Provincial health spokesman Roz Jordan said 62 of the cases were reported in Eshowe and 53 in Ngwelezane, pushing the number of cases reported since the out-break in mid August to 2039.
All cases of diarrhoea in the province were being investigated and monitored for surveillance purposes, she said.
Meanwhile, in addition to the involvement of Departments of Provincial and Local Government, Defence and Safety and Security, Cabinet on 11/10 approved further investigations by the Department of Water Affairs and Forestry into short and longer-term measures for the supply of safe water to the affected areas. (Source: SAPA, 11/10/00)
The report on the impact of HIV/AIDS on adult mortality in South Africa mirrors what is happening in hospitals across the country.
This was the opinion of doctors and specialists in the HIV/AIDS field yesterday following claims that the highly controversial report released on Tuesday was inaccurate.
The report definitely mirrors what we see every day in our wards, said Dr Francois Venter, of the HIV Clinical Research Unit at the Johannesburg Hospital. I believe this is an historic document as it reflects what we are dealing with in the country.
Dr Venter told The Citizen a fundamental shift had taken place and patients living and dying with HIV/AIDS were becoming younger.
I would agree with the MRC report that the number of deaths between the age of 20 to 40 has dramatically increased. Ten years ago we hardly saw people dying, but now it is by far the most common cause of death.
He said organisations like Stats SA were poorly informed if they considered notification as the best means of determining how many people were dying of HIV/AIDS. I think the numbers are no longer important. It has been established by various organisations that there are about five million people in South Africa living with HIV.
Source: The Citizen, 18 October 2001
Health Minister Manto Tshabalala-Msimang and the health MECs in all nine provinces are to defend the court action launched by the Treatment Action Campaign (TAC) and hundreds of doctors to force them to provide antiretroviral treatment to HIV-positive pregnant women in the public health system.
The TAC and doctors sent a letter of demand followed by court papers asking the national health ministry and provinces to supply the antiretroviral drugs or details of a plan to do so.
Government was given until yesterday to say if it would defend the action.
Western Cape, which has a plan in place, is defending the action but notified Tshabalala-Msimang its approach would be different. A spokesman for health MEC Nick Koornhof said last night that the province would have preferred it had the TAC not included it in the action as it had a plan in operation to provide the treatment.
The province would use its own team of lawyers and would likely try to avoid being lumped into the same action with the other respondents.
A similar approach seemed possible from Gauteng, which, while defending the action, has written a letter explaining its own rollout for the provision of treatment.
Earlier in the year, Gauteng launched the rollout of its plan, making it clear it intended to give treatment more widely than the provision of two sites would allow for.
It has become clear that the court case and the issue of the provision of antiretroviral treatment are dividing the public health system.
The letter from the health department of Gauteng shows the two sites for the national expansion programme. It then names several more sites already approved by the province and says more will be announced in due course.
Western Cape wrote to the TAC's lawyer Geoff Bud lender in July, saying the health minister has indicated she believes it to be appropriate that a single submission serve as a response to the legal moves.
Koornhof, however, sent Bud lender a copy of his letter to Tshabalala-Msimang that details the province's plans for the provisions of anti-retroviral treatment.
Source: Business Day, 13 September 2001
HIV/AIDS is devastating farming and worsening hunger in sub-Saharan Africa, the United Nations world food body said on Tuesday.
In Africa's 25 most affected countries, seven million farm workers had died from AIDS since 1985 and 16 million more might die within the next 20 years, the UN Food and Agriculture Organisation (FAO) said in a report entitled The State of Food and Agriculture 2001.
"FAO expects the HIV/AIDS epidemic to exacerbate food insecurity, the report said.
It is clear that the epidemic is undermining the progress made in agriculture and rural development over the last 40 years.
Africa, with about 10 percent of the world's population, accounts for nine out of each 10 new cases of HIV infection. Eighty three percent of all AIDS deaths are in Africa.
The FAO said recent UN studies showed output by smallholders in parts of Zimbabwe might have fallen by 50 percent over the past five years, mainly as a result of AIDS.
Labour shortages were particularly serious for agriculture since production was seasonal and timing was crucial.
A shortfall in household labour meant more land became fallow and the household's output declined.
HIV/AIDS was also having a big impact on agricultural estates, FAO said.
Evidence from one sugar estate in Kenya suggests that the epidemic adds substantially to costs, the report said.
Profitability has been undermined by increased absenteeism owing to sickness, substantially reduced productivity and higher overtime costs as other workers replace their sick colleagues.
Over an eight-year period in the 1990s, spending on funerals and health costs at the estate rose fivefold and tenfold respectively.
The company, which was not identified, had estimated that about three-quarters of all illnesses among employees were related to HIV infection.
The impact on the livestock sector was also severe.
Evidence from Namibia and Uganda indicated that livestock was often sold to support the sick and to cover funeral expenses.
Selling livestock eats into a household's savings, making them more vulnerable to new shocks, the report said.
The drop in livestock numbers means a reduced availability of organic material and hence increased pressure on soil fertility.
Recent evidence from Tanzania suggested that food spending by poor households could drop by nearly a third after the death of a young adult.
Source: Business Report, 12 September 2001
The Health Ministry has hit out at critics of President Thabo Mbeki's plan to review the profile of South Africa's mortality statistics.
An article in Business Day newspaper on Monday said the move was apparently intended to de-emphasise the HIV-AIDS crisis in the country in the light of 1995 death statistics Mbeki extracted from the Internet.
A statement from Health Minister Manto Tshabalala-Msimang said Mbeki had written to her in her capacity as chair of the Social Cluster of Ministers (SCM), requesting that the cluster review the profile of mortality statistics and to consider whether the government's programmes were aligned with people's needs.
We (the SCM) take issue with the suggestion in Business Day that this initiative is extended to de-emphasise the impact of HIV/AIDS, Tshabalala-Msimang said.
The significance of HIV/AIDS and the challenges it poses to our service as well as to our society in general are not in question.
United Democratic Movement leader Bantu Holomisa said Mbeki's latest comments on HIV/AIDS were conclusive proof that he did not deserve to lead South Africa.
The letter (to Tshabalala-Msimang) should serve as the final verdict on his incompetence and incapability to look after the best interests of the country," he said.
Tshabalala-Msimang said the SCM did not view Mbeki's request as an exercise to reduce the resources and energy devoted to the HIV/AIDS programme, but as a critical appraisal of whether the government were sufficiently focused in other areas of healthcare and social service.
