Building Solidarity – An opportunity to reflect on a whole society response
As we commemorate World Aids Day on 1 December 2020, we remember all those we have lost as a result of HIV/AIDS, the families and communities impacted by this disease and their loss. We salute all those on the frontlines both in service and mobilisation – our only defence for the future is solidarity.
World Aids Day offers an opportunity to reflect on the collective strides that have been taken in ensuring accessible treatment and dismantling stigma around HIV/AIDS in South Africa and the SADC region. It is also a moment to look ahead at how we respond to communicable diseases. The COVID-19 pandemic, again, made clear that disease does not discriminate. Notable efforts were made to ensure that vulnerable communities were protected during the COVID-19 and subsequent lockdown, for example, with the top-up of the Child Support Grant. However, responses by the state and its institutions have perpetuated exclusion and re-emphasised historical inequality. There are lessons here which are essential to remember as we plan for the future of South Africa’s public health systems – ensuring that our responses to health do not discriminate.
We must use this time to continue to advocate for universal health treatment – fundamentally, a system that provides healthcare to everyone. The attempt to introduce a National Health Insurance (NHI) Bill can, in essence, be supported. It aims to ‘achieve universal access to quality health care’ services in the Republic in accordance with section 27 of the Constitution. But until significant structural and organisational change is brought to the current health system, the NHI is nothing but a chimera. Public knowledge of widespread corruption, financial misconduct and mismanagement, which if not dealt with adequately, will prevent the realisation of the NHI and continues to threaten the health of all who are living in South Africa. Public health responses must be whole society responses.
There is work to be done – the current draft of the NHI is still purporting to exclude certain populations from universal coverage – refugees, asylum seekers and migrants, therefore undermining its fundamental aim.
Jesuit Refugee Services health care workers have seen first-hand the consequences of exclusion on their patients and their communities. Recent changes to the fee-paying schedule in Gauteng clinics and hospitals has meant that refugees and asylum seekers have been classified as private patients and pay increased consultation fees – making these services inaccessible. This has for some clients meant that they are unable to go for their regular doctors’ appointments. Being unable to collect prescriptions has, for some, meant defaulting on medication and worsening of their condition. The health of one affects the health of all.
Both the HIV/AIDS epidemic and the COVID-19 pandemic provide a moment for reflection as to how we respond next. Perhaps widening our community and thinking about shared responsibility and solidarity across the region? Regional problems require regional solidarity. Can migration and movement be normalised and integrated into our health responses? How can we ensure that health responses are an opportunity for ensuring equality rather than perpetuating inequality?