In a little over 20 years since South Africa
underwent a peaceful transition from apartheid to a constitutional democracy,
considerable social progress has been made toward reversing the discriminatory
practices that pervaded all aspects of life before 1994. Yet the health and
well-being of most South Africans remain plagued by a relentless burden of
infectious and non-communicable diseases, persisting social disparities, and
inadequate human resources to provide care for a growing population with a
rising tide of refugees and economic migrants.
Even though South Africa has the
largest economy on the continent, a quarter of its people live on less than a
dollar each day.
Social grants have reduced absolute
poverty, but 45% of the population still lives on approximately $2 per day (the
upper limit for the definition of poverty). More than 10 million people live on
less than $1 per day — the so-called food poverty-line below which people are
unable to purchase enough food for an adequate diet. Even at an income of $4
per day, the quality of life would not be remotely near the level that the
majority of South Africans had hoped for after the end of apartheid. Relative
poverty has become worse, with the Gini coefficient increasing from 0.6 in 1995
to almost 0.7 in 2009, we can only imagine the level of poverty now in 2017.
Reflection on some major health challenges
and recent trends in health, wealth, health care, and health care personnel
provides dire glimpses into near future prospects. South Africa, with 0.7% of
the world's population, accounts for 17% of the global burden of human
immunodeficiency virus (HIV) infection. The devastating effects of the pandemic
on the lives of individuals, families, whole population groups, and society in
general has received special attention. This is clearly visible in mining areas
of the country, and the trend should be confronted with acute strategic
interventions which often require commitment from the corporate sector.
Health should be considered within the
broader context of direct and indirect links between wealth and health,
although these relationships are complex. When extreme poverty affects a large
proportion of the population, as in South Africa, health is predominantly
affected by a lack of access to the basic requirements for life — clean water,
adequate nutrition, effective sanitation, reasonable housing conditions, access
to vaccinations, good schooling, and the childhood and adolescent nurturing
that, with the availability of jobs, set the scene for improved health and
longevity.
OXFAM recently reported that The top 10% of
South Africans earn 58% of the total annual national income, whereas the bottom
70% combined earn a mere 17%. These disparities, the widest in the world, are
associated with what is often termed ‘diseases of poverty’.
The persistence of
such disparities is incompatible with improvements in population health, and
that would beg the question, what direct implications do these disparities have
at a microcosmic level of municipalities such as Merafong Municipality and even
towns such as Fochville? Many of the municipal hospitals and clinics are in a
state of crisis, with much of the public health care infrastructure run down
and dysfunctional as a result of underfunding, mismanagement, and neglect.
The municipal management of Merafong City
has regrettably been quite inundated and characterized by many personages of
disrepute, including those in leadership positions, who have been co-opted into
the lavish lifestyles, wasteful consumption patterns, and nepotism that
frustrate the ethos required to reduce inequities in our communities. It would
therefore be essential to address the municipality as a whole in my quest to
sequester an inkling of empathy from the well-off on behalf of the depraved.
Our townships are sick, and appropriate
responses to Merafong City’s health care challenges would be to address the
social determinants of health (which lie outside the health system) as a
municipal over and above a national priority, strengthen the health care system,
and facilitate universal coverage for health care. The local Mining Companies
are first and foremost the culprits who should be engaged on issues of social
development more vigorously before they pack their bags of jewels and emigrate
to international greener pastures. As corporate institutions with
constitutional obligations for developing host communities, they should be
mandated to created avenues for funding the training essential health care
practitioners such as Nurses and Community Health Workers.
Nurses have long been central to health
care, especially in underdeveloped areas where physicians are reluctant to
practice. Between 2003 and 2012, the total number of nurses in all categories
on the Nursing Register increased by more than 40%. Although many registered
nurses may not be practicing there is still a dire shortage of qualified nurses
in areas such as Merafong, and Community health workers who are recognized as a
means of improving access to health care and encouraging community participation
in health care in peri-urban, are mostly are employed by nonprofit
organizations.
Concerted action will be needed to
strengthen our district-based primary health care system, to integrate the care
of chronic diseases and management of risk factors and to develop a municipal
surveillance system with the goal of applying well-managed and cost-effective
interventions in the primary and secondary prevention of disease within whole
populations. Merafong requires at least three times its current health workforce
to provide adequate care for patients with HIV/AIDS. The recent thrust toward
training more community health workers (without the support of mining
companies) and the successful development of front-line worker–based programs
to control tuberculosis and HIV infection offers considerable promise.
