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Competition law and healthcare – lessons from the Hazel Tau case

Competition law can be used to facilitate access to affordable medicines, as demonstrated by the 2002 Hazel Tau & others case against big pharma companies GlaxoSmithKline and Boehringer Ingelheim. This case is a reminder that for many South Africans with chronic illnesses, access to medication remains a struggle.
A seminar on the Hazel Tau case was held by the Competition Commission and the Health Justice Initiative on World Aids Day to commemorate the monumental role that the case played in the fight for affordable antiretrovirals (ARVs) in sub-Saharan Africa.
The case set a precedent for the way competition law can be used, the Competition Commission’s Nandi Mokoena said at the seminar:
“Competition law is one measure available to progressively realise the right to healthcare to all and it needs to be actively used, otherwise we would not be meeting our constitutional mandate as an entity.”
Those lost to big pharma
At the time of the case in 2002, 5.9 million South Africans were infected with HIV/Aids and were unable to access treatment, added the director of the Health Justice Initiative, Fatima Hassan.
“The state-sponsored ARV denialism influenced the lack of access in the public sector and prices,” she explained. “Unless you had a lot of money or a really comprehensive medical scheme or private sponsor, you would not be able to access ARV. You would die prematurely.”
Tau was one of the first complainants against the pharmaceutical companies and although her treatment was sponsored, she maintained that “with or without a sponsor, I was willing to push until we get treatment”.
A bittersweet win
Tau has mixed emotions about her win.
“It was a bittersweet experience because everyone could not be saved. I was still in pain. I lost friends, family, colleagues,” she said.
While the availability of ARVs had helped many in the country, there were still problems facing the HIV/Aids community that needed to be addressed.
“We lost millions of people who were breadwinners, which has left the country with orphans and child-headed households.”
There is still a long way to go with stigma, added Tau.
“(Your HIV status is something) that people think is easier, but it is not easier to disclose. It depends on the type of support you have”.
One reason behind the stigma is HIV-specific clinics, said Tau, and health workers who disclose people’s status when handing them forms or medication in clinics.
To negate this, Tau suggested that all sicknesses are grouped together, and that separate clinics for HIV ...

Domestic workers call on President to sign compensation bill into law

The legislation was sent to Cyril Ramaphosa more than two months ago.
“We sacrifice everything to make sure the homes of our employers are in top shape. But no one cares about us,” says Eunice Dladla, of the South African Domestic Service and Allied Workers Union (Sadsawu). This was the feeling expressed by several domestic workers at a dialogue for workers, unions and government representatives on matters affecting domestic workers, held on Wednesday at the Nelson Mandela Foundation in Houghton.
The dialogue was given the title, “Two Years after Mahlangu”, referring to the case of Mahlangu and Another v Minister of Labour and Others. In its ruling on the case in November 2020, the Constitutional Court declared invalid a section of the Compensation for Occupation Injuries and Diseases Act (Coida). The section had effectively excluded domestic workers employed in private households from claiming compensation for workplace injuries.
The court order was made retrospective, allowing claims to be lodged by domestic workers and dependants, who had experienced work-related injuries, diseases or death from 27 April 1994 onwards.
Pinky Mashiane, president of United Domestic Workers of South Africa (Udwosa), urged President Cyril Ramaphosa to sign the amendment bill for Coida into law. (Parliament sent it to the President for assent in September 2022.)
Visit Daily Maverick’s home page for more news, analysis and investigations
“In the two years since the Mahlangu victory, fewer than ten claims from domestic workers have been processed,” said Keitumetse Moutloatse, of social movement Black Womxn Caucus.
Possible reasons for this were given by Mashiane. She said the Labour Department needs to do more to educate employers and domestic workers, because many don’t know about the Constitutional Court hearing. She also said that domestic workers might not report their injuries out of fear of intimidation or dismissal.
“Employers will take domestic workers to their own doctors, who will write medical reports that please employers instead of accurate medical reports that would assist the injured worker in reporting and claiming from the fund,” she said.
“The [labour] department is making it very difficult for domestic workers to put in claims and benefit from the fund. They say the claim forms must be completed by employers,” she said. DM
First published by GroundUp.

