STATEMENT TO THE WORLD HEALTH ASSEMBLY
BY THE HONORABLE DR MANTO TSHABALALA-MSIMANG,
MINISTER OF HEALTH OF SOUTH AFRICA ON BEHALF OF THE SADC HEALTH MINISTERS

GENEVA, SWITZERLAND
MAY 2001

On behalf of the Southern African Development Community member-countries, SADC, I am honored to be able to give this year!&s SADC statement to the World Health Assembly.

The SADC region is afflicted by ill-health in the form of HIV/AIDS, TB, malaria, cholera and other communicable diseases. In addition, we have more than our fair share of non-communicable diseases including tobacco and alcohol-related diseases. High maternal and child mortality rates continue to be a prominent feature in our statistics. The floods which hit parts of Mozambique very severely, and ongoing armed conflicts in our region and elsewhere in the world, exacerbate these and other health related and social problems.

On an annual basis, 13 million cases of malaria are reported in the region. In some countries up to 40% of the population has suffered from malaria at some point during any year. For this reason, we welcome the recent decisions to allow limited use of DDT for malaria control.

At least 3 million cases of diarrhea are reported each year. These include the recent and ongoing cholera epidemics in 7 of our 14 countries. This emphasises the need for development to provide basic infrastructure in our region.

These health-related problems are exacerbated by poverty, poorly-resourced health systems and general underdevelopment. It is only the overall development of our countries and people that will solve the problems at their source. Furthermore, we urge the WHO to work towards the identification and implementation of durable, development orientated solutions to alleviate external debt and to solve the debt-servicing problems of our developing countries.

As a region our fundamental goal is to build health systems that are based on the twin foundations of equity and justice. In pursuit of our goals we are fully aware that there will be no easy victories and that there will be many obstacles in our path. However, we remain committed to our vision and its practical implementation because for us, access to health care is above-all, a basic human right.

Mental health poses a major challenge to our underdeveloped services. We welcome the emphasis and prominence that the WHA has given to this problem. We believe better integration of mental health with other health services will contribute to dealing with the stigma associated with mental and neurological illnesses. We also look forward to the discussions on infant and child nutrition. We hope that we will address this matter with due regard also to how we can support the mothers to better cope with the challenges of prolonged and exclusive breastfeeding.

HIV/AIDS is a major challenge in our region. In the past year we undertook a number of initiatives at the regional level to complement the many activities taking place at the country level.

  1. The SADC HIV/AIDS Strategic Framework and Programme of Action for 2000-2004 was approved by the SADC Summit of Heads of State and Government in August 2000.
  2. The Principles to Guide Negotiations with Pharmaceutical Companies on provision of Drugs for the Treatment of HIV/AIDS Related Conditions in SADC Countries were developed by the SADC Health Ministers, and approved by the SADC Council in August 2000.
  3. Council approved the inclusion of the SADC economic sectors in the regional HIV/AIDS response.

We remain firm in the view that what we need to fight HIV/AIDS are a complex set of interventions, each occupying a special place and which together constitute a comprehensive and multi-sectoral approach and response that is fundamental for success. We have identified as:

  1. Socio-economic upliftment,
  2. The strengthening of health systems,
  3. Strong preventive programmes,
  4. Robust and aggressive treatment of opportunistic infections,
  5. Strong mitigation programmes for those infected and affected,
  6. Targeted and appropriate use of antiretrovirals.
Such an approach will also ensure that we do not make the mistake of developing a vertical response to this epidemic.

As regards antiretroviral medicines, let us reiterate that at current prices our public health sector budgets remain inadequate. In addition, in most of our health systems, the infrastructure including human resources remains incapable of wide-scale provision of these drugs. Even if providing antiretrovirals is cost effective in the long term, they nevertheless remain unaffordable at the present time.

Chairperson, during the past twelve months we have been caught up, as a region, in protracted interactions with the five multinational pharmaceutical companies who appeared to be making offers around affordable access to medicines. The experience has been frustrating and confusing. But because Africa is a hopeful continent we trust that there is wisdom to be gleaned from this experience. As we move towards discussions around the Global Trust Fund for Health we hope that we will be able to build upon the valuable lessons learned.

SADC appreciates that during this session of the WHA we will be given an initial opportunity for engagement on the form and shape of the Fund. Nevertheless, we would like to urge the Assembly to consider the following aspects:

  1. We believe that the fund should be open to all developing countries;
  2. Developing countries should have a say at all levels of political decision-making;
  3. The Fund must support only those plans, many of which already exist, that are approved by member states;
  4. It must support an overall strengthening of health systems generally, as opposed to a narrow focus on the purchase of medicines;
  5. Where it does focus on the purchase of medicines, the Fund must be open to bids from companies that manufacture generic equivalents of medicines; and finally,
  6. The Fund must be operated on a fast track basis and with the leanest possible administrative and governance structures.
As many of you are already aware, the African Presidents have tasked the Presidents of Algeria, Nigeria and South Africa to drive the Millennium Africa Programme, commonly known as MAP. We believe that the Global Trust Fund for Health should also be able to provide funding for some of the public health initiatives under MAP.

Let me take this opportunity to thank all those member states and organisations, including the SADC and NAM Ministers of Health for the support given to my country in our battle against the pharmaceutical companies. We hope that this victory has made a small contribution to our common pursuit for affordable access to medicines.

Regarding the court case, let me briefly set the record straight. Firstly, there was no out of court settlement. What we have is an unequivocal withdrawal in a public court of law of all elements of the legal challenge. In addition, the pharmaceutical companies will pay all costs incurred by the South African government since the inception of the case.

Secondly, the issue of the court case has been portrayed persistently as a battle only for affordable access to anti-retroviral medication. This is erroneous. The case really concerned affordable access to medicines of all kinds.

Whilst we welcome the withdrawal from the legal action by the pharmaceutical industry, we realise that there is still a long way to go before all of us can be secure in the knowledge that the battle for affordable medicines has been won. This, is a matter that affects most, if not all of the member states of WHO, and it therefore imposes an obligation on the WHO to unequivocally and firmly take the lead in what is clearly a key element in the struggle for better health for all.

As SADC, we would like to make the following earnest appeals to the WHO as important elements that will take us in the direction of achieving just and equitable health systems for all our peoples:

  1. That the WHO reviews its linguistic system, in an effort to promote gender equality by ensuring the use in all it documents, publications and meetings, of gender sensitive and inclusive language.
  2. That the WHO gives serious consideration to its representivity both from the gender perspective and the perspective of developing versus developed countries. It is a matter of grave concern to us that the developing world is barely represented in the recent appointments.
  3. That the WHO acts in a more transparent manner with regard to both the process and substance of a document that aims to deal with a campaign against the diseases of poverty.

Let me conclude by thanking the Director General, Dr Brundtland, for her stewardship of our organisation. My colleagues in SADC and I also wish to reiterate our commitment to work alongside Dr Samba as he endeavours to restore the dignity and respect of our regional organisation, AFRO. Of course, we will continue to be critical of both of you when we believe that it is appropriate, but we trust that you will not doubt our respect and support for your overall leadership. You can count on us to work together with you for the advancement of public health as a basic human right.

Let us be strong and soldier on!

I thank you.

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