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9 October 2006

President of World Medical Association Dr Kgosi Letlape
Council members of the World Medical Association Africa Region
Distinguished guests

It is an honour for me to address the Inaugural Council and General Assembly of the World Medical Association Africa Region. It was a triumph that the Africa Region grouping was launched earlier this year. It is commendable and insightful that the World Medical Association Africa Region has convened to consider its role under the theme "Human Resources Challenges in Health – An African Perspective". This is responding to an urgent crisis in the global shortage of medical personnel, which has been identified by the World Health Organisation (WHO). As Africa and part of the developing world, we are hardest hit by the migration of our medical professionals to developed countries. We are therefore honoured that the WHO Report for 1996, which has a special focus on health workers, was launched in Lusaka, Zambia on the 7th of April this year.

Prior to our democracy in 1994, South Africans were isolated from one another and from our brothers and sisters on the African continent. Now South Africans in the medical profession have had the opportunity to unite and learn from one another in the South African Medical Association (SAMA). The inauguration of the World Medical Association (WMA) Africa Region gives an opportunity for all medical personnel in Africa to learn from one another and provide leadership and guidance on matters that are particular to Africa. They have an opportunity to represent Africa’s health priorities and share Africa’s expertise with the world, through the World Medical Assembly.

You have given South Africa the privilege of hosting this inaugural gathering and we hope we are able to live up to your expectations. I had the privilege last month of addressing the South African Medical Association and I know they will do everything in their power not to let you down. In choosing to launch the WMA Africa Region you have stepped up to the starting blocks to provide ethical and scientific leadership in Africa, as does the WMA worldwide. The Geneva declaration provides guidance for the training of doctors and the conduct of the medical profession. The Tokyo declaration was a beacon of hope in South Africa when people were being detained without trial and tortured. The Helsinki declaration gives ethical guidance in medical research involving human subjects.

Other functions of the WMA that can be developed in Africa are regional conferences, continuing education, development and lobbying on public policy, support and development of African medical journals, ensuring ethical and scientific standards, raising human rights issues, particularly those related to health and the medical profession, as well as looking after the interests of its members. As part of professional development, I hope you will be discussing an exchange of your association’s medical journals and contributing to the research and publication of articles.

It is important that there be a strong and representative Africa Region of the WMA as Africa provides particular challenges which you have chosen to put yourselves in a position to address.

When he addressed the opening of the 48th General Assembly of the WMA in Cape Town, the then deputy president of South Africa and now president, Mr Thabo Mbeki, made a number of important points. He highlighted what happens when there is not a strong and representative medical association to provide the ethical leadership and guidance that is necessary.

The former Medical Association of South Africa (MASA) adopted a resolution of "unreserved apology to persons, within and outside the medical profession who might in the past, have been hurt or offended by acts of omission or commission on its part in the past". They were referring to their going along with apartheid policy and not allowing black people to join their association, as well as the acts of MASA members who had not provided the best possible health care for people detained by the state without trial, including Steve Biko, who was not given proper medical care and died in detention. We are glad that we now have one united and representative medical association in South Africa.

On the issue of professionalism, he said the challenge of those working for unity in the medical profession was to create a body, one of whose prime objectives was to "strive for the best possible health care for all." This body should be seen to promote the public interest and not merely the narrow interests of its members.

President Mbeki also identified the challenge of the migration of doctors and other health professionals. This is another issue to which a strong and representative medical association in Africa could make a valuable contribution and you have identified this as one of the focal points of your deliberations. He issued a challenge to develop an international declaration on the issue of medical migration. Perhaps this could be the Pilanesberg declaration, which comes out with a creative and innovative solution to this problem.

South Africa has committed to doing our best to ensure that the continent’s resources are not depleted in the way that ours have been depleted through migration. We have undertaken to abide by ethical migration policies and will only enter into professional exchanges under the auspices of government-to-government agreements. Furthermore, a certain number of places at health sciences faculties as well as other faculties go to students from other African countries that are generally treated as local students.

President Mbeki acknowledged that we all compete as part of the global village and that migration of doctors from poorer to richer countries is one of the consequences. This competition also focuses on the important question of the economy. Effective measures that promote and protect the health of all citizens, and good healthcare for all those who do fall ill are not only desirable goals. They are also an important factor for economic development.

Since the WMA and its constituent national associations wish to fulfil their objective of "striving for the best possible health care for all," it may be that we should explore the economic benefits of better health services and which services provide the greatest benefits. Armed with information, you will be in a strong position to support your Ministers of Health and to argue for greater resources for appropriate healthcare.

He ended with a plea. "May the people who need healthcare the most, the poor and the least powerful in our societies, benefit from your assembly." These are points that the WMA Africa Region may choose to address as it works with its present membership, while at the same time striving to extent its membership to all 52 African countries.

Other issues that the WMA Africa Region may choose to take up are:

* how to provide the "best possible healthcare for all" in poor countries?
* bridging the gap between the private and public health sectors
* the relationship between medicine and traditional healing and how to co-operate in developing the scientific understanding of traditional therapies and practice
* scientific and ethical guidance to governments on HIV and AIDS as well as other diseases that affect Africa in particular.
* co-operating with other health professions such as dentists, nurses, pharmacists and technologists in forming strong national and continental associations and giving ethical and scientific leadership on health issues in Africa.
* co-operating with the academies of science in forming strong national and continental structures to provide the scientific advice and research to guide governments on addressing health issues such as HIV and AIDS, TB and malaria.
* the role of the medical profession in areas of conflict and post conflict reconstruction in Africa. Apart from the loss of lives from war, there are severe physical and mental consequences, which place an increased burden on an already overburdened health system where health facilities may also be destroyed.
* how to save Africa’s children who die because their parents are poor? We need to step up immunisation coverage. We need to combat mother to child transmission of HIV. We need to access to treatment for children a priority.
* how to save the lives of African women who die each year from preventable diseases? Many of these women are of child-bearing age and at the prime of their lives and die from pregnancy complications and during childbirth. All reports indicate that women bare the biggest brunt of the HIV and AIDS pandemic.