She said South Africa also recorded a large number of deaths due to cardiovascular conditions, injury (both intentional and accidental), respiratory dysfunction and cancers each year and the SCM needed to consider whether the factors causing these were also being tackled in an effective way.
South Africa remains a highly unequal society with extremes of wealth and poverty, and this fact reflects in our complex burden of disease in which classic diseases of poverty combine with emerging diseases of lifestyle.
The Business Day article said Mbeki's request was likely to be criticised because he had based the methodology for his request on statistics form the mid-1990s, while the pattern of AIDS deaths had shifted significantly since this time.
Tshabalala-Msimang defended Mbeki's methodology, saying the President had used the statistics, because they were the latest available and formed the basis of international reports on South Africa's national health status.
However, government has been conscious of the need for more current AIDS-related mortality figures, she said.
The need for updated figures was one of the recommendations emanating from the Presidential AIDS Advisory Panel.
Largely as a result of this, an Interdepartmental Task Team on Mortality Statistics was set up.
Tshabalala-Msimang said Statistics South Africa, a participant in the task team, had prioritised the processing of general mortality data for 1997 to 2000. The figures are expected to be released by December.
These figures will constitute new 'official' death statistics for our country.
Business Day said Mbeki's request could be undone by a soon to be published report by the Medical Research Council (MRC), that was expected to find that AIDS would become the country's leading cause of death.
Tshabalala-Msimang said the report should be seen as part of this broader process.
She said on September 3 the MRC's research results were presented to a meeting that included the Statistician General, the head of the Department of Home Affairs, the Director-General of Health, representatives of the Human Sciences Research Council and the population unit of the Department of Social Development.
The meeting recommended that the report should be presented to Cabinet and the process of routing it to Cabinet has begun.
The Minister said the purpose of presenting the research to Cabinet was to inform ministers of the findings and not to seek endorsement.
We believe that the figures that underpin policy on a matter as significant as HIV/AIDS need to be interrogated and fully appreciated by national decision makers.
Given the stigma that still surrounds HIV/AIDS, the collection of data in this area presents social methodological problems and we need to understand how researchers have tackled these challenges in order to evaluate their work.
When asked for a statement on the article, the President's office said the Health Ministry statement reflected Mbeki's views.
Source: SAPA, 10 September 2001
The South African Nursing Council has asked the government to impose an export tariff on nurses who want to work abroad.
The move coincides with an alarming increase in nurses moving overseas - recruited by foreign agencies offering large salaries and the chance to escape dismal local working conditions.
It also follows news that foreign nurses are being lured to South Africa by a private hospital group with the promise of free bush safaris.
I have recommended to the state that they impose import and export duties on valuable human resources like nurses, said the chief executive of the Nursing Council, Hasina Subedar.
The foreign recruitment agencies are recruiting the cream of the crop at great cost to our country.
She said she had yet to receive a response from the Department of Health.
The Democratic Nursing Organisation of South Africa, a trade union, is calling for urgent pay increases for local nurses. But it says it will defend the right of nurses to go overseas because freedom of movement is their constitutional right.
Source: Sunday Times, 9 September 2001
Leading medical journals yesterday accused the pharmaceutical industry of meddling in tests of new drugs and said they would scrutinise clinical trials more carefully before deciding whether to publish their results.
The dozen signatories include prestigious media such as the New England Journal of Medicine, the Journal of the American Medical Association, the Canadian Medical Association Journal, the databank Medline and The Lancet.
In a joint declaration, the editors said it was vital for clinical trials - human tests of prototype treatments - to be conducted independently, to ensure product was safe.
But, they said, more and more pharmaceutical companies, eager to complete the costly process of getting a drug to market, saw trials as a regulatory hurdle or a mere tool for publicising the product.
The fight for funding had enabled pharmaceutical firms, through their sponsorship, to dictate the shape and outcome of a trial and even stifle broad disclosure of any unfavourable results, they said.
Investigators may have little or no input into trial design, no access to the raw data and limited participation in data interpretation, the editors said.
These terms may be draconian for self-respecting scientists but many have accepted them because they know that if they do not, the sponsor will find someone else who will.
Even if a researcher does have some control over the trial, there remains the risk that the results may be buried rather than published if they are unfavourable to the sponsor's product, they said.
The editors pointed to a case in 1999 in which US doctors who carried out the trial of an anti-HIV drug fell out with their sponsor, the Immune Response Corporation.
The researchers said that after results found the treatment was worthless, the sponsor withheld data that would have enabled them to complete the study.
The team went ahead with publication anyway. Their paper, which ran in the Journal of the American Medical Association last November, said the conclusions were based on final but incomplete data.
The joint declaration said meddling was most commonly associated with pharmaceutical sponsors but governments and government agencies were also prone to interfere if the results of a study ran counter to official policy.
The signatories are among the cream of medical journals. These publications play a key role in the multibillion-dollar pharmaceutical business.
Publication in their pages can seal or destroy the outcome of a years-long endeavour to design a new drug, influencing a pharmaceutical company's stock value.
The editors said they would set down ethical safeguards aimed at identifying any intrusion in a trial by its sponsors. The cost of bringing a drug to market in the US is about half a billion dollars.
Source: The Sunday Independent, 9 September 2001
Dancing, singing and laughter filled the marquee in which several hundred people gathered to attend the launch of Pharmacy Awareness Week 2001 in Orange Farm, south of Johannesburg, on Monday.
Health Department officials including Health Minister Manto Tshabalala-Msimang and representatives of the Pharmaceutical Society of SA and the SA Pharmacy Council gathered at the Stretford Clinic to mark the beginning of the commemorative week.
Tshabalala-Msimang said the day was a very emotional one for her.
I cannot explain, but this was my dream to see the launch of Pharmacy Awareness Week and promote drug literacy in the country.
The week's theme is Quality Pharmacy Care - Your Right.
It is our vision that all South Africans have access to affordable, good quality, effective healthcare and medication. In this endeavour, drug products are one of the main cornerstones, Tshabalala-Msimang.
She said it was crucial that the government and the pharmaceutical industry ensured patients and prescribers used drugs appropriately.
The pharmacy profession with its various specialities is a crucial profession in this regard.
Our department, through the current Medicine and Related Substances Control Amendment Act (1997) the Pharmacy Act (1997) and the National Drug Policy (1996), established a legal and policy framework that will ensure we have safe, quality and effective drugs in this country and ensure access to affordable essential medicines.
