How salaries are eating into provincial public health budgets

South African Health Review says poor-quality primary healthcare services and a growing burden of noncommunicable diseases cripple the system.  Public health expenditure has ballooned to R183bn over the past 20 years, but a large chunk of provincial health budgets is spent on salaries, a review released on Tuesday shows. Simultaneously, poor-quality primary healthcare services and a growing burden of noncommunicable diseases crippled the system, said the South African Health Review.

The report by public health organisation Health Systems Trust analyses health sector challenges, reform initiatives and their implications for transformation of public healthcare. Managing editor of the South African Health Review Ashnie Padarath said the review had identified areas where sustained and concerted action was required. “It paints a mixed picture and shows evidence of progress in many of the programmes that are needed to ensure the successful implementation of NHI [National Health Insurance].” ….more

SAHR 2017 Web version


THABO MBEKI: The ANC’s insistence that MPs serve the party is a betrayal of the revolution and the Constitution

On August 8 2017 our National Assembly convened to consider and vote on a motion of no confidence in the president of the republic, the honourable Jacob Zuma. Following a judgment which had been handed down by our Constitutional Court, the speaker of the National Assembly, honourable Baleka Mbete, had prescribed that the members of the National Assembly, our MPs, would respond to the motion through a secret ballot.

It is a matter of public record that this no confidence motion failed. This was because the majority of the members of the National Assembly, our MPs, voting in a secret ballot, effectively confirmed their confidence in the president of our republic. The process in which the National Assembly engaged, resulting in this outcome, represented an admirable manifestation of the health of our democracy. ….more

How the NHI will affect SA’s middle class — and add to the burden on the public health system

Government’s plan to ditch medical aid tax credits is expected to force nearly 2-million people into the already overcrowded state health system. If the tax credit is removed‚ 20% of medical aid users will no longer be able to afford it‚ a leading economics consultancy warned in a study published on Friday.

It would mean 1.9-million of the 8-million medical aid members‚ including children‚ will drop out of the private healthcare system. This is according to an analysis by Econex‚ a Stellenbosch-based economics consultancy. When the new National Health Insurance policy document was released in July by Health Minister Aaron Motsoaledi‚ he said he wanted to remove the tax credit to users‚ which amounts to R20bn…..more

WONCA E-Update Friday 25th August 2017

WONCA E-Update
Friday 25th August 2017

WONCA News – August 2017
The latest WONCA News (August 2017) is accessible via the WONCA website, with lots of WONCA news, views and events.

Policy Bite: Getting the Evidence for the Impact of Family Medicine
Last month’s policy bite addressed the value of describing what is happening in different countries, and the launch of a new website which would allow WONCA members to share their country’s data. A different kind of evidence is needed to evaluate the impact of new inputs through primary health care and – in our specific area of interest – family doctors. In this month’s Policy Bite, Professors Felicity Goodyear Smith and Amanda Howe invite WONCA readers to let them know of any research going on globally looking at various aspects of health systems.

We are putting out a ‘call for evidence’. We are keen to know if anyone is working on studies that explicitly evaluate the role of family doctors within a service. If you are due to publish in the near future, please share your early findings with WONCA leads for your country / regional / globally, so that we can ensure we have the most up to date evidence available. And if you are not a researcher, then please help your academic colleagues as best you can – by collating data, or letting them know of new opportunities to evaluate service developments that involve family doctors. 

Another busy and fruitful year @RuralWONCA
Every year the WONCA Working Party on Rural Practice produces an annual report for WONCA Executive and this year decided that it would be useful to share some of the topics in Rural Roundup. It’s been a particularly busy year for the WP, with two conferences within six months; at the World WONCA Conference in Rio de Janeiro (November 2016) and at their own 14th WONCA World Rural Health Conference in Cairns Australia (April 2017). Catch up with this very active Working Party at:

Promoting Planetary Health
The WONCA Europe 2017 conference seemed a very favorable setting to promote the issue of Planetary Health and increase the general awareness for it. Some of this happened, but the potential is much greater, as well as its appropriate place to be mentioned to a wider audience, such as any medical conference (especially by primary care physicians) as an issue which should require everybody’s attention.

