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Increasing access to medicines 145
were intended. Furthermore, those that do have access to
public sector health facilities usually end up queuing for hours,
and are often turned away, trying to get even the most basic
medicines. Not surprisingly, in 2000 the World Health
Organisation (WHO) ranked South Africa’s health-care system
175th out of the 191 member countries.
There is also a great deal of theft in public hospitals. For
instance, in Mpumalanga province, 46 medical professionals
ended up behind bars in the first two months of 2003,
charged with the theft and resale of government medicines
meant for the rural poor in Mpumalanga. Those arrested
included a manager of a rural hospital, doctors, pharmacists
and medical technicians as well as a syndicate of ‘bag men’
who delivered stolen drugs, including birth control pills, pain
killers and antibiotics, to private doctors.
The medicine shortages caused by the syndicate’s medicine
thefts reportedly prevented routine operations from being
performed, and complicated the day-to-day treatment of
patients at the Rob Ferreira and Themba hospitals in Nelspruit,
the capital of Mpumalanga. 14 The extent and nature of theft
and corruption in the public health system reinforces the severe
shortcomings in hospital management, administration and
control systems.
The South African drug regulator, the Medicines Control
Council (MCC), is notoriously inefficient and tardy with its
approval process. On average, drugs that have already been
registered for use in the US, EU and Japan can wait for 39
months to be approved by the South African system. A further
barrier to access in South Africa is Value Added Tax
(VAT). The SA government continues to charge VAT on
pharmaceuticals despite the fact that the tax is highly regressive
since it disproportionately affects the poorest members of
society.
If the South African government is serious about increasing
access to medicines to the poorest of the poor, then they will