‘We shall overcome’ Really? I’m beginning to doubt it but not giving up yet

We live in desperate times. Many of us often insist we have not given up hope. But, be honest for a moment, how many of us hide that nagging feeling that actually we may have? The heart hopes and the brain calibrates; but mine feel at odds with each other and are sending different signals.
“We are not afraid We are not afraid today Cause deep in my heart I do believe We shall overcome some day.”
Wouldn’t it be better to start by admitting this, than bravely but untruthfully telling people that “everything’s going to be alright?” For example, I’ve often heard activists say that the current crises we face in South Africa and the world “create a moment of opportunity?”
Pull the other one.
That’s what we said about Covid-19. “Build Back Better” went the maxim, in reality a catchphrase substituting alliteration for thought (as we do so often these days). But building back better clearly isn’t happening.
We are building back worse.
As an example of what I’m talking about, consider a claim by Doug Abrams’s, the author of the wonderfully written and evidenced Book of Joy, recording a series of conversations that took place between the Arch and the Dalai Lama in 2014.
At the 2022 Tutu Memorial lecture Abrams said that “our best days are ahead of us”.
“Our greatest threat is not the pandemic or fascism or climate change, but the loss of hope that we can solve the challenges we face.”
Perhaps Abrams framed his thought in this way precisely because he knows many people are losing “hope that we can solve the challenges we face”.
Sadly, I found a lament by Roland Baines, the lead character in Ian McEwan’s new novel, The Lessons, more resonant:
“By what logic or motivation or helpless surrender did we all, hour by hour, transport ourselves within a generation from the thrill of optimism at Berlin’s falling Wall to the storming of the American Capitol? [Baines] had thought 1989 was a portal, a wide opening to the future, with everyone streaming through. It was merely a peak. Now, from Jerusalem to New Mexico, walls were going up. So many lessons unlearned. . From peak to middern in thirty years. . As he saw it, simply getting through intact to the last day of the twenty-first century. would be a triumph.”
I am a person who has always lived within hope.
But I have decided to raise these questions publicly because ...

Mind the gap — solutions to Joburg’s inner-city housing crisis hamstrung by budget constraints

A housing shortage is one of the biggest problems faced by South Africa, with the City of Johannesburg especially struggling.
Daily Maverick has interviewed various experts on how to counter the urban housing crisis in Joburg and around the country.
Read part 1: “Bad to worse — massive gap in rightful housing and basic service delivery for Joburg’s inner city low-income residents”
Inner cities are spaces to live, work freely, learn and play — facets of life previously denied to the majority of South Africans under apartheid. However, under the banner of democracy, the urban poor continue to be marginalised by being denied affordable low-income housing options.
Addressing this inequity would mean undoing many injustices of the apartheid government.
Lebogang Lechuba, marketing communications manager at South African Cities Network, told Daily Maverick it is critical that metropolitan core nodes, with the opportunities to further densify, offer multiple housing options for those with lower and no incomes in the inner city.
She notes that affordable housing in the inner cities requires all stakeholders, including the government, to maximise the use of municipal land and buildings that are underutilised, vacant and underdeveloped.
“It also requires maximising of resources with the use of policies such as the inclusionary housing policy, land value capture tools and the social housing capital grants. for social housing institutions and also other delivery agents such as the private sector,” said Lechuba.
“Then there are innovations and partnerships required between multiple role-players (cities, national departments, banks, and property owners) for rehabilitating sectional title properties, which are a significant portion of hijacked buildings in Johannesburg and are very complex to solve.”
Municipal programmes and budgets
However, the primary responsibility of affordable housing lies in the already overstretched programmes and budgets of municipalities.
In the City of Johannesburg, there is no housing code or a more permanent solution to the growing housing need for the urban poor, as confirmed by the city’s Patrick Phophi.
“The housing department’s strategy is to drill deep into the lowest income groups R0-R3,500. the destitute is encapsulated in the Inner-City Housing Implementation Plan [Ichip — a programme for tackling the housing challenge within the inner city and creating safe, clean and connected communities with access to economic opportunities within the area]. At this time, the programme is solely funded by the city and is not in the housing code. It speaks to the provision of Temporary Emergency Accommodation and Alternative Rental Accommodation,” Phophi said.
‘No interest’ from City of ...