Ralph Guggenheim, from WONCA’s Working Party on the Environment, posted his reflections on Planetary Health to the group’s discussion forum. You can read it here, together with the WONCA Statement on Planetary Health and Sustainable Development Goals.

Featured Doctor: Professor Zalika Klemenc Ketis

One of this month’s Featured Doctors is Professor Zalika Klemenc Ketis, who is a member of the WONCA Europe Executive Board, representing EQuiP. At the Faculty of Medicine, University of Maribor, she is the chair of the Department of Family Medicine and associate professor of family medicine as well as head of the research group. She is also partly employed in the largest healthcare centre in Slovenia – Ljubljana Community Health Care Centre, where she works in family medicine practice – and at the Institute for the research and development of primary healthcare.

WHO On-line Courses on epidemics, pandemics and health emergencies
WHO has launched a series of video courses on epidemics, pandemics and health emergencies. Geared for those working in emergencies, the courses are also accessible to the public. The courses – which are on a platform called OpenWHO –   transform complex scientific knowledge into easy-to-understand introductory video lessons, using a smaller bandwidth so that people in any country can access them. Offline versions are available on both IOS and Android devices. The platform can host an unlimited number of users and is free and open to anyone wishing to register.

Public-private partnerships provide evidence for value of co-operation

Budget reviews are generally good platforms from which to announce plans to boost economic growth, create jobs and alleviate poverty. They are also good mines of information and are often read over and over again to get those important bits the finance minister did not mention directly in his speech before Parliament.

The Budget Review for 2017-18 is no exception. Tucked away, almost at the back of this lengthy document, is an update on public-private partnership (PPP) arrangements and the role they have played in meeting infrastructural development objectives. It remains compelling evidence for what the government and the private sector can accomplish together. ….more

Public-private partnerships provide evidence for value of co-operation

Budget reviews are generally good platforms from which to announce plans to boost economic growth, create jobs and alleviate poverty. They are also good mines of information and are often read over and over again to get those important bits the finance minister did not mention directly in his speech before Parliament.

The Budget Review for 2017-18 is no exception. Tucked away, almost at the back of this lengthy document, is an update on public-private partnership (PPP) arrangements and the role they have played in meeting infrastructural development objectives. It remains compelling evidence for what the government and the private sector can accomplish together. ….more

Medical ethics, law and human rights – A South African perspective

Healthcare delivery in the 21st century has become increasingly complex and demanding. Clinical consultations frequently raise scientific, ethical and legal challenges. While scientific issues may be resolved using an evidence-based medicine (EBM) approach, ethical theory is needed to justify decision making in the face of ethical conflict. Medical ethics, law and human rights: a South African perspective provides the conceptual background and analytic skills necessary to assist with the resoluti on of ethical dilemmas encountered in the South African healthcare environment.

Medical ethics, law and human rights use case studies to help the healthcare team to identify and analyse ethical, moral and value concepts, and to apply these to scenarios that they may encounter on a daily basis. Part 1 explores theories and principles of ethics (including African philosophy), introduces medical law, discusses health and human rights, and also makes the transition from theory to practi ce. Part 2 looks at specifi c topics in healthcare that raise challenges from an ethics perspecti ve – HIV/ AIDS, use of social media, euthanasia, human reproduction, geneti cs and genomics.In view of the increasing emphasis on ethical

In view of the increasing emphasis on ethical considerations in healthcare from the Health Professions Council of South Africa (HPCSA), coupled with the rising incidence of litigation in healthcare, Medical ethics, law and human rights is essenti al reading for health science, law and philosophy students as well as practising healthcare professionals

Book Pamphlet

WONCA E-Update: Friday 18th August 2017

WONCA E-Update
Friday 18th August 2017

WONCA News – August 2017
The latest WONCA News (August 2017) is accessible via the WONCA website, with lots of WONCA news, views and events.

