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A dose of strong medicine

01 March 2004 Anso Thom - Healthe News Service

Anso Thom, reporting for the Healthe News Service asks whether the issues around cheaper drugs, certificates of need, social health insurance, mean that government has made sudden and major shifts in health policy? This is part one of a 2-part series.

From the African National Congress' perspective it is perhaps timely in a year that we celebrate the 10th anniversary of democracy and with a general election only a few months away, three critical pieces of health legislation are about to be signed into law or are being drafted for future legislation.

The three pieces include Regulations relating to a Transparent Pricing System for Medicines and Scheduled Substances (Medicines and Related Substances Act of 1997), Social Health Insurance (Medical Schemes Act of 1998) and the Certificate of Need (National Health Bill - still to be signed into law by the President).

Regulations relating to a transparent pricing system have already resulted in robust public debate.

But the issue of the high cost of drugs in South Africa is not new. Way back in 1990, the ANC health committee highlighted the issue along with another that has been recently revived - national health insurance.

In 2001 the pharmaceutical industry took the Government to court intending to strike down major provisions of the Medicines and Related Substances Control Amendment Act of 1997.

It was an action that drew international attention.

Big pharma backed off paving the way for the introduction of legislation that afforded Government various legislative tools to introduce affordable medicine by among others, making the pricing system more transparent; offering generics as a cheaper alternative either by importation or local manufacturing; or importing cheaper medicine from other countries.

In 1994, all of the current issues were on the agenda, some simmering away on the backburner.

Back then doctors were consulted and met with the then Director-General of Health, Dr Olive Shisana, about the now controversial Certificate of Need. Agreement was reached that this would be a necessary move to ensure a future more equitable health system.

The need for an introduction of some form of national health insurance began gaining momentum again in 2003, almost 14 years after it was first discussed. It is expected that it will now be implemented in 2006.

Where there is agreement it is that South Africa's health system has been one of the most inequitable in the world, with a small percentage (less than 17%) having access to the best "walk-in" healthcare while the majority remains reliant on a buckling public health system.

In 2000 the World Health Organisation ranked South Africa a paltry 175 out of 191 countries in its health report. But the ranking was not only concerned with the amount of money spent on public healthcare.

South Africa's biggest shortcoming, according to the report, was its inability to regulate the private sector and in turn control the widening gap between rich and poor.

The low ranking appears to have served as a wake up call that has now led to the three pieces of legislation.

Although South Africa is probably one of only a handful of lower to middle income countries to introduce such legislation, countries like Australia, France, Germany, Canada, Belgium and the United Kingdom, have used different models (depending on their particular health and social systems) to achieve the same outcome.

The long awaited regulations aimed at lowering drug prices are likely to become law as early as May 2. South Africa's old pricing structure is notoriously complicated, secretive and confusing with incentives, discounts and mark ups hidden along the drug chain.

The regulations, part of the Medicines and Related Substances Act are likely to change this.

While the pharmaceutical industry has become one of the most lucrative in the world, raking in what experts term as "super profits", the new legislation does not seek to deny the pharmaceutical industry, pharmacists, private hospitals and dispensing doctors the right to earn a profitable living.

Although only likely to be introduced around 2006, groundwork is being done to introduce Social Health Insurance.

part 2/tomorrow

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