Monitoring equity and research policy

Several prominent demographers and scientists have vigorously refuted Health Minister Manto Tshabalala-Msimang's claim that South Africa's HIV epidemic is declining and that the country 'may be making some real progress in its response to the HIV epidemic'. Tshabalala-Msimang's statement was based on a national survey of HIV prevalence among pregnant women, which researchers are describing as deeply flawed. The authors detected a problem when they noticed that changes in prevalence by age group did not tally with the change in overall prevalence, and that district figures were inconsistent with provincial estimates. They deduced that, in the 2006 survey, the results from district antenatal clinics were simply totalled to derive prevalence estimates for the country's nine provinces, but, in the 2007 survey, the health department began weighting provincial figures according to age groups, based on general population estimates for age distribution.

The South African Child Gauge monitors the realisation of children’s rights and is published annually. Key features include: legislative developments affecting children; child-centred data tracking children’s access to social assistance, education, housing, health and other services; and a series of essays to inform, focus and sometimes direct national dialogue and debate. While South Africa is making progress towards meeting the Millennium Development Goal (MDG) target on sustainable access to safe drinking water, this has not trickled down to children – only 64% of children have access to safe drinking water on site. Progress has been slow for access to basic sanitation, education and gender equality. On the MDG targets for reducing child hunger, HIV, tuberculosis and child mortality, South Africa is not making any progress, according to the Gauge. South Africa has also failed to submit its reports on progress in relation to implementing the UN Convention of the Rights of the Child – the key accountability mechanism aimed at monitoring South Africa’s progress in promoting the maximum survival and development of children. The report further notes that South Africa is one of only twelve countries worldwide that has failed to reduce child mortality since 1990.

The South African Government is to allocate more funds to health research over the next decade and add clinical research centres to hospitals earmarked for revitalisation so that it can build relevant evidence-based knowledge into the public health system. Deputy Minister of Health, Dr Gwen Ramokgopa, said that her department was currently spending 0.6% of its budget on health research, less than the 2% minimum it committed to in its 2001 health research policy.

Two of the most important targets to achieving the United Nation’s Sustainable Development Goals (SDGs) for reducing violence and other injuries are Target 3.6: to ‘halve the number of global deaths and injuries from road traffic accidents’ by 2020; and Target 16.1: the significant reduction of ‘all forms of violence and related death rates everywhere’. Police statistics on homicide, and transport deaths from the Road Traffic Management Corporation, are considered to be under-reported and are not a reliable source for monitoring SDGs. In South Africa (SA), vital statistics data are the only routine source that captures unnatural and natural deaths through death registration. Since the early 1990s, focused initiatives have identified and addressed deficiencies in the completeness of death registration and recent estimates indicate that completeness for persons aged ≥2 years is >90%. However, there are still concerns about the quality of data relating to the cause of death, i.e. under- reporting of HIV/AIDS deaths owing to misclassification to other causes, a large proportion of deaths with ill-defined causes, and the validity of single-cause data. The misclassification of injury deaths is another major limitation. The Inquest Act of 1959 precludes forensic pathologists from reporting the manner of death, i.e. whether it is due to homicide, suicide, transport or other unintentional injuries, on the basis that it may prejudice the findings of the inquest. Homicides are therefore grossly under-represented in official vital statistics. The misclassification of injury deaths was clearly demonstrated in a nationally representative study of injury deaths presenting to state forensic mortuaries in 2009. The absence of information on the manner of injury death in the official statistics needs to be addressed urgently. A review and possible amendment of the Inquest Act would possibly take years. The authors recommend that the death notification form be amended in line with the updated World Health Organisation’s recommendation, to include a stand-alone field for information about the manner of injury death for unnatural causes. Forensic pathologists when uncertain can include a proviso stating that such information is for statistical purposes only. This matter is currently being discussed with relevant stakeholders.