowest stillbirth rate.  Of the metropolitan areas, 
Johannesburg and Ekurhuleni have the worst stillbirth rate 
(35), followed by Tshwane (34).  Cape Town has the lowest rate 
(21).  HST researchers assert that while Gauteng districts have 
consistently high stillbirth rates, this could be because women 
from neighboring provinces choose to deliver in Gauteng, 
complicated pregnancies are referred there and the recording of 
stillbirths may be more accurate. 
 
¶9.  The most overworked nurses in the country are in the 
Southern district (Klerkdorp-Potchefstroom-Ventersdorp) of the 
North West, where clinics reported that their professional 
nurses saw an average of 92 patients a day.  The recommended 
average is 35 patients per day.  Nurses in the Northern Cape's 
Kgalagadi district were the most overworked of all rural 
districts, seeing 63 patients each every day. Nurses in Chris 
Hani district in the Eastern Cape saw the least patients, 
around 21 per day.  In the metropolitan areas, Cape Town nurses 
were busiest, seeing 54 patients.  eThekwini followed close 
behind with 50 patients.  These nurses had more than double the 
workload of Johannesburg nurses, who saw 21 patients in a day. 
 
¶10.  Tuberculosis is one of the country's most common 
infectious diseases, yet in many districts the cure rates are 
very low.  The cure rate is defined as people who test negative 
for TB after six months of treatment.  The country's average 
cure rate is 56%, and covers people hospitalized as well as 
attending clinics.  The worst performing district is Sisonke 
(Kokstad area) in KwaZulu-Natal, which cures less than a 
quarter of its patients (23.7%).  Eden district (Mossel Bay to 
Knysna) in the Western Cape performed best with over three- 
quarters of its TB patients (77.9%) being cured after six 
months.  The Western Cape, which has one of the country's 
highest TB rates, is the best performer and the Cape Town is 
the best performing metropolitan area (70%).  Six of the ten 
worst performing districts are in KwaZulu-Natal, and the 
eThekwini is the worst performing metropolitan area, curing 
less than a third of its patients (30.1%).  The HIV epidemic in 
the province is a likely complicating factor as TB is the most 
common opportunistic infection. 
 
¶11.  A high rate of diarrhea usually means that people do not 
have access to clean water.  This is evidently the case in 
Mopani in Limpopo (Phalaborwa-Tzaneen) where close to 400 
children under five per 1000 were treated for diarrhea.  The 10 
districts with the highest incidence of diarrhea were all in 
rural areas, the majority in KwaZulu-Natal and Limpopo.  The 
eThekweni area also had an exceptionally high rate of 270 cases 
of diarrhea per 1000 children, double that of the next highest 
metropolitan area.  With the exception of eThekwini, urban 
areas have the lowest rate of diarrhea.  The 10 districts with 
the lowest incidence of diarrhea include all six districts of 
Gauteng, three Western Cape districts and the Nelson Mandela 
metropolitan area.  Source:  Health E-News, February 28. 
 
Health Inequalities between Khayelitsha and Cape Town Still 
Present 
--------------------------------------------- ------------- 
 
¶12.  In Khayelitsha, diarrhea and gastro-enteritis have 
overtaken HIV/AIDS as the biggest killers of children under 
five years with the deaths doubling over the last four years. 
By mid- 2004, 60 Khayelitsha toddlers had died of diarrheal 
disease, a preventable and treatable illness.  The Cape Town 
Equity Gauge, established to address the inequities in 
Khayelitsha, assessed the public health facilities in the 
township.  At least 55% of people in Khayelitsha, with 
approximately 500,000 residents, live below the poverty line. 
Half of all adults are unemployed while one in three people 
have no access to water in their homes.  There is an average of 
105 people per toilet in Sites B and C in Khayelitsha, or one 
 
PRETORIA 00000990  004 OF 004 
 
 
toilet per seven households where toilets have been provided. 
Several toilet systems have been tried in Khayelitsha but most 
fail as the systems are unable to handle the demand. 
 