Early learning centres get a ‘SmartStart’ and children are winning

All children deserve access to a quality early learning programme, but in South Africa, the need outweighs the supply — particularly in lower-income communities. Early learning nonprofit, SmartStart, is working to close the access gap by providing support and training to those seeking to get centres off the ground.
The results of the ECD (early childhood development) Census 2021 showed that of the estimated 6.7 million children under six in South Africa, only about 25% were being taken care of at an early learning programme on any given day. Given the importance of development in the early years, this points to a need for considerable expansion of the country’s ECD sector.
One local organisation, SmartStart, is contributing to this expansion by providing support and training for prospective ECD practitioners working to get home- and community-based centres off the ground.
“Obviously there’s a big crisis around access – over a million children either don’t access any early learning programme before school, or the ones they do attend are inappropriate,” said Justine Jowell, programme design and development lead at SmartStart.
There is a “double barrier” to setting up an ECD centre in South Africa, as the infrastructure required is not attainable in many communities, and once a centre is set up, it often falls short of the standards needed to access the state early learning subsidy.
Read in Daily Maverick: “Early childhood development centres in SA continue to struggle with registration and access to subsidies”
“SmartStart was set up as a [means of] trying to look for. a quality solution that’s relatively quick and affordable to set up and deliver across the country, so that we can bring in as many children as fast as possible into early learning,” said Jowell.
Using a social franchise model, SmartStart works with organisations across South Africa to recruit and train those who are interested in starting their own early learning centres.
“[Participants] have to meet certain recruitment criteria. Then if they do, they get their initial training, which helps them to understand how to set up a quality programme [and] how they will deliver it,” explained Jowell.
Those who complete the training receive support in setting up their own ECD centres. SmartStart field workers, known as “coaches”, check on the basic health and safety standards at each site.
“[SmartStart practitioners] are supported by their coach, their infield worker, to deliver a quality programme,” said Jowell. “Then, within three to six months, the quality of their ...

HIV/Aids inequality must end to halt the persistent epidemic

As we look at the year ahead, urgent work remains to build on past successes and to bring the HIV epidemic sustainably under control. Amongst others, we need to address persistent stigma and discrimination, as well as the structural and social factors that put women and girls at increased risk of HIV infection, argues Rachel Toku-Appiah.
Today, on World Aids Day 2022, we are living in such a different world from 20 years ago.
Let’s just take the statistical temperature:
In 2021, there were 38.4 million people living with HIV.
Africa remains statistically over-represented. 67% of those living with the disease are in sub-Saharan Africa, but we’ve also seen the sharpest reduction in infection of any region in the world. Between 2010 and 2020, HIV infection rates declined by 43% in eastern and southern Africa.
For those living with the disease, access to treatment has soared. 78% of people in eastern and southern Africa now receive treatment (while the global average sits at 75%).
And, between 2010 and 2021, Aids-related deaths in eastern and southern Africa fell by 58%.
It’s fair to say that the dramatic advances we have seen in the fight against HIV amount to one of the greatest success stories in global health and development.
It is because of the successful global collaboration among activists, policymakers, governments, community leaders, and donors that achievements like these have been made possible. The result of these collaborations can be seen across Africa.
In Botswana, thanks to ongoing partnership and collaboration between its government and the US Centres for Disease Control and Prevention and the US President’s Emergency Plan for Aids Relief, the country reached the UNAids “95-95-95” strategy target in July this year. This is four years ahead of the target date. That means 95% of all people in the country living with HIV are aware of their status, 95% of those aware of their status are receiving sustained antiretroviral treatment (ART), and 95% of people receiving ART are achieving viral load suppression — meaning a reduction of HIV in the body to undetectable levels. All this just some months after the World Health Organization had awarded the country Silver Tier status for lowering the rate of mother-to-child HIV transmission to less than 5% and providing prenatal care and ART to more than 90% of pregnant women living with HIV.
‘The fight is not over’
We have come so far. But despite these astonishing efforts and incredible advancements, the fight is ...