Tshabalala-Msimang said it was encouraging to the values and principles of Batho-Pele (people first) were captured in the rights the people had when visiting a pharmacy. She stressed that people be treated with dignity, be seen by a pharmacist who can be identified by name and who kept confidentiality regarding an illness.
Deputy president of the Pharmaceutical Society of SA, Siddiq Tayob said: We eagerly await the promulgation of the Medicine Act, Act 90 of 1997 as amended.
We hope that the government and the profession will come together and provide legislation which will empower pharmacists to perform their much spoken about professional role - a healthcare role that is far greater than the sale of medicines - in an equitable fashion and be remunerated appropriately therefore.
Tayob said pharmacists recognised the potential the Act had for patients and pharmacists.
The Pharmaceutical Society believed access to medicine was a fundamental human right.
Mariam Cassimjee, vice-president of the SA Pharmacy Council's Durban branch, said patients, particularly the majority who came from rural areas, needed to be educated and enlightened on all aspects including the need for medication for certain illnesses, nutrition and the responsibility to take medication timeously.
The Council hopes that this week will lead to a more brighter future for all and that everyone works more strongly together to build a pattern for care and individual responsibility which will lead to a better, healthier nation.
The crowds enjoyed the entertainment of traditional dancing, singing and performances from the Orange Farm community and school children.
New findings contradict President Mbeki's denial that the epidemic is the leading cause of deaths in this country
AIDS is now the single biggest killer of South Africans and will have taken the lives of about six million people by 2010.
A groundbreaking SA Medical Research Council report estimates that the deaths of 40% of all South Africans aged 15 to 49 last year were because of AIDS.
The July report, titled The Impact of HIV/AIDS on adult mortality in South Africa, contradicts President Thabo Mbeki's denial of AIDS being SA's leading killer.
Based on data from the Health Department's annual antenatal survey and the Actuarial Society of SA's AIDS model, the report documents rapid changes in SA's mortality data, with an increasing trend in the deaths of young adults since 1997, interpreted to be mostly caused by AIDS.
The report, which has not officially been released, but which the Sunday Times has a copy of, has already been seen by top government officials.
There seems to be confusion in government circles about the status of the report. On Thursday, Minister of Health Dr Manto Tshabalala-Msimang told a press briefing in Parliament that the researchers had worked alone outside the collective which had been established, something which worries us. This is despite an earlier statement released on Monday by the Department of Health, with the minister's name on it, that said the report was part of a broader process which had emanated from a recommendation by the Presidential AIDS Advisory Panel to compile current AIDS mortality figures.
This week it was also reported that in a letter to Tshabalala-Msimang, Mbeki had questioned government spending on AIDS based on 1995 mortality data he had found on the World Health Organisation website.
On the basis of 1995 figures Mbeki called for a re-examination of South Africa's spending priorities when it comes to social policy, warning Tshabalala-Msimang that this move would provoke a howl of displeasure and a concerted propaganda campaign from those who have convinced themselves that HIV/AIDS is the single biggest cause of death in South Africa.
Writing in the preface to the report, council President Dr Malegapuru William Makgoba, says that the denial of AIDS was predictably the first African public response to the epidemic.
He writes that in 1982, when the first cases of what was to become known as HIV/AIDS among homosexual men were discussed, the seeds of denial to justify why AIDS would not be prevalent in African communities were first sown.
When AIDS was first wrongly linked to homosexual practice many Africans promoted the notion that homosexual practices were 'unAfrican'."
He writes that even at that time he believed that the syndrome was more common than people believed in Africa.
Bheki Khumalo, spokesman for the President, declined to comment on issues of statistics or on why President Mbeki had not spoken to local researchers about South Africa's mortality data.
Source: Sunday Times: 16 September 2001
Although pharmaceutical companies have cut the price of AIDS medication, South Africa still cannot afford to provide the drugs through the public health system, the health minister said Thursday.
More than 4,7 million South Africans, 11 percent of the population, are HIV positive - one of the world's worst infection rates.
The government has drawn widespread criticism for not supplying antiretroviral drugs to those infected.
The budget I have for medicines is R2-billion, Health Minister Manto Tshabalala-Msimang told a news conference. If I were to buy antiretrovirals I would have to forget about everything else.
Tshabalala-Msimang said the government will oppose a lawsuit filed last month by AIDS activists and paediatricians aimed at forcing it to give the drug nevirapine to all HIV-positive pregnant women to reduce their chances of passing the virus to their babies during labour.
Nearly 200 South African babies are born infected with HIV every day, and studies show nevirapine can reduce that number by nearly 50 percent.
The government has established several research sites to test the effectiveness of the drug, but has said it cannot be administered without support for the patients.
Patients need counselling, follow-up treatment and assurances they would not be isolated from their communities, Tshabalala-Msimang said.
Last month more than nine thousand women visited the research centres and 6 400 of these had opted to be counselled and tested for HIV.
Zackie Achmat, chairman of the Treatment Action Campaign, said the government's opposition to the lawsuit was regrettable.
Every day the government delays (providing the drugs) will cost lives and those are lives they could have saved, he said.
Tshabalala-Msimang announced contracts worth R90-million had been awarded to two private communication consortiums, to shore up the government's AIDS prevention campaign.
There is no way we are de-emphasising HIV and AIDS in this country, she said.
Source: SAPA-AP, 14 September 2001
The King Committee on Corporate Governance has criticised the South African corporate community for having an inadequate understanding of the economic impact of AIDS.
In a statement on Monday, the committee called on company directors to move beyond putting HIV/AIDS policies in place, towards monitoring performance indicators and reporting to stakeholders on a regular basis.
The committee was formed in 1992 under the auspices of the Institute of Directors, to put the increasing global interest in corporate governance in the South African context.
The report's recommendations will become the Code of Corporate Practice and Conduct as from January next year.
The growing practical impact of AIDS on SA businesses is potentially huge. Some current indications show that over 20 percent of our country's economically active population will be directly affected by HIV/AIDS within the next five years, the committee said.
Tobe Hope, managing director of Group Solutions and Capital Alliance (CA), said directors needed to be aware of the full extent to which AIDS impacted on their business, while keeping HIV-infected employees healthy for as long as possible.
SA companies need to operate in a global environment and need to compete with companies that are located in countries where HIV prevalence and associated costs are lower, Hope said.
