Background to the People's Health Summit
Co-hosted by the Treatment Action Campaign (TAC), the Health & Other Services Personnel Trade Union of South Africa (HOSPERSA), the South African Democratic Nurses' Union (SADNU), the Public Service Accountability Monitor (PSAM), the Eastern Cape Provincial Council of Churches, the Rural Doctors Association of Southern Africa (RuDASA) and Médecins San Frontières (MSF)
Adopted in plenary session on July 4, 2004, East London, South Africa
General Summit Statement
On 2 - 4 July 2004, more than 530 delegates - including more than 80 health workers and representing over 60 organisations and institutions - met at the first People's Health Summit (PHS) to discuss the crisis and inequity in the health system and the roll-out of antiretroviral (ARV) treatment.
While recognising the impact of the legacy of injustice and inequality of apartheid on the health service of our country and our people, delegates to the PHS expressed grave concern that in spite of many good policies, laws and programmes, the public health service is in crisis and the quality of many services is in decline. This is an emergency and needs urgent solutions from government, the private health sector and civil society.
In spite of significant attempts to transform the health system in the first decade of democracy, based on the ANC's vision of equality in access to health care, there is growing inequity between the health care services received by people who can afford to use the private sector and those received by people whose poverty makes them largely or wholly dependent on the public sector.
There are also growing inequalities between urban and rural areas. Amongst other problems, people in rural areas face the chronic understaffing of health facilities and large distances to travel to access health care.
In particular, the PHS recognises that:
- Our struggle for a quality people's health service is a struggle for the realisation of the rights to life, dignity, access to health care services, equality, autonomy and social justice.
- The worthy vision of the public sector as being the lead provider of quality health care seems to have crumbled. This crisis has come about as a result of a number of factors, including the -
- Underfunding of public health;
- Overpriced, inefficient and exclusive private health sector;
- HIV/AIDS epidemic;
- Failure to train and re-train health workers; and
- High degree of corruption and mismanagement in the delivery of public health services.
- Refusing to recognise or confront this crisis is a violation of the principle of a better life for all.
- All organisations represented at the PHS are committed to working with the Department of Health all levels to build a quality people's health service.
- There is an urgent need for the establishment of a permanent and broad-based consultative forum to discuss, debate and formulate all aspects of health care policy.
1. Crisis in the public health system: defining an agenda for resolving it
Recognising the need to transform the public health sector, the PHS resolves to:
- Campaign to create a unified people's health system based on the principle of free and equal access for all. As part of this campaign, we resolve to strengthen the public health sector by:
- Monitoring the implementation and ensuring the success of the ARV treatment programme across all provinces
- Ensuring that the rollout of the ARV treatment programme is used to improve the health service generally, and calling public meetings about the programme to explain how it can and should be used to build a better public health system
- Encouraging government officials and employees to use public health services
- Calling for unity and better co-ordination between public sector health worker trade unions
- Exploring the formation of a people's health movement.
- Support public health care workers' by calling for:
- The establishment of a Commission of Inquiry to make recommendations on conditions of service and employment for all health workers in the public sector
- The urgent development of a long-term human resource strategy for the public sector which links hospital renovation and clinic construction plans directly to human resource needs
- Negotiations for better wages and conditions of employment
- Endorsing and supporting the quality services campaign of Public Services International (PSI)
- Better management of HIV/AIDS among health care workers, including access to confidential counselling, HIV testing and ARV treatment
- Better attention to human resources for mental health.
- Campaign to improve access to and the quality of health care services for women and girls, in particular services for survivors of sexual violence
- Ensure effective health service delivery at provincial and district level by obtaining business plans for key health programmes in all provinces and by monitoring their implementation.
2. Crisis in the private sector: defining an agenda for resolving it
Recognising that access to health care services is a human right and that all health care providers need to take this into account when providing health care services, the PHS resolves to:
- Campaign against exploitation and over-pricing within the private health care system so that it is made more efficient, accountable and transparent. In particular, the PHS resolves to:
- Raise public debate on the inefficiency of and lack of accountability within the private health system
- Investigate the extent of profiteering within the private sector and how this can be addressed
- Campaign for necessary reforms to ensure greater access to private health care services and thereby reduce some of the public sector burden by:
- Challenging the high costs of private hospitals, particularly by those major hospital groups that operate as a cartel
- Challenging the high costs of medicines, specialist services, and non-health expenditure
- Ensuring that medical scheme members access prescribed minimum benefits (PMBs), regardless of which sector provides the required health services
- Ensuring that ARV treatment is provided as a PMB from 2005
- Engaging more directly in the medicines pricing and dispensing debates