From the CEO’s Desk

The northern hemisphere summer means a quieter time for the Secretariat in terms of e-mail traffic, but there is still plenty to do. This month Dr Garth Manning reports on preparation of the Annual Report, reflects on WONCA Europe in Prague and looks forward to forthcoming WONCA events.

North America Region Report
Speaking of the Annual Report, we will be featuring some of the submissions in future e-updates. This week we concentrate on the report from Professor Ruth Wilson, North America Region President, on what’s been happening in her region over the past year.

Super Early bird registration for WONCA Rural 2018: New Delhi
The 15th WONCA World Rural Health Conference will take place in New Delhi from 26th to 29th April 2018. Get ready to participate in an international event that will see delegates from around the world inspiring and exchanging ideas on the latest developments and challenges in rural family practice and rural and remote health generally. Super Early Bird Rates for delegates are available until 31st August.

Free e-book: Leadership in Family Medicine: From the Personal to the Policy Level
Leadership in Family Medicine: From the Personal to the Policy Level is a compilation of chapters from CRC Press texts, selected by our President, Professor Amanda Howe, with an Introduction giving her insight into each chapter.

“[The FreeBook] starts with one of the many important papers about family medicine, highlighting the key barriers and ways to overcome them as the speciality moves forward: then goes back to basics, looking at how a medical school curriculum can use family medicine to enhance professional learning and develop early leadership competencies in medical students. We then look at leadership in team work, both from the practical group work perspective, and in effective inter-professional.”

To find out more, and to download the book, go to:

Featured Doctor: Dr Kim Griswold
Dr Kim Griswold of USA is one of this month’s Featured Doctors. She works in a University setting, in Buffalo, NY, providing clinical care and teaching medical students and residents. Currently she is the medical director of an integrated primary care-behavioral health clinic, caring for an urban, under-served population.

PATIENT ADVICE: What Causes Insomnia?

Insomnia can be caused by psychiatric and medical conditions, unhealthy sleep habits, specific substances, and/or certain biological factors. Recently, researchers have begun to think about insomnia as a problem of your brain being unable to stop being awake (your brain has a sleep cycle and a wake cycle—when one is turned on the other is turned off—insomnia can be a problem with either part of this cycle: too much wake drive or too little sleep drive). It’s important to first understand what could be causing your sleep difficulties.

Medical Causes of Insomnia

There are many medical conditions (some mild and others more serious) that can lead to insomnia. In some cases, a medical condition itself causes insomnia, while in other cases, symptoms of the condition cause discomfort that can make it difficult for a person to sleep.

Examples of medical conditions that can cause insomnia are:……MORE

Saying Goodbye to Lectures in Medical School — Paradigm Shift or Passing Fad?

“Become a doctor, no lectures required.”1 This headline about the University of Vermont’s proposed new approach to medical education generated considerable controversy. Although this proposed change is more drastic than the curriculum reform taking place at other medical schools, the movement away from traditional lecture-based courses has been under way in U.S. medical schools for more than three decades. Transformation began with the introduction of problem-based learning; more recently, lecture-based teaching has increasingly been replaced by team-based learning, interprofessional education, and exercises integrating clinical medicine and basic science. But are the newest proposed changes evidence-based, or are they merely the latest fad in medical education? Are all lectures to be avoided?….more

PATIENT EDUCATION: The 7 Biggest Weight-Loss Mistakes, According to Dietitians

the7biggestweightlossmistakes-752x472Dietitians have seen it all when it comes to weight loss. From crazy fad diets to bulletproof coffee — while appealing, what sounds too good to be true usually is.

We are all susceptible to the lure of the quick fix or thinking there’s one magic bullet to achieve ultimate weight-loss success. But this mindset often leads to mistakes that eventually get in the way of the long-term goals we’re trying to achieve.