He said few employers made provision for the expected cost of HIV in their financial statements, mostly because the incidence of the disease amongst employees and the associated cost was unknown.
This insurance is designed to protect claimant confidentiality and to prevent possible discrimination in the workplace. Only aggregate claims data will be provided to employers, assisting them in adhering to some of the King Report's recommendations, said Hope.
He said it showed that the business sector could do more in addressing the HIV/AIDS scourge in the country.
CA's move has been met with the approval of members of the AIDS Consortium, Oxfam and all six leading trade unions.
CA will provide five percent of the profit from LifeAid to the Southern African HIV Clinicians Society to train additional doctors via an internationally accredited course on the epidemic.
Source: SAPA, 17 September 2001
Draft legislation that aims to take a new look at mental healthcare in South Africa is expected to be tabled in Parliament next week.
Briefing journalists in Parliament on Thursday, Health Minister Manto Tshabalala-Msimang said the Mental Healthcare Bill had been approved by Cabinet and was ready to be submitted to Parliament.
The proposals should come into law towards the end of the year or early in 2002.
The bill seeks to move the country away from a model that depended heavily on institutionalising individuals almost indefinitely to an approach that was more consistent with the Bill of Rights.
In April this year, on World Health Day, we committed ourselves to supporting the international WHO (World Health Organisation) campaign for the rights of all people affected by mental illness.
We pledged to break the chains of prejudice and fear that still exist. And I truly believe that this legislation is in the spirit of the undertaking we made, she said.
Amongst other things, the bill will replace the old system of committal of patients to psychiatric hospitals, with the concepts of assisted and involuntary care.
It provides for more regular reviews of patients in involuntary care to assess the suitability for discharge, and interprets how basic human rights are to be interpreted for individuals unable to exercise independent judgement.
The bill also seeks to allow for access to information on psychiatric hospitals and entitles individuals subject to involuntary care legal representation.
Source: SAPA, 13 September 2001
Eight more health professions are to be drawn into the community service net from 2003, Health Minister Manto Tshabalala-Msimang and her provincial counterparts have decided.
They are radiographers, physiotherapists, speech and hearing therapists, occupational therapists, environmental health officers, dieticians, clinical psychologists, and professional nurses.
The decision was made at a meeting between the minister and MECs in Cape Town at the weekend, ministry spokesman Sibani Mngadi said in a statement on Monday.
The new groups will join doctors, dentists and pharmacists, who already do a year of community service on completion of their academic studies.
The proposal to bring in the seven so-called scarce skills groups was mooted by the health department in late 1999, the year in which the first doctors began their service.
Mngadi said service for the new groups would be phased in from 2003, starting with the clinical psychologists and dieticians.
The last group would be professional nurses in 2007.
Mngadi also said the minister and MECs met representatives from university medical faculties at the weekend to discuss racial representivity among their students.
It said though some progress had been made, attention had to be given to the high level of student dropouts especially in the early years of their studies.
This had led to an imbalance in the output of graduates.
It had been agreed that faculties would be assessed separately to ensure that progress was made in all the institutions.
The institutions and the Department of Health are to meet to look at setting targets for recruitment, retention and final output to ensure that the medical profession finally reflect the demographics of the country in terms of race and gender, the department said.
The minister and MECs also decided universities should reserve space for 100 medical students from Southern African Development Community countries.
This programme - meant mainly for Botswana, Lesotho, Mozambique, Mauritius and Namibia, which did not have their own medical schools - would be phased in from next year.
South Africa was taking decisive measures to control tuberculosis and malaria, according to health minister Dr Manto Tshabalala-Msimang.
Addressing parliamentary correspondents, the minister said she would wait for the outcome of a forensic audit of the SA National Tuberculosis Association (SANTA) before deciding whether the department should investigate individual TB hospitals.
She said they were closing one hospital in the Eastern Cape because of its bad condition as well as suspending funds to SANTA’s Betterment and Community Service because there was an indication that this money was not going into targeted services.
Another challenge was the emergence of multi-drug resistant TB, which represents the legacy of poor treatment practices from the past.
Tshabalala-Msimang revealed that a national survey of TB drug resistance had been conducted to better understand the magnitude of this problem.
The minister identified Malaria as another major challenge with 10 percent of the population living in what is called malaria risk areas.
Malaria cases have increased steadily in the country since 1996 with the highest number of cases reported at 61 447 in the 1999/2000 malaria season.
However, with the re-introduction of DDT and the investment of an additional R39-million into the Lubombo Spatial Development Initiative, cases in the northern parts of KwaZulu-Natal were reduced by 70 percent.
The development initiative also led to a substantial decrease in malaria cases in Swaziland and Mozambique.
Tshabalala-Msimang said the successes in KwaZulu-Natal led to a decision to introduce DDT for malaria control in Mpumalanga and the Northern Province.
I would like to assure you that we are using the insecticide with much care to ensure that there is no threat to the environment, she said.
Source: Health-e News Service, 14 September 2001
The findings in summary are:
(Full text available from http://bmj.com/cgi/content/full/323/7314/670)
An article on allAfrica.com (http://allafrica.com/stories/200108310306.html) suggests that AIDS could orphan one third of Africa's children - already there are reported to be some 1.2 million children in South Africa orphaned as a result of HIV/AIDS.
The death of parents due to HIV/AIDS is leaving a growing number of children vulnerable and in need of care. The more fortunate are taken in by grandparents or other relatives, but this does not protect them from the a life of poverty where food and clothing is scarce and often they are turned away unconstitutionally from schools because they can't afford school fees. In this audio report produced by Health-e, we hear from amongst others, a young girl from the Northern Province. (http://www.health-e.org.za/view.php3?id=20010909)
At the 1990 World Summit for Children held in New York, world leaders designed a blueprint for improving the lives of children and women within a decade.
Their goals were straightforward: Reduce child mortality rates. Improve maternal health care. Cut malnutrition rates in half. Assure safe drinking water and access to sanitation for everyone. Deliver basic education to all children. Improve the protection of children.
Following the World Summit many leaders aggressively began the work that was called for, and the outcomes were impressive. Under-five mortality rates were reduced by 14 per cent. Neonatal tetanus was eliminated in 104 of 161 developing nations. Vitamin A and iodized salt were delivered to nearly 75 per cent of children.
But a decade that began with promise was marked by missed opportunities.
