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South Africa: South Africa Health Profile



health professionals in South Africa


SA's mortality rate at its lowest in over a decade

Tuberculosis remains the leading cause of death among South Africans, according to data released by Statistics South Africa (Stats SA) on Tuesday. The Mortality and Causes of Death Report shows that HIV has risen to become the third leading cause of death in the country. It was in sixth position in 2012.

But Statistician General Pali Lehohla said the rise was because recording deaths from HIV had improved, not because it was actually an increasing cause of death.

Lehohla said Stats SA and the Medical Research Council had helped to train doctors in cause-of-death-certifcation, which had resulted in more accurate reporting.

Death certificates

The report is based on data collected by the Department of Home Affairs through the death registration system. The data comes as South Africa commemorated World Aids Day on 1 December. About 6.4-million South Africans are living with HIV/AIDS, according to the Human Sciences Research Council.

"The number of people that are dying in South Africa has declined … over time," Lehohla said. The report found that 458&933 people died in 2013 – 6.5% down from 491 100 deaths recorded in 2012. It is the lowest number of deaths since 2002, when 502 797 deaths were registered.

The report found that more males were affected by HIV than females in 2013.

In 2013, the majority of deaths resulted from the main group of certain infectious and parasitic diseases (22,6%), followed by diseases of the circulatory system (16,7%).

Tuberculosis (8.8%) remained the leading cause of death among South Africans, followed by influenza and pneumonia (5.2%), HIV (5.1%), cerebrovascular diseases (4.9%), and diabetes mellitus (4.8%).

Of the total 458 933 deaths reported, 23% were due to infectious and parasitic diseases; 25% were other diseases; while 17% of deaths were due to circulatory system diseases.

Death due to injuries

Rob Dorrington, a professor of actuarial science at the University of Cape Town, told Business Report that the decline in deaths was probably largely attributable to the government's HIV/AIDS treatment programme, which now reaches 2.7-million people.

The percentage of deaths due to injuries for men was above 60% in the 20-24 age group, while the percentage of deaths due to injuries among women peaked at 28%.

With deaths caused by accidents in the country, Limpopo province had the highest at 30.6% followed by the Northern Cape at 24.1%. Gauteng province had the lowest number at 3.6%. Transport accidents which led to death were shown to peak in June (10.4%) and December (10.1%).

The Northern Cape recorded the highest number of assault-related deaths as a percentage of non-natural deaths at 23.1%. In fact, the Pixley ka Seme district in the Northern Cape has the country's highest death rate at 19 per 1 000 people. eThekwini in KwaZulu-Natal recorded the lowest death rate at 5 per 1 000.

The report also found that 44.2% of South Africans die in hospitals while 23.2% die at home.

The death registration of adults in South Africa was at 94%.

In 2009, drug spending in South Africa reached ZAR22.49bn (US$2.68bn). In 2010, we calculate that spending will reach a value of ZAR24.56bn (US$3.37bn), posting a year-on-year (y-o-y) local currency growth of 9.2%. Patients are likely to be switching to over-the-counter (OTC) medicines given the current financial downturn, particularly as they are easier to obtain, cheaper and may postpone more expensive treatments by temporarily treating problematic symptoms.

Nevertheless, patented medicines represent the largest single segment of the total market (calculated as the sum of patented, generics and OTCs) by value, at just under 62% in 2009, although this share is expected to continue to decline. By 2014, we forecast that drug spending in the country will reach ZAR35.97bn (US$6.14bn), experiencing a 2009-2014 compound annual growth rate (CAGR) of 9.85% in local currency terms and of 18.00% in US dollar terms.

Over the extended 2009-2019 forecast period, we calculate that drug spending will reach a value of ZAR57.65bn (US$12.56bn), which equates to a CAGR of 9.87% in local currency terms and 16.69% in US dollar terms. Government policies to encourage the private instead of public healthcare sector will force more people to spend out-of-pocket on drugs. Recovery of domestic demand remains 'fragile', which will have a bearing on the availability of public financing for medicines. Domestic difficulties are being compounded by the relative strength of the rand, given its negative implications for the competitiveness of exports and - in turn - revenues achieved in this manner.

Factors other than patent expirations that will be responsible for the shaping of the market include the new set of medicine pricing regulations. Pharmaceutical product mark-ups are now calculated in a tiered pricing structure. Pharmacists can charge a larger mark-up for lower priced drugs, which incentivises them to dispense more generic drugs. The government is, in the meantime, planning on enacting a longdiscussed National Health Insurance (NHI) reform scheme. The programme is to be introduced from 2012 and will be implemented in two phases over the next 14 years. The entire population will be obliged to join the scheme, with the option to also remain in private healthcare.