No doubt these and others are the subjects of your deliberations now and your plans for the future. It is encouraging to note that your meeting will also address the burden of diseases facing developing countries. Demographic transition, globalisation and development have brought about a new disease profile, an epidemiological transition, which is especially very noticeable in the developing world. Lately there has been a decline of infectious diseases, an upsurge of new infections such as HIV and AIDS and the re-emergence of "old" infections like TB, cholera and malaria. You can help us rid Africa and the world of these health emergencies.

In his inaugural presidential address to the WMA General Assembly last year in Santiago, Chile, Dr Kgosi Letlape chose to focus on "patient centred medical care" as his presidential initiative. How wonderful it would be if the WMA Africa Region took the lead in this initiative. He also identified two themes in the vision of the WMA, ethics and access. "Whilst we have been at the forefront on ethics, there is still al lot to be done on access. We have a collective responsibility globally to ensure access to basic healthcare for all citizens of the world." Again it would be wonderful if the WMA Africa Region took the lead.

I have touched on the huge challenge facing the health system, posed by the growing burden of HIV and Aids. To illustrate, allow me to quote statistics from South Africa. According to the 2006 report of the Medical Research Council, there are now an estimated 5,54 million HIV-positive South Africans. More than a quarter of a million South Africans died of AIDS related illnesses in the past year. Tuberculosis, one of the most prevalent of the AIDS defining illnesses, has emerged as one of our biggest challenges as we battle the HIV and AIDS pandemic. We are seeing a growing number of multi-drug resistant TB. We need your research expertise in finding new and more effective drugs and technologies to fight TB, which together with HIV have become huge medical threats to our lives.

Through broad consultation the South African government developed a comprehensive plan and strategy on HIV and AIDS. With Deputy President Mlambo-Ngcuka at the lead, there is new hope and we appeal to all to unite behind her efforts to unite the nation in fighting HIV and AIDS. We also appeal to all to help us accelerate the implementation of the Comprehensive Plan on HIV and AIDS. This plan provides a platform for united action in the campaign to reduce new infections, provide treatment and care and conduct research. This places us in a good position to give patients the best available scientific information about prevention, treatment and care.

As doctors you can help us especially with treatment literacy and the medical management of HIV and AIDS. A recent study published by the Health Systems Trust of South Africa found that knowledge about treatment for HIV and AIDS is very low in South Africa. Many infected people die before they have a chance to receive appropriate medical treatment.

I am disturbed to learn from the report about how some unscrupulous traditional practitioners are ripping our people off, promising them a cure. The saddest part is that some of our nurses are reported to be involved in directing patients to traditional practitioners when they come to our health institutions.

You can help us fight the stigma around HIV by offering voluntary counselling and testing to your patients. I am encouraged to see inclusion of the "D" of disclosure to the ABC prevention message. It has been pointed out that we need to strengthen our prevention campaign and go beyond the abstinence, be faithful and condomise message. Socio-economic factors like poverty and gender inequality are and socio-economic inequality is undermining the prevention campaign. You can help promote disclosure by encouraging your patients to disclose to their spouses and partners.

You are bound by the Hippocratic Oath to protect the human and legal rights of your patients and you may not disclose their HIV status without their permission. I trust that you would as concerned for the partners of your patients as well. I therefore would urge you to, within the limitations of the law and the ethical code that regulates your professional conduct, you assist us in getting your patients to agree to disclose to their partners. Many women in stable "monogamous" relationships are infected by their partners. Gender, social and economic inequalities render poor women particularly vulnerable to the ravages of the HIV pandemic.

In closing I wish to pay a special tribute to medical science for helping us find solutions to our medical problems. While there is as yet no cure for HIV and AIDS, scientific advances have been made in treatment and care. When combined with good nutrition and a healthy lifestyle, treatment with antiretrovirals (ARVs) for those who need them and qualify, has been shown scientifically to prolong lives.

So far, the only effective method of stopping people getting infected who have been exposed to HIV, either from needle pricks or after rape, is prophylactic treatment with ARVs. Post-exposure prophylaxis is the only hope for rape survivors and needle prick victims. ARVs have also been found to be effective in the prevention of mother to child transmission from HIV positive mothers. This is the basis for the message of hope that must go out to people who are trying so desperately to live.

South Africa and I am sure other countries as well, need strong ethical and scientific leadership from the organised health profession, as it seeks to educate and guide people who are desperate for a cure and are easy prey for those who offer promises of cures based on anecdotal evidence that does not stand up to the rigours of scientific evidence based research.

With the launch of the World Medical Association Africa Region we can expect innovative interventions and strategies that will contribute to solving medical problems on the continent. I wish you well on the launch of the WMA Africa Region as you continue your deliberations and contribute to the WMA General Assembly for the first time later this week. I am sure the WMA Africa Region will make a significant impact.

I thank you.

Issued by: Department of Health
9 October 2006