One third of all children were still not being registered at birth at the end of the year 2000, resulting in no official record of their existence and leaving them vulnerable to denial of health care and schooling. Around 30 million infants are still not reached by routine immunizations. In sub-Saharan Africa only 47 per cent of children are immunized against diphtheria, whooping cough and tetanus.
A third of the children in the world suffered from malnutrition during the 1990s. Children's malnutrition rates declined by only 17 per cent in developing countries rather than being halved. The drop in malnutrition in Asia was a mere 7 per cent. In sub-Saharan Africa the absolute number of malnourished children actually increased.
Today 1.1 billion people remain without safe water and 2.4 billion are without adequate sanitation.
The goal of universal basic education has not been achieved. Over 100 million children of primary school age are not in school and many more receive poor quality education. The gender gap leaves more girls than boys out of the classroom.
The maternal mortality ratio remains at 1990 levels instead of being halved. The goal for all pregnant women to have access to prenatal care and trained attendants during childbirth has not materialized. Only 29 per cent of South Asian births and 37 per cent of sub-Saharan African births are attended.
On balance, while there have been some notable successes since 1990, much more is needed from governments and individuals if the rights of all children are to be realized.
The report, State of the World’s Newborns, argues that high death rates could be reduced by such practices as exclusive breast feeding, keeping babies warm, and ensuring that there are skilled attendants at the birth. By combining these with other measures, such as ensuring that delivery environments are hygienic and that mothers receive basic health care and advice, thousands of unnecessary deaths could be prevented, it claims. The report is available from http://www.savethechildren.org/mothers/newborns_report.html
In Thailand, AIDS has now been acknowledged as the leading cause of death, overtaking accidents, heart disease and cancer. (Source: http://ww2.aegis.org/news/afp/2001/AF010886.html)
An article on allAfrica.com reports predictions that AIDS will claim 10 million southern africans by 2015 (Source: http://allafrica.com/stories/200109170081.html).
Stellenbosch University's Bureau for Economic Research (BER) cautions against a doomsday scenario, although the epidemic will affect the economy adversely.
The BER expects the labour force to shrink 21% by 2015 compared with an outlook without the disease. But the decline in economic production, employment and income is expected to be less severe.
The bureau says unemployed people replacing lost labour and companies using more productive technology should offset the effects of the labour force shrinking.
Cost pressures arising from the epidemic may create extra spending in the economy, as shifts in spending do not necessarily represent a reduction in gross domestic product (GDP).
It is still possible for inflation to average 7% over the next 10 to 15 years, and real interest rates may rise only marginally as a result of the epidemic. The BER says the current account on the balance of payments can still average under 2% of GDP, and the budget deficit below 3% over the study's 14-year period.
The effect of AIDS on GDP growth is expected to be gradual, with real GDP 1,5% lower by 2010 than in a no-AIDS scenario. By 2015, the effect is expected to be far more severe, as GDP may be 5,7% lower than it would be without AIDS. Over the 2002-2015 period, GDP growth rate is seen to shrink 0,5% annually.
The effect on the budget is also negative, with forced rises in health spending and related services.
Population growth is expected to fall dramatically. SA's population grew 1,4% in 2000, from 2,1% in 1990, and the population is expected to peak in 2007 and decline gradually after that. No growth is expected by 2009 and negative growth of 0,5% is expected in 2015. (Source: Business Day, 26 September 2001)
Dr Elvis Irusen, of the department of medicine, said this at the Nelson Mandela Medical School at the University of Natal in Durban on Wednesday.
He was taking part in a panel discussion on the AIDS situation in South Africa and a possible scenario in 20 years.
Dr Irusen said that 5 360 people had died of AIDS at King Edward Hospital between 1994 and 2000.
An idea of the scale of the epidemic could be gathered by multiplying this figure by the number of other AIDS-related deaths in South Africa in the past six years.
He said more women patients than male patients had died of the disease at King Edward. The percentage of deaths from AIDS was 73 percent of all the deaths in the hospital's medical wards in the period under review.
This percentage had remained above 70 percent for the six-year period, peaking at 79 percent of all deaths in medical wards in 1995.
Dr Irusen said the epidemic was causing additional stress on the already-stretched medical professionals at King Edward.
He said some of the data around HIV/AIDS was inadequate because researchers were faced with working with antiquated equipment provided by government sources.
Professor Salim Karrim, deputy vice-chancellor in charge of research and development, said South Africa had already gained much information in the past 20 years.
We have enormous opportunities now to deal with the disease, he said. What is missing is a national willingness and commitment to action.
Occupational health and safety practitioner Honey Allee asked: Must we have another disaster such as happened in the United States last week before we get a wake-up call about AIDS?
The incoming head of the Victor Daitz Foundation chair for HIV/AIDS at the medical school, Professor Jerry Coovadia, criticised the government for its lack of leadership in the fight against AIDS.
Coovadia said that, ideally, President Mbeki should take charge of a massive campaign to fight the disease. However, if he was too busy, he should appoint a charismatic figure to drive a campaign.
Coovadia said it was not essential to use a health professional to drive such a campaign. In Thailand it was an economist and in Kenya it was an advocate.
At present 4,7 million were infected. Coovadia said the country could afford the cost of between R3 000 and R4 000 for treating each patient with antiretroviral drugs.
Source: Patrick Leeman: Daily News, 21 September 2001
Calls for the release of the AIDS report by the Medical Research Council (MRC) grew louder yesterday after Gauteng and Free State announced HIV/AIDS was the biggest killer in these provinces. Gauteng Department of Health subsequently released a statement disassociating itself from this announcement [SAPA, 3 October 2001].
President Thabo Mbeki also came under scathing attack from political parties for his questioning of AIDS being the biggest cause of deaths in SA.
The Pan Africanist Congress general secretary Thami ka Plaatjie said Mbeki was not qualified to debate the AIDS issue and should leave it to experts.
We wonder whose interests Mbeki is serving. Scientific evidence cannot be challenged through political statements that are mostly thumb-sucked. We are also not aware of any medical qualifications he acquired to enable him to contradict scientific evidence on AIDS, he said.
Ka Plaatjie called on government to release the MRC report so its findings could be used as a basis to fight the scourge appropriately.
The withholding of the report leads one to suspect there is some sinister motive at play. We are sitting with a serious problem on our hands and there is no time for silly arguments too many lives have been lost already.
The Democratic Alliance health spokesman Kobus Gous said the two provinces deserved praise for their courage to come out openly about the seriousness of the situation, although it was contrary to government's line of thought: This is a welcome dose of realism and truth where mysticism and denial has been pervasive.