Size doesn’t matter – four ways to make it easy to take the HIV prevention pill

The Aurum Institute is making it easier for people to access HIV prevention medication. Its project includes a screening tool and support groups, and has already reached more than 100,000 people.
How would you feel if a nurse held out an enormous blue tablet and said you have to swallow it with water every single day?
The HIV prevention pill Tenemine (a generic form of the branded drug Truvada) is big and bulky. At nearly 2cm long and almost 1cm wide, it’s about the size of a large jellybean.
The tablet is made up of two antiretroviral drugs (the medicine used to treat HIV), tenofovir and emtricitabine. If taken daily, it can reduce someone’s chance of contracting HIV through sex by up to 93%, studies have shown. Researchers have also found that taking the medication a day before and two days after sex worked just as well to prevent infection in men who have sex with men and transgender women.
This type of protection is called oral pre-exposure prophylaxis, or PrEP. (So, it’s a medicine you take before you’re exposed to a potentially harmful germ.)
But the high level of protection kicks in only if people take the tablets – and stick to it. The less often someone uses the medication, the lower the level of protection becomes.
At the Aurum Institute, an HIV and tuberculosis nonprofit, we’ve been running a PrEP programme at five of our Pop Inn wellness centres in KwaZulu-Natal, Gauteng and Mpumalanga. These facilities are set up specifically for men who have sex with men and transgender women, groups who are more likely to be become infected with HIV than the general population, partly because the chance of getting HIV from anal sex can be up to 18 times higher than from vaginal sex.
The size of the tablet was one of the reasons people were put off from taking the medicine. By September 2019 only about 8% of people visiting Pop Inn clinics in Ehlanzeni, eThekwini, uMgungundlovu, Tshwane and Ekurhuleni were on PrEP.
But our researchers have figured out how to help people understand that when it comes to protecting yourself against HIV, size doesn’t matter.
Here’s what we’ve learnt.
When people are on the move, move with them
Many of the people we help at Pop Inn clinics are migrants. They move around the country or to other parts of Africa for work or to find better jobs.
Migrant workers who have moved between 40km and ...

In-depth — Experts agree multifaceted approach needed to boost behaviour change efforts in the PrEP era

