TAC analysis of political party responses to the People’s Health Manifesto

The Treatment Action Campaign (TAC) thanks the 10 political parties who responded to the 11 questions in our People’s Health Manifesto. These responses have been collated in a document that can be downloaded here.  We encourage voters to engage with these unfiltered responses from political parties.
 
Below we provide the TAC’s analysis of these responses. We stress that the TAC is independent of all political parties and does not campaign for or against any parties. We do however believe that all political parties must be asked tough questions about how they plan to respond to key problems in our health system. We will also not hold back from saying if we believe that the responses provided by these parties are inadequate.
 
Our commitment is not to any political party, but to people living with and affected by HIV and TB and any other users of the public health system in South Africa.
 
Which parties failed to respond?
 
On March 6th and 7th the TAC sent out our "People's Health Manifesto" with 11 questions to 20 political parties. The manifesto and questions were informed by the TAC’s experiences in the communities where we work and live and were developed in consultation with community members and partner organisations. Through the manifesto we aimed to put the critical problems experienced by users of the public healthcare system onto the political agenda. With the 11 questions we aimed to get political parties to make clear policy commitments on the key problems in our health system. The manifesto can be downloaded here
 
We asked political parties to respond to the 11 questions in the People’s Health Manifesto by March 14th. On request from political parties we extended the deadline to 12 noon on March 18th. By this deadline eight of the twenty political parties had responded. A ninth party, the African National Congress (ANC), responded on March 19th. A tenth party, the African Christian Democratic Party responded on March 24th.
 
We thank the following ten parties for engaging with the People's Health Manifesto and responding to our questions:
 
·         African Christian Democratic Party
·         African National Congress
·         Agang SA
·         Azanian People's Organisation
·         Democratic Alliance
·         Freedom Front Plus
·         Inkatha Freedom Party
·         Pan Africanist Movement
·         Patriotic Alliance
·         United Democratic Movement
 
We are disappointed that high profile parties like the Congress of the People (COPE) and the Economic Freedom Fighters (EFF) did not respond to the People’s Health Manifesto. We engaged extensively with these parties, both telephonically and by email, to try and get them to respond. They have had sufficient opportunity and appear not to have considered our request to demonstrate commitment and political will to face our healthcare problems to be of high enough priority.
 
While COPE initially indicated a willingness to respond, they failed to do so by the extended deadline. We still have not received their responses. The EFF initially indicated a willingness to respond, but then claimed not to have heard about the manifesto.
 
Quality of responses
 
While we are most concerned by the failure of some parties to respond, the poor quality of some of the responses that we did receive is also worrying. With the exception of the ANC, the DA, and to some extent Azapo, most of the responses we’ve received suggest a relatively poor understanding of the challenges facing our health system. We are disappointed that a number of parties engaged only superficially with our 11 questions. So for example, a party like Agang SA makes the good point that more qualified and capable people must be appointed in the health system – however, while we fully support the appointment of more qualified and capable people, they fail to show any understanding of the problems in our health system beyond this one issue. The UDM did worse, they failed to respond directly to our questions but only sent a general comment.
 
A number of parties standing in the elections seem to have a very poor understanding of the complexities of delivering healthcare in a country like South Africa. Furthermore, the poorly formulated responses submitted by many parties show a disregard for the issues from our communities that we put to these parties. Access to health care services is a Constitutional right. It creates legal duties to take "reasonable legislative and other measures" to progressively improve healthcare services. Parties that have shown that they do not understand or appreciate the importance of health services also display a contempt of the Constitution. Rather than uninformed rhetoric, we much prefer the African Christian Democratic Party’s approach of simply admitting to it when they are not on top of an issue.
 
As mentioned earlier, the responses from the ANC and DA stand out. As in their respective party manifestos, these two parties show a good understanding of health issues and have engaged seriously with our questions. While our policy positions on issues like National Health Insurance (NHI) and other key areas generally correspond to those of the ANC, we strongly disagree with their support for a statutory media appeals tribunal and the Protection of State Information Bill. These are civil society issues as well as media issues. We are also concerned with the ANC’s tendency to appoint MECs for Health . several whom lack the ability, qualifications and commitment to serve people in their provinces effectively.
 
We are also in agreement with many of the policy positions expressed by the DA. Both the ANC and DA, for example, support reform of South Africa’s patent laws – something that the TAC has been campaigning for for a number of years. We were also very impressed with the DA’s well-informed response on our question about TB in prisons. We, however, find the DA’s half-hearted support for the proposed NHI programme disappointing. Together with the re-engineering of primary healthcare, NHI has the potential to significantly improve the quality of healthcare available to all in South Africa.
 
 
TAC analysis of responses to specific questions:

  1. Commitment to National Strategic Plan for HIV, STIs and TB 2012 – 2016 (NSP) and commitment to setting ambitious new targets when current NSP ends in 2016

We are encouraged that almost all parties indicate that an ambitious new target of 100% ARV coverage must be set when a new National Strategic plan is developed in 2016. We will keep parties to these responses when the new NSP is negotiated.
 