Is it possible to avoid some of these pitfalls that inevitably occur on your weight-loss journey? Absolutely — but we must be able to recognize those pitfalls first. Below are the seven of the biggest and most common weight-loss mistakes dietitians see, with tips from real-life RD’s to help you stay on course…..more

What’s happening inside the ANC, not parliament, is key to why Zuma prevails

What matters inside the African National Congress, the party that governs South Africa, is not necessarily what matters outside it. This obvious point is missed by much of the commentary on the latest unsuccessful motion of no confidence in President Jacob Zuma – and in much discussion of South African politics.

One result of ignoring this reality is the claim that the vote seriously weakened Zuma because several dozen ANC members of parliament supported the motion or abstained.

This was the first time some ANC MPs supported a motion of no confidence in an ANC president. But, while Zuma came within 21 votes of losing in parliament, he was probably backed by 80% or more of the ANC caucus. Most of the votes against him were cast by opposition MPs, who do not have a say in who is ANC president, not ANC members, who do.

Unless parliament passes a motion of no confidence in him, which is not on the cards any time soon, his future depends on whether he was weakened in the ANC, not parliament.

Within the ANC, Zuma’s future is not the absorbing fixation it is outside it. ….more

WONCA E-Update: Friday 11th August 2017

WONCA News – August 2017
The latest WONCA News (August 2017) is accessible via the WONCA website, with lots of WONCA news, views and events.

From the President 
In her President’s column this month, Professor Amanda Howe reflects back on WONCA Europe in Prague, and her presentation highlighting the challenges of building relationships and reducing social conflict:

“In Prague, I talked about the role of family doctors in building relationships and reducing social conflict. Globally, separatist forces operating across our world today are a source of anxiety, threat and conflict. Concepts of tribe and nation can be a source of pride but also division. Professional groups such as WONCA face the challenge of trying to find shared values and means of improving our professional standing and impact, while respecting the diverse settings and backgrounds of our members and patients. Almost all our members will be working with people from different ethnicities, cultures, and social settings, both as their patients and colleagues: also external stakeholders from community leaders to politicians. This is actually a great privilege and often a pleasure but their worlds, experiences and priorities may be very different from our own, and we need to become skilful in working with others”

Read the full article via the WONCA website, and remember also that there are Spanish and French versions of Amanda’s column.

WP on Education – update
Professor Val Wass, Chair of the WONCA Working Party on Education, reports on two workshops which were held at the recent WONCA Europe conference in Prague on the undergraduate curriculum.  There is undoubtedly strong interest in improving the status of family medicine as a career choice to medical students globally. The workshop in Prague in June concluded with a number of actions. For a full update on the WP on Education go to the WONCA website at:

Education for Primary Care – free access to paper
Education for Primary Care are pleased to announce free access for a month to a paper in the 28: 5 issue of the journal which is now on line.

In Denmark group supervision for general practitioners is an established part of continuing professional development. This paper explores ways peer group supervision in a long term well established group of general practitioners can improve communication and patient centred care  at the same time maintaining enthusiasm and preventing burn out. 

Witnesses in the consultation room – Experiences of peer group supervision.
Helena Galina Nielsen & Annette Sofie Davidsen
University of Copenhagen , Denmark 

Family violence – how to ignore it?
Dr Ana Nunes Barata sits on the WONCA Executive as the Young Doctors’ Movements representative.  She’s also acutely interested in family violence, and is involved in both the WONCA SIG on Family Violence and also the Vasco da Gama Movement Family Violence Group.  Here she writes on the subject:

I’ve been collaborating with Vasco da Gama Movement’s Family Medicine Violence group since 2013, and it has been an incredibly rich experience. I had the opportunity to meet other colleagues who are developing inspiring work on this topic, to collaborate with them in their initiatives and, most importantly, to learn with and from each other. From this group’s workshops, sessions and texts, I have collected very useful resources when it comes to assessing Family Violence. 