Thabo Molelekwa asked several experts what behaviour change communications should look like in this new era of HIV prevention.
HIV prevention pills are becoming more widely available in South Africa and the country is set to soon start piloting the use of an HIV prevention injection and vaginal ring. But merely having these pre-exposure prophylaxis (PrEP) tools available in clinics and other places does not mean people will use them.
This dynamic is nothing new.
As seen with Covid-19 vaccines, some people will take up an intervention and others will not. It is also nothing new to have awareness or communications campaigns aimed at encouraging certain behaviours and discouraging others. Some, like encouraging HIV testing and condom use, have worked relatively well — others like promoting abstinence have failed.
So what lessons can we take from the last few decades of health behaviour change efforts as we enter the era of HIV prevention pills, rings and injections?
Meet people where they are
One common refrain from experts we spoke to is that behaviour change efforts have to take into account the views and lived realities of the people the efforts are aimed at. What is needed, argues Professor Susan Goldstein, Deputy Director and COO at the SAMRC Centre for Health Economics and Decision Science — Priceless SA, is holistic social and behaviour change communication that engages with not only the individual but the social, economic, commercial, and political environments that the individual finds themselves in. This should take into account social norms, patriarchy, poverty, gender-based violence, and unemployment.
“Behaviour change communication needs to entail an interactive approach. [It] is adopted in order to develop the most appropriate messages through inclusion of relevant stakeholders, including representatives of the communities or populations for whom the messages are being developed,” says Professor Thesla Palanee-Phillips of the Wits Reproductive Health and HIV Institute (Wits RHI). Furthermore, she adds, stakeholders who are crucial to the implementation of these efforts need to be capacitated and supported to plan for and ensure the incorporation of these activities as part of a larger comprehensive and sustainable programme.
The importance of sustaining such efforts over time is another common theme.
“Social and behaviour change is a process,” says Goldstein, “so a person doesn’t just start using a condom (or antiretroviral therapy) and then your job is done. They need to continue to do this over their lifetimes.”
There also seems to be general agreement that it is better to ...

Fraud trial against suspended SJC manager escalated, set for January 2023

Xolani Klaas faces charges related to fraud in excess of R730,000.
The fraud case against the Social Justice Coalition’s (SJC) suspended general manager has been escalated to the regional court in Khayelitsha, Cape Town.
Xolani Klaas made a brief appearance at the Khayelitsha Magistrates Court on Thursday. Klaas faces charges related to fraud in excess of R730,000.
In June, a GroundUp investigation revealed that Klaas appeared to be using SJC funds to pay for furniture, household appliances, luxury clothes, watches, groceries, and expensive technology.
Klaas was subsequently suspended and SJC staff laid criminal charges against him at Lingelethu West Police Station. In July, we reported that Klaas had returned some furniture, purchased using SJC money, to the organisation’s offices.
During the hearing on Thursday, it was revealed that the police investigations are complete and that the trial would be heard in the regional court in January 2023.
Visit Daily Maverick’s home page for more news, analysis and investigations
Arson attempt at Khayelitsha Magistrates Court
Meanwhile, in an incident unrelated to Klaas’s case, a fire started by an unknown man at the entrance to the court resulted in activities being suspended for the day.
There were screams and smoke coming from the security area. A few minutes later the building was evacuated.
“A man came in by the security area, started pouring petrol and set it alight. Luckily the security guards acted quickly and managed to stop the man and put out the fire. No one was injured,” said court manager Velile Yayi.
Cases and services at the court were suspended for the day. The court is expected to reopen on Friday.
Yayi said the man was arrested and the motive for the fire is unknown.
A witness said that before the man set the petrol alight, he was heard saying, “I have been coming to this damn court for eight years”. DM
First published by GroundUp.

From the Archives: Rest for the Restless Mind (Part One of Two)

No matter what you experience, be it loss, trauma or everyday shocks that are making you restless, here is some guidance on how to find rest for the restless mind, says clinical psychologist Stefan Blom.
Ed’s note: This story was first published on 19 May 2021. But we know it’s a tough time, so we thought you might need something to help you find some calm in the storm that is our political world right now.
It started with me documenting my own restless mind, in a kind of diary, noting the process from disconnection to connection, from restlessness to peace of mind. Over time, I started observing the journeys of others in therapy: From “I am feeling so lost” and “I don’t know what I need”, to “I feel grounded, aligned, centered. the best I have felt in years”.
“How do you find rest for the restless mind?” is the question I hear most often from my clients; it’s a question I have been wrestling with for many years myself. You might believe that finding rest for your restless mind lies in something extraordinary, something you have never heard of before, but it comes in life’s freest, simplest and gentlest ways.
Here, I share some of my own tried and tested ways while weaving in the wisdom of others whose guidance I’ve found worthwhile.
Understand loss and trauma
Loss and trauma often arise from life’s unexpected and inevitable shocks or surprises. They range from everyday shocks, like a car suddenly swerving in front of you on the road or a stranger shouting at you, to more traumatic losses, like the passing of a loved one or the loss of one’s job or one’s health. We underestimate the distressing effects of a child not being well, or a loved one screaming at you or ignoring you. These experiences often shake us to our core as we feel them in our minds, bodies and souls; and yet, despite their real impacts it seems we often spend most of our time suppressing, avoiding and hiding from our truths.
We experience multiple losses during traumatic events, shocks and new beginnings. The birth of a child or getting married can come with many traumatic experiences and losses (along with the beautiful gains). The effects of a break in trust, the loss of job security or mental ill health can be experienced as loss on many levels, limiting our ability to be ...