Gous said government's failure to release the report was ridiculous.
In addition to evidence reported on by Gauteng and Free State, there is a large body of other evidence proving the president wrong in his belief the focus on AIDS should be downgraded.
Despite this body of evidence, Gous said, government persisted in believing it could hide embarrassing information from the public indefinitely.
Inkatha Freedom Party (IFP) MP Ruth Rabinowitz said government was downplaying the AIDS problem.
We are not applying our minds urgently to the matter, she said.
Rabinowitz said that, although the IFP endorsed the call for the release of the MRC report, there was sufficient evidence to conclude AIDS was claiming more lives than any other cause.
We do not even need the (MRC's AIDS) report, people are dying in our hospitals, said Rabinowitz.
Source: Business Day, 4 October 2001
A coal-based drug, already on the market as a nutritional supplement, had improved the condition of HIV-positive patients, said Professor Connie Medlen, an immunologist at the University of Pretoria.
It is not a cure for AIDS. AIDS can't be cured at this stage, Dr Tony Surridge, acting chief executive officer of the Central Energy Fund subsidiary, Enerkom, told reporters in Pretoria.
The company does research in finding value-added products arising from coal. The drug, oxihumate-K, was developed by one of its employees, Dr Johan Dekker, Surridge said.
Tests on animals proved it to be non-toxic. Following those, the first phase of testing on humans took place at Kalafong Hospital near Pretoria, and the second phase was underway in Tanzania.
We don't say it kills the virus, said Medlen, who is handling the trials. It had brought about a clinical improvement in patients, although not those who were already seriously ill, she said.
Oxihumate-K stimulated the type of immunity necessary to cope with opportunistic infections, Medlen said.
It increases the quality and quantity of life of HIV patients, said Surridge. It could also prevent people from contracting flu and common colds, as it boosted the immune system.
The capsules were already marketed on a small scale as Oximate, a nutritional supplement. Plans were being made for the full commercialisation of the product once the tests had been completed successfully, Surridge said.
Source: SAPA, 1 October 2001
Not a single doctor reported to the Health Professions Council of SA (HPCSA) has been found guilty of misconduct, unethical or unprofessional behaviour for testing domestic workers for HIV without their consent.
The AIDS Law Project has brought several cases to the attention of the council, but according to attorney Anita Kleinsmidt not one case has delivered results. In many instances the HPCSA has taken so long to call a hearing that the patient has died, causing the file to be closed with no consequences for the doctor. In other instances the HPCSA simply stated that no improper conduct had been found. Many employers insist that domestic workers must be tested for HIV because of their fears that HIV can easily be transmitted in the household.
It is, however, medically well established that there is virtually no risk of HIV transmission where a domestic worker with HIV has cleaning duties or prepares food. In order for HIV to be transmitted, there must be a substantial exchange of bodily fluids (blood, semen, vaginal fluids and possibly saliva). It is therefore clear than there can be no transmission of HIV when a domestic worker washes dishes, does the laundry or cleans the toilet. A doctor may not test a domestic worker on the instructions of a second person (employer).
The doctor must obtain the domestic worker's informed consent, without which, the doctor acts illegally and unethically and is liable to disciplinary and legal action. An employer who deceives a domestic worker (or an applicant for such a position) into taking an HIV test opens himself/herself to action under the Labour Relations Act. This Act recognises job applicants as employees. Myrtle Witbooi, General Secretary of the Domestic Workers' Union (DWU) said that many domestic workers were being exposed to HIV tests without their knowledge. They are told they are receiving a flu injection, in the meantime they are undergoing an HIV test, Witbooi said. She said many workers were reluctant to take the cases further because they did not want to lose their jobs.
Many employers are also asking domestic workers to produce certificates proving that they are HIV negative when they interview them with the view of employing them, said Witbooi. Many domestic workers are losing their jobs because they are HIV positive. The HPCSA confirmed that it had a number of formal complaint cases that related to breach of doctor/patient confidentiality with regard to HIV/AIDS patients, but declined to give specific numbers or details.
Spokesperson Thola Nzusa said that at this stage they had not found any of the doctors guilty because they are pending professional conduct inquiries (disciplinary inquiries) into some of the cases. She confirmed there were cases that were finalised at a preliminary stage where the Preliminary Committee of Inquiry noted the explanation of a doctor and thus resolved not to proceed with disciplinary action. She did not elaborate on what explanations were offered. Nzusa explained that the role of the Preliminary Committee was to determine whether or not, on the basis of a complaint lodged, there was a prima facie case to hold a formal disciplinary inquiry.
She said the HPCSA had published a set of guidelines in which it was clear that the status of the HIV patient was confidential unless the patient gave permission for disclosure. The doctor may reveal the HIV/AIDS status of the patient only when convinced that non-disclosure may endanger the life or health of other individuals. The practitioner concerned must, however, thoroughly counsel the patient to that effect in an attempt to persuade the patient to consent to disclosure, Nzusa said.
HIV cannot be transmitted by hugging or holding another person. Employers often insist that it is in their children's best interest that the domestic worker employed by them be tested for HIV. If this reasoning is followed, then every individual who comes into contact with children should be tested for HIV (parents, grandparents, extended family, friends, teachers, food preparers).
Domestic workers may refer a dispute on the grounds of discrimination to the CCMA. In the context of HIV testing, a dispute against the employer by a domestic worker can either be lodged when the employer insists on an HIV test or once the test has been carried out. When a domestic worker is dismissed because of HIV status, it is doubtful that she or he would seek reinstatement. It is clear though that they would be able to claim compensation if they had been tested illegally and unfairly or where they were incorrectly informed that HIV testing is a prerequisite for employment. The compensation awarded depends on the circumstances of each case. If an employer dismisses a domestic worker solely on the grounds of HIV status, the dismissal is unfair and it can be challenged as unfair discrimination or as an unfair labour practice.
The dismissal will amount to unfair discrimination if it can be established that:
If a domestic worker is permanently unable to work because they are incapacitated through full-blown AIDS, an employer may be allowed to dismiss the employee. The decision cannot be unilateral and there must be proof of consultation with the employee as well as proof of ill health. Even if it is established that the domestic worker is suffering from ill health and is unable to continue working, there must be a fair procedure for the dismissal. Without a fair hearing the dismissal can still be unfair. Without proof of incapacity and without a fair hearing, an employer cannot dismiss a domestic worker.