Read more on Ana’s reflections on the WONCA website at:

WONCA SAR Nepal conference:  deadlines approach
After their devastating earthquake, Nepalis are trying to rebuild themselves and their country. As part of this regeneration, they will be hosting the WONCA South Asia Region conference in Kathmandu, on November 25th and 26th 2017.  The deadline for submission of abstracts is 31st August, 2017 and this is also the deadline for Early Bird registration.

PATIENT EDUCATION: Adult Obesity Causes & Consequences

Obesity is a complex health issue to address. Obesity results from a combination of causes and contributing factors, including individual factors such as behavior and genetics. Behaviors can include dietary patterns, physical activity, inactivity, medication use, and other exposures. Additional contributing factors in our society include the food and physical activity environment, education and skills, and food marketing and promotion.

Obesity is a serious concern because it is associated with poorer mental health outcomes, reduced quality of life, and the leading causes of death in the U.S. and worldwide, including diabetes, heart disease, stroke, and some types of cancer. ….more

Why you should care about the #GuptaLeaks (an international view)

London – After nearly nine disastrous years of a Jacob Zuma presidency, the Rainbow Nation dream of Nelson Mandela lies in tatters.

At an historic secret ballot of no confidence in the South African Parliament on Tuesday, the country’s scandal-hit president survived – but by a small majority of 21 as 40 of his own ANC MPs rebelled against him.

South Africa is now at yet another crossroads.

At the recent funeral of one of Nelson Mandela’s closest friends and fellow long-time Robben Island detainee, his ex-wife Winnie Madikizela-Mandela (herself an MP) said: “All what we fought for is not what is going on right now … our country is in crisis and anyone who cannot see that is just bluffing themselves.” ….more

Community-level antibiotic access and use (ABACUS) in low- and middle-income countries: Finding targets for social interventions to improve appropriate antimicrobial use – an observational multi-centre study


In many low- and middle-income countries (LMICs), a poor link between antibiotic policies and practices exists. Numerous contextual factors may influence the degree of antibiotic access, appropriateness of antibiotic provision, and actual use in communities. Therefore, improving appropriateness of antibiotic use in different communities in LMICs probably requires interventions tailored to the setting of interest, accounting for cultural context. Here we present the ABACUS study (AntiBiotic ACcess and USe), which employs a unique approach and infrastructure, enabling quantitative validation, contextualization of determinants, and cross-continent comparisons of antibiotic access and use. The community infrastructure for this study is the INDEPTH-Network (International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries), which facilitates health and population research through an established health and demographic surveillance system. After an initial round of formative qualitative research with community members and antibiotic suppliers in three African and three Asian countries, household surveys will assess the appropriateness of antibiotic access, provision and use. Results from this sample will be validated against a systematically conducted inventory of suppliers. All potential antibiotic suppliers will be mapped and characterized. Subsequently, their supply of antibiotics to the community will be measured through customer exit interviews, which tend to be more reliable than bulk purchase or sales data. Discrepancies identified between reported and observed antibiotic practices will be investigated in further qualitative interviews. Amartya Sen’s Capability Approach will be employed to identify the conversion factors that determine whether or not, and the extent to which appropriate provision of antibiotics may lead to appropriate access and use of antibiotics. Currently, the study is ongoing and expected to conclude by 2019. ABACUS will provide important new insights into antibiotic practices in LMICs to inform social interventions aimed at promoting optimal antibiotic use, thereby preserving antibiotic effectiveness…..more


Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood. You can also have prediabetes. This means that your blood sugar is higher than normal but not high enough to be called diabetes. Having prediabetes puts you at a higher risk of getting type 2 diabetes.

Over time, having too much glucose in your blood can cause serious problems. It can damage your eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the need to remove a limb. Pregnant women can also get diabetes, called gestational diabetes……. see more at Medline Plus

Blood tests can show if you have diabetes. One type of test, the A1C, can also check on how you are managing your diabetes. Exercise, weight control and sticking to your meal plan can help control your diabetes. You should also monitor your blood glucose level and take medicine if prescribed.