Increasing the number of health care
professionals and reshaping health services pose major challenges and the wide
gap between planning new training schools and making these functional will not
be easily traversed without the mining industries in the region. One of the
first priorities must be to resuscitate and strengthen existing facilities and
to strive for high-quality teaching, conditions of service, and an ethos of
care in clinical services (at all levels) that, in synergy, could foster the
dedication of health care professionals to provide services with excellence,
rather than merely seek the security of a job and a salary.
Given the different strengths and
weaknesses of the public and private health care sectors, any strategic
alliances forged with the private sector to improve health care services in the
public sector will have to be mutually agreeable while biased toward strengthening
the public sector in the national interest.
It is in this light that I propose that
each mine operating in the region construct world class health infrastructures,
such as well-equipped and professionally staffed clinic for public health care.
·
Each mine must construct a
fully functional clinic, with priority being made to pediatric clinics for the
growing number of single mothers and water borne diseases which are threatening
the lives of little ones.
·
All eleven mines can gunner
support and funds to construct six world class hospitals which can
accommodate and services communities
from Merafong City, Westonaria and Randfontein Municipalities.
·
All eleven mines must each fund the
construction and refurbishing of a single boarding school, which will cater for
the young, provide them with environments conducive to high quality learning
without the distractions of township poverty and moral degeneration.
The sustainable contribution of the youth
to local community development relies to a large degree to corporate support and
with regards to a strategic intervention, Multi Purpose Community Centers are
essential for recreation and knowledge generation, which requires resources
combined with well-managed infrastructure. These MPCC’s can function as a precinct
where a variety of innovative activities that are people-oriented, community-minded,
programme-oriented, professionally solid with well-trained personnel and above
all, children-friendly, can be executed to play a major role in the development
of Merafong as a whole.
While our municipality should tirelessly
strive for the development and promotion of sustainable youth activities, such
as skills development training, tertiary education sponsorships and even arts
and culture support for the many creative talents boasted by the region, and
the mines can play a crucial role in the achievement of these goals.
The contribution of quality education in
advancing development is unquestionable the world over, and our youth need
education and vocational training so they can make the most of their country’s
assets and opportunities availed by progressive municipal structures. In every
township there are ‘open spaces’ that are left abandoned are at risk of
physical decay or redevelopment, and they can represent a loss of opportunity
to revitalise structures that contribute to the identity of a community and
its social traditions. These spaces can cater for a variety of recreational
facilities, such as parks and playgrounds as one effective way of ensuring that
the interests of children are given consideration.
Cultural diversity and the appreciation
thereof has been at the forefront of our identity as a country, but in light of
recent xenophobic attacks one is left to wonder whether the issue has rather become an issue of business survival and
business viability of local business entrepreneurs.
It is here that MPCCs can play a critical
role in educating our communities about other cultures; a space which will
boast a library with a diverse compendium of literature, a gallery which will
host various communal artworks and a performance space for all the poets,
thespians and dancers who are around every corner. And as the youth are the
voice of cultural diversity, untainted by norms and traditions; they should
therefore be prioritized as Robert Sobukwe had advised.
If we want our youth to inculcate an
entrepreneurial acumen that will contend with many business models employed by
more frequently our foreign economic migrants, we should as a municipality be
looking at developing learner-ships that will enrich business knowledge and
therefore business viability in our communities. The mines can benefit
immensely by investing in this aspect of human resources development; and as
centers of interaction of various cultures they can also play an important role
in maintaining peace among the various groups employed.
Peace is essential for happiness and joy in
the family, in the community, in the society, in the nation and in the world.
Our world is troubled in many ways today and peace is threatened so often
because people do not understand their neighbours. The mines can engage in
communal conflict resolution and reconciliation as essential elements for the
attainment of sustainable peace and unity. They can, through their programmes
and activities, reconcile the various interests in the society for the
collective good of the nation; they can use their unique positions to reach the
conscience of the nation and to foster dialogue, and they can become rallying
points for the country in ensuring that peace is enthroned.