Source: Health-e News Service, 2 October 2001
A programme that would seek to provide counselling and medication to employees in the Office of the Auditor-General who were HIV-positive or had AIDS was launched in Pretoria on Monday.
Chief executive officer Terence Nombembe said the Employee Assistance Programme (EAP) also comprised a helpline for HIV/AIDS-infected employees. The 24-hour tollfree number is 0860446688.
We believe that this helpline is a key weapon against the spreading of HIV/AIDS. It is a proactive measure that seeks to deal with this scourge on the ground.
Nombembe said professional counsellors had been employed to work as operators to provide help and information to callers. Medication would be supplied on request.
The programme was designed to help the office record the number of employees infected and affected by HIV/AIDS.
Yet, we do not know how much is this epidemic a threat to our human resources because in the past we did not set up mechanisms to deal with it, Nombembe said.
Our employees are the centre of the office's operations and functions. If we do not strive to harness them, we will be non-existent in a few years time.
He said the EAP would function in line with the office's HIV/AIDS policy that also provided for HIV/AIDS education to employees.
The policy ensured that fair and confidential treatment of infected staff was available. It also called for infected staff to be informed of their rights without risk of being labelled, Nombembe said.
South Africa is training sufficient doctors for its needs, but they do not include enough blacks or doctors prepared to serve in rural areas, Parliament's Health Portfolio Committee has been told.
The country's medical schools should be producing about 1250 doctors a year, said Professor Thanyani Mariba, acting president of the Health Professions Council, who is dean of the Medical School at the University of Pretoria.
The numbers we are producing are sufficient for this country, so we do not have a shortage of doctors in South Africa. What we have is a maldistribution, where the doctors are concentrated mainly around Gauteng, the Western Cape and other urban areas.
But there remained a gap between blacks and whites studying for the medical professions. Last month the Health Ministry called together deans of the medical schools claiming the number of black students was not increasing enough.
This we are aware of. This policy has been in place six or seven years, and the Ministry was very unhappy that the University of Stellenbosch had only two black students, said Prof Mariba.
Prof Mariba said that in the past black students with qualifications in mathematics and science could train to become doctors or nurses. Now other fields were open to them, such as engineering or IT professions.
Therefore universities had to fight over the pool of black students who qualified with science and mathematics to enter university - about 5 000 last year.
Source: The Citizen, 3 October 2001
An increasing number of women are being diagnosed each year with breast cancer and the condition has become the most common among all South Africans.
About 3 800 women were diagnosed with breast cancer this year alone. The condition is most prevalent among whites and Asian women.
Breast cancer brings with it emotional trauma as it strikes immediate fear into the hearts of women. Unlike many other types of cancers, it affects self-image, Health Minister Manto Tshabalala-Msimang said yesterday when she marked October as Breast Cancer Awareness Month.
Breasts have always been seen as symbolising the femininity of women, and the thought of losing a breast makes most women very uncomfortable. Emotional support and understanding from their partners and loved ones is an essential element of recovery, she said.
About 90 percent of patients survive for many years after diagnosis when breast cancer is detected at the early stages. Early detection of the condition can lead to effective treatment and a positive prognosis can prevent unnecessary deaths, according to experts.
The department will host a series of awareness campaigns across the country to educate the public about the need for regular self-examination, to have regular mammograms and to provide information about early symptoms and the various treatment options available.
The department will work with the public and private healthcare structures in its drive to raise awareness of the debilitating disease across all races and class structures.
It is essential to inform the public that early detection will result in more effective treatment, leading to a significant decrease in the loss of life, said Tshabalala-Msimang.
Source: Sowetan, 3 October 2001
Prices for AIDS drugs will become more affordable with the announcement this weekend of two initiatives aimed at cutting the cost of the most frequently prescribed antiretrovirals.
Multinational pharmaceutical company GlaxoSmithKline (GSK) said yesterday it was granting a voluntary licence to local firm Aspen Pharmacare to produce AZT and 3TC - as well as the combination pill Combivir exclusively for the public sector.
The deal also obliges Aspen to pay 30% of the net sale price to non-governmental organisations dealing with HIV/AIDS.
At the same time Cipla-Medpro, the local associate of Indian pharmaceutical manufacturer Cipla, has submitted a complaint to the Competition Commission alleging that GSK and Boehringer Ingelheim abused their patents. Cipla manufactures Nevirapine, an antiretroviral drug that helps to prevent the mother-to-child transmission of HIV. Cipla-Medpro CEO Jerome Smith said late last night that the complaint might now have to include Aspen Pharmacare.
The only real market in SA for antiretroviral drugs has been in the private sector as government has consistently refused to provide the life-prolonging drugs to public sector patients who could not afford them.
GSK has kept the lucrative - albeit small - market that includes medical aid schemes and larger buyers, like mining or manufacturing companies like Ford or DaimlerChrysler.
The Cipla action is groundbreaking and challenges the way the patents have been used by both companies to keep drug prices high.
Cipla has chosen to challenge the patents through the commission initially, but it will use the Patents Acts if necessary.
Cipla's complaint says that the patents and licence-holders qualify as a dominant firm in terms of the Competition Act, and claims that they have abused that dominance.
The patentees and all the licencees charge an exorbitant price for the relevant pharmaceutical products to the detriment of consumers, according to the complaint.
The claim argues that people with the virus or those who have been exposed to it are obliged to pay the sum demanded by these patentees and licencees".
At the time the complaint was filed, Cipla was unaware of the details of GSK's move, but Smith believes that the move will not impede his complaint.
He says it appears as though Aspen and GSK are now acting in concert. However, he felt that any move that sought to make much-needed drugs accessible was to be welcomed.
James Love, director of the Washington-based consumer project on technology, believes that GSK needs to be challenged further on its drug policy for the private sector, and says that the competition which the Cipla action will bring, will see prices lowered further.
The complaint describes the prices charged for the drugs until recently, as well as the prices at which these drugs could become available through Cipla.
The Indian parent company offered substantial reductions on the prices earlier this year.
The drug known as 3TC in a 150mg dose of 60 tablets would have cost R12 000, while Cipla would have supplied the same drug for R195,46.
Aspen CEO Steven Saad said he did not have exact prices yet, and that much would depend on the demand.
However, industry sources said that the prices likely to be charged would be considerably higher than Cipla's offers.