¶13.  The infant mortality rate in 2003 (deaths of babies under 
a year old) was 43 per 1000 live births in Khayelitsha, while 
in Cape Town, it was 25.  In 2004, the Infant Mortality Rate in 
Khayelitsha was reduced to 36.  Almost 30% of residents do not 
have easy access to water and 80% of Khayelitsha residents live 
in shacks. A total of 14,521 households do not have access to 
water while the sanitation backlog is around 29,811 households. 
Top 5 causes of death among the under 1 year olds (2004) 
include:  (1) Ill defined and unknown causes including natural 
(55 deaths at 19.2%); (2) Diarrhea and gastro-enteritis (52 
deaths at 18.8%); (3) Short gestation and low birth weight (39 
deaths at 13.5%); (4) HIV/AIDS (37 deaths at 11.7%); and (5) 
Pneumonia (27 deaths at 9.2%).  In 2005, there were 26,794 
cases of Tuberculosis treated in Khayelitsha, a yearly increase 
of 9.7%.  One clinic in Khayelitsha had the same number of TB 
cases as the three entire districts in Cape Town.  In 2005, 
over 2000 cases of TB were registered at the Site B Clinic 
alone.  Epidemiologists believe the AIDS epidemic is fuelling 
the TB epidemic with 74% of TB patients in Khayelitsha also HIV 
positive.  At Site B, nine out of ten TB patients are HIV 
positive.  Source:  Health E-News, February 28. 
 
South Africa to Develop Vaccine Manufacturing Facility 
--------------------------------------------- --------- 
 
¶14.  The Cape Biotech Trust, an initiative of the Department of 
Science and Technology, finalized an agreement with the Biovac 
Consortium, a public/private partnership with the Department of 
Health to develop a manufacturing and research facility for 
vaccines.  South Africa is the first sub-Saharan country with 
this capacity.  Egypt is the only other African country having 
this capability.  Once completed, the facility will speed 
development work on various pediatric vaccines, including DTP, 
hepatitis B and HIB into a single dose.  The Cape Biotech Trust 
will provide R24 billion ($6 billion) to develop the facility 
in Cape Town.  Source:  Sunday Argus, February 19. 
 
Firms Begin to Feel HIV/AIDS Impacts on Work Force 
--------------------------------------------- ----- 
 
¶15.  According to Grant Thornton's 2006 International Business 
Owners Survey (IBOS), South African business owners are 
increasingly starting programs to intervene against HIV/AIDS. 
Concern runs particularly high in the Eastern Cape cities of 
Port Elizabeth and East London, where 97% of the businesses 
surveyed reported a sizable impact on their business growth. 
The sectors showing the highest growth in concern were 
construction and retail, where the percentages increased to 87% 
and 88%, respectively, from 75% and 74% in 2005.  Training 
proved the most popular element in companies' HIV/AIDS 
management plans, with 65% participating in these programs. 
However, only 35% of companies pay for employees' treatment 
costs.  Lee-Anne Bac, the director of strategic solutions at 
Grant Thornton, said the extent of interventions is increasing 
compared to 2005, when the majority of business owners did not 
have any companywide policies.  A study commissioned by AIC 
Insurance in 2005 showed that South Africa loses an estimated 
R12 billion a year due to absenteeism in the workplace, of 
which between R1.8 billion and R2.2 billion could be directly 
attributed to HIV/AIDS.  In the mining sector, Harmony 
estimated costs related to HIV/AIDS would amount to 7.5% of 
total labor costs over the next 15 years, while its HIV/AIDS 
workplace program cost R10 million ($1.7 million) in the last 
financial year.  AngloGold Ashanti spent R14.6 million ($2.4 
million) in 2005 providing antiretrovirals, voluntary 
counseling and home-based care for terminally ill former 
employees, as well as research, monitoring and evaluation. 
Recently, the Epicenter AIDS Risk Management Foundation was 
appointed as consultant for a R2.4 million ($400,000) research 
project funded by the Global Fund for HIV/AIDS. The study will 
also examine the impact of the pandemic on the business sector, 
focusing on KwaZulu-Natal, which has been the hardest-hit 
province.  The Grant Thornton IBOS Survey contacted 300 
business owners who employ between 50 and 250 staff in South 
Africa.  Source:  Business Report, March 8. 
 
TEITELBAUM