We are however also reminded that most parties responding here showed very little interest during the development of the current NSP and therefore their commitment remains to be demonstrated.
 

  1. Plans for dealing with stock-outs of essential medicines

In relation to the problem of chronic stock-outs of essential medicines, we note that very few parties appreciate the complexity of the problem. While the ANC provides the most detailed response on how to solve the problem, it should also be noted that ANC members in government have consistently questioned and underplayed the findings of the report of the Stop Stockouts Project (this report systematically highlighted the seriousness of this problem across the country). We were hoping that the ANC would use this opportunity to correct their denials in this regard.
 
While the DA’s suggestion of medicines distribution through private sector pharmacies is one of many options worth considering, we would have liked more detail in their response. Though most other parties acknowledge the seriousness of the problem, they show little understanding of the technicalities involved and fail to offer concrete solutions.
 

  1. Need for reform of South Africa’s patent laws to ensure better a access to medicines

In relation to the ongoing development of a national intellectual property policy and reform of South Africa’s patent laws we note that most parties, with the exception of the FF+ and Agang SA, acknowledge the need for patent law reform. While the FF+ actively questions the need for policy reform, Agang SA evades the question and provides no clear answer.
 
We are however encouraged by the strong positions taken by the ANC and the DA. The DA describes the reforms as “critical” and states that it must be a priority for the next administration. The ANC for the first time to our knowledge explicitly supports the process of law reform. They state as follows: “The ANC initiated and supports the amendment of South Africa’s Intellectual Property laws in order to protect the right to health and to fully utilise all pro-public health flexibilities that are in the Trade and Related Intellectual Property Rights (TRIPS) agreements available in international law. The ANC-led government is giving urgent attention to this matter, with various departments and other local and international partners collaborating to bring this matter to its conclusion.”
 

  1. Commitment to functioning provincial, district and local AIDS councils

In this section the ANC and DA provided by far the most detailed responses. We appreciate the commitment expressed by both these parties to ensure that functioning and inclusive AIDS councils are at the centre of our AIDS response. We will remind these parties of these commitments after the elections.
 
Yet, while the ANC provides a thorough and excellent answer to this question, the evidence of the last five years suggest that they struggled to run effective AIDS councils in most provinces and districts where the TAC is active. Unfortunately, this theme of good high-level commitment from the ANC and poor implementation at provincial and district level is becoming a familiar pattern in our health system. In the Western Cape DA premier Helen Zille does not chair the AIDS Council.
 
We are concerned by the lack of detail in the answers provided by the other parties. Unfortunately this mirrors the poor buy-in we’ve observed into AIDS councils over the past five years.
 

  1. Plans for combatting over-crowding and TB in prisons

We are impressed by the thorough and well-informed response provided by the DA. They clearly understand the problems relating to TB in prisons better than any other party and provide considered solutions that would help reduce over-crowding in prisons.
 
By contrast, while the ANC notes some positive steps like the building of new prisons, the use of new screening technology, and contact tracing, there is no indication that the ANC appreciates the scale of over-crowding in prisons and its impact on TB transmission. While they mention a few new prisons, they are quiet on the need for sentencing reform. The party rightfully notes the collaboration required between government departments, but in reality we have seen little evidence of such cooperation. While we have seen willingness from the Department of Health, we have seen a serious lack of political commitment from the Departments of Correctional Services and Department of Justice and Constitutional Development.
 
As with a number of other questions, we note Agang SA’s focus on appointing only qualified persons. Furthermore, while we fully agree with the party’s contention that people should be empowered to take responsibility for their own health, Agang SA seems insensitive to the fact that the essential problem in prisons is precisely that inmates are deprived the opportunity to take this responsibility.
 
We note the IFP’s suggestion for alternative sentencing guidelines for minor offences. Taken together with the more detailed recommendations from the DA, we hope to see progress in this regard under the next government. Given the apparent lack of willingness from the ANC to act in this area, we encourage the DA and IFP to drive this initiative.
 

  1. Willingness to act against quackery

To the question as to whether parties will commit to sufficient funding for the Law Enforcement Unit (LEU) in the Department of Health, the ANC responded “The ANC strongly believes that Quackery is a danger to the healthcare system, and will do everything in its power, including making resources available to combat it.” We consider this to be a commitment from the ANC to ensure better funding for the LEU. We will monitor whether the ANC keeps to this commitment after the elections. Unfortunately, no other parties made such commitments and there seems to be a general lack of appreciation for the harm quackery does in the fight against HIV and TB and in our society more generally.
 
We are however glad to note general agreement on the need for the new South African Health Products Regulatory Authority (the replacement of the Medicines Control Council) to be independent and run by suitably qualified persons. Again, we will be watching closely to make sure this happens.
 