The Cipla case also claims that the patent-holder has entered into exclusive licensing agreements with both GSK and Boehringer Ingelheim, which exclude other entities from marketing the same products in competition.
Source: Business Day, 8 October 2001
Anglo American, the London-based resources group, cannot afford to supply antiretroviral drugs to all its HIV/AIDS infected workers in South Africa, according to the company's medical department.
Brian Brink, Anglo American's senior vice-president (medical), said the company's 14 000 senior staff would receive antiretroviral treatment as part of their medical insurance, but that the provision of drug treatment for lower income employees was too expensive.
About 21% of Anglo American's employees in South Africa are HIV-positive. The company employs 160 000 people in sub-Saharan Africa, the bulk of them in South Africa, which has one of the highest HIV/AIDS infection rates in the world with about 250 000 people forecast to die of related diseases this year.
The obstacles to providing therapy are huge. The more I look at it, it's not possible, said Brink. Medicines at cost were too expensive, strict adherence to drug protocols uncertain and the extent of a company's obligation to treat current and ex-employees and their dependants too daunting, he said.
An antiretroviral treatment costs about R1 500 a month.
It could save on absenteeism and improved productivity. The saving you achieve can be substantial, but we really don't know how it will stack up. We feel that the cost will be greater than the saving, he said.
Anglo American hopes to launch a pilot project in partnership with GlaxoSmithKline, the UK pharmaceutical company, and the London School of Hygiene and Tropical Medicine, before the end of the year.
But for wider distribution of drugs to employees and their dependants, Anglo American said it would have to seek additional funding from international donor agencies.
GlaxoSmithKline showed its willingness to help South Africa at the weekend by giving the rights to its latest HIV/AIDS medicines to a local generic producer to encourage greater access to treatment.
The government has insisted that HIV/AIDS drug treatments are too expensive for provision through the public health system.
Most large employers, including mining companies, have also shied away from costly commitments to providing antiretroviral treatment, restricting their use to pregnant mothers and children.
On Monday, GlaxoSmithKline was among a number of UK drugs companies that met Clare Short, British minister for international development, in an effort to negotiate a system that would make a broad range of medicines more affordable to developing countries.
The companies say they want to see safeguards to stop cheap drugs filtering back to developed markets.
Source: Financial Times via Business Day, 9 October 2001
The Medical Research Council (MRC) was free to release its controversial report on the number of South Africans dying as a result of HIV/AIDS, the cabinet said yesterday.
Government has been accused in recent weeks of keeping the report from the public because of dramatic revelations in it about the fatality rate as a result of AIDS.
The report's results were in sharp contrast to the 1995 figures used by President Thabo Mbeki in a letter to Health Minister Manto Tshabalala-Msimang, in which he asked her whether the spending priorities of her department were correctly focused.
The statement released yesterday said the (cabinet) meeting had also examined the report of the MRC on the impact of HIV/AIDS on adult mortality in SA. The meeting noted the interdepartmental task team and Statistics SA expressed concern on the methodology and findings of the report.
Chief government spokesman Joel Netshitenzhe said cabinet had decided the MRC could release its report and Stats SA would explain its reservations.
Stats SA released a statement later saying it had difficulty with the MRC's contention that 40% of adult deaths were as a result of HIV/AIDS. It said there was a wide range of reasons for the gaps in knowledge about HIV/AIDS. For example, HIV/AIDS is not a notifiable disease. Therefore it is difficult to trace the disease and its manifestations from its origin.
Stats SA said the antenatal clinic tests used to establish HIV prevalence in the population were not necessarily a representative sample.
The only way of proceeding was to resort to demographic modelling. It welcomed the MRC report because it contributed to the debate but warned that the model had built-in risks, like the difficulty in testing underlying assumptions, and data possibly being inaccurate or unrepresentative. The main problem with the MRC model is the calculation of the probability of transmission.
Malegapuru Makgoba, the MRC president, said last night he had not yet studied the comments from Stats SA and would respond fully when the MRC released its report.
The comments by Stats SA reflect a long-running dispute between it and the MRC on mortality figures. Makgoba told Business Day last week this dispute had ended but clearly it has not.
Source: Business Day, 11 October 2001
The HIV/AIDS epidemic means that even real growth in future health budgets will not be adequate to deal with the increase in demand for services and the effects of the syndrome on health resources.
The 2001 Intergovernmental Fiscal Review contains a comprehensive assessment of provincial and local government budgets and expenditure patterns, with particular reference to education, health, social development, housing and roads. It noted that patients admitted to public hospitals with HIV/AIDS-related problems had grown substantially and were progressively displacing other patients, as hospital outputs had not increased significantly.
Provincial governments were estimated to spend about R4bn on HIV/AIDS, and the report said the effect of the disease is becoming more visible and is likely to be felt severely in the provincial and local spheres. It added that: it is clear that the current social safety net is not adequately designed for dealing specifically with the impact of HIV/AIDS on households and to confront the complex interaction between HIV/AIDS and poverty. There has been close interaction between the department of health and national treasury recently to ensure that programmes to confront the disease are expanded to the required scale in coming years. Apart from HIV/AIDS, the report highlighted the stark inequities in health provision between provinces.
Excluding central funding for hospitals, per capita expenditure on health services in Gauteng was nearly twice that of Mpumalanga and 1,6 times higher than that of Northern Province. Hospital beds ranged from 3,49 per 1 000 people in Gauteng to 1,82 per 1 000 in Mpumalanga. Hospital admissions ranged from 155 to 85 per 1 000, and there was unequal access to specialists with Mpumalanga having 0,9 specialists per 100 000 compared with Gauteng's 30,9. And while there had been progress in the quality of primary healthcare services, significant inequity remained and the report urged further investigation into the real budget decline in allocations for primary care over the next three years.
An audit of health facilities in 1996 found a third of hospital facilities required replacement or major repair. This was estimated to have reached about 40% in 2000 and estimated then to cost R12bn over eight to 10 years. Provincial health expenditure grew by more than 2% in real terms in 2000/01 after real declines in the previous two years and was projected to continue rising over the period from 2000/01 to 2003/04 by an average of 1,7% a year. All provinces, except Western Cape and Eastern Cape, would see real growth in health spending over this period, with the bulk of real growth in non-personnel expenditure, which was set to grow in real terms by about 3,5% a year. Health capital expenditure was projected to increase from 4, 1 % of expenditure to 8,9%.
Source: Business Day, 10 October 2001
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