  1. Commitment to increased cervical cancer screening

We note broad agreement among the parties regarding the need for better access to cervical cancer screening and greater awareness of the importance of screening. We note important strides taken by the ANC nationally and the DA in the Western Cape in providing cervical cancer screening services and HPV vaccination to young girls. We do however encourage parties to be much more ambitious in providing screening and ensuring all women understand the need for screening.
 
The TAC will monitor the availability of cervical cancer screening and HPV vaccination in the coming years.
 

  1. Provision of sex education and condoms in schools

To the question as to whether parties support the provision of comprehensive sex education and condoms in schools, the DA, Patriotic Alliance and Pan Africanist Movement all answered “yes”. We will hold these parties to this positive response.
 
We are disappointed that the ANC did not commit to providing condoms in schools, but indicated that while some teens would access condoms at school, others would have to go to clinics. The FF+ and the ACDP opposed the provision of condoms in schools.
 
We believe there is a legal duty to make condoms and appropriate sex and life-skills education available in schools. Failure to do so violates children's rights and places them at a higher risk of HIV, STIs and pregnancy. The Human Sciences Research Council (HSRC) recently estimated that a quarter of all new HIV infections occur in females aged 15 to 24. In order to help teens take responsibility for their own health, condoms must be made easily available. Expecting teens to go to clinics to get condoms is unrealistic. Similarly, expecting teens not to have sex is also not realistic and certainly not a pragmatic or a responsible policy position.
 
We commend the DA, PA and PAM for taking a principled stance on this issue.
 

  1.    Support for and commitment to National Health Insurance

While the ANC provides a very good response in this section, delays in the implementation of NHI and delays in the development of key policy documents are of concern and bring into question the ANC’s true commitment to NHI. We will therefore have to wait and see how committed the ANC really is to implementing an NHI system that makes a real difference in our lives. We are however encouraged by the clear statement that, “The ANC strongly believes in the reasonable regulation by law, of medicine prices and of private health facilities and services.” We encourage the ANC to push on with National Health Insurance as an urgent priority.
 
While we are uncomfortable with the DA’s half-hearted support for the principles underlying NHI and while we think their faith in private sector business models in the health sector is misplaced, we are in full agreement with their statement that budgeting in the health sector should be based on need. We encourage the party to take up this general point in future discussions relating to health budgets.
 
We are encouraged by Agang SA and Azapo’s support for NHI and the IFP’s provisional support.
 
We also recognise that some of the parties opposed to NHI have legitimate concerns that have to be addressed. However, we disagree that these concerns should amount to a rejection of NHI altogether. In TAC’s view, a properly implemented single-payer NHI system together with the accompanying re-engineering of primary healthcare is the most promising way forward for our health system.
 

  1. Good commitment to good governance

We are glad to see all parties condemning intimidation and affirming the rights of whistle-blowers. We hope that parties can stick to these principled ideals when whistle-blowers put these same parties in a bad light.
 
Not surprisingly, all parties expressed a willingness to act against corruption once officials have been found guilty. No parties took the bait in our question and committed to suspending officials facing charges of corruption. In our view, officials like Free State MEC for Health Benny Malakoane who are facing serious charges of corruption must be suspended pending the outcome of court proceedings. Such suspensions would send a very clear message that government is serious about clamping down on corruption.
 
In one of their responses in the governance section the ANC writes “It will continue to be the practice of the ANC in all provinces to appoint appropriately qualified, competent and committed persons as MECs of Health.” If the ANC is serious about this, then why was Sicelo Gqobana appointed MEC of Health in the Eastern Cape and Benny Malakoane as MEC of Health in the Free State? Neither of these MECs have shown the commitment or competence required to effectively serve the people of their respective provinces. Reappointment of these and other failing MECs will be an affront to people depending on the public health system. We will be watching appointments in the new administration very closely.
 
All the other parties also commit to only appointing suitably qualified and committed MECs of Health. Apart from the DA in the Western Cape it seems unlikely these commitments will be tested. It is nevertheless heartening to see such wide recognition for the urgent need for better leadership. We particularly note and support Azapo’s principled rejection of cadre deployment.
 

  1. Rejection of Protection of State Information Bill and media appeals tribunal

We find the ANC’s continued support for the Protection of State Information Bill (POSIB) and a statutory media appeals tribunal deeply disturbing. Both the bill and the tribunal will have a chilling impact not only on the media, but also on the ability of civil society organisations like the TAC to hold government to account.
 
We are however encouraged that all other parties who answered this question were both in favour of repealing the POSIB and against the establishment of a statutory media appeals tribunal. The TAC will support efforts to repeal the POSIB and will actively oppose the establishment of a statutory media appeals tribunal.
 
For any further questions contact Anele Yawa, TAC Chairperson, on 073 555 8849.