Postbank loses over R18-million to cybercrime attacks in three months

Most of the money stolen came from the Sassa beneficiary grant payment system, says CEO.
The South African Postbank is to spend R400-million over the next three years to upgrade and modernise its IT systems.
This follows the state-owned entity losing more than R18-million over a three-month period to cybercrime attacks.
On Tuesday, Postbank CEO Lucas Ndala told Parliament’s portfolio committee on communications that it had “a number of cyber fraud incidents — most of them relating to the Sassa beneficiary grant payment system”.
Ndala said the Postbank IT system had been flagged by the Auditor General for having “control weaknesses”.
“There has been a concerted effort to address these system deficiencies since the grant system was ceded to Postbank in 2021. A lot of these weaknesses come from the system itself because it came with a number of flaws that needed to be addressed over time,” Ndala said.
In response to DA MP Dianne Kohler Barnard on the total cost of the IT update, Ndala said, “The total cost approved is just around R400-million. This will be funded from Postbank resources. The modernisation will be over a three-year period.”
He said the accounts of 141 grant beneficiaries were hit in a cyber attack in August. The state-owned entity lost R5.8-million in this incident.
The second incident happened in September, also involving accounts receiving social grants on behalf of children. Ndala said the Postbank’s Fraud Risk Team discovered that some of these accounts were fraudulent, and, as a preventative measure, these were blocked.
Visit Daily Maverick’s home page for more news, analysis and investigations
However, “the blocking was not done properly,” said Ndala. “Anyone could unblock them within our branch network,” he said. Postbank lost about R4-million in this incident.
In October 2022, Ndala said the Postbank banking system suffered another cybercrime attack and lost about R9-million.
Earlier this year it was revealed that the Postbank had suffered a loss of at least R90-million in cybercrime attacks in October 2021.
Ndala told MPs that Postbank is on the same IT network as the South African Post Office (Sapo). One of the requirements when Postbank applied for a banking licence from the SA Reserve Bank, was that it needed its own “stand-alone IT environment that cannot be impacted by the risks from Sapo”.
Ndala said the report on a forensic audit into the recent cybercrime incidents is expected to be released in December, while the second part of the report is expected in February 2023.
Nonkqubela ...

SIU probe flags hand sanitiser, disinfectant contracts as irregular at Free State’s Lejweleputswa Municipality

The Special Investigating Unit’s latest report has found that the procurement process followed by Lejweleputswa Municipality in procuring hand sanitiser and disinfectant was irregular, prompting referrals from the SIU for disciplinary action against three municipal officials.
A Special Investigating Unit (SIU) investigation has uncovered procurement irregularities in two contracts awarded by the Lejweleputswa District Municipality in the Free State to Biomass Equipment (Pty) Ltd for hand sanitiser and disinfectant.
The municipality failed to ensure the prices charged by Biomass were in line with the prices for personal protective equipment (PPE) determined by National Treasury, resulting in irregular expenditure amounting to R198,792.74 incurred by the municipality.
This is according to the SIU’s supplementary “final” report on its investigation into allegations of corruption in the procurement of goods and services during the National State of Disaster.
The SIU’s final report on its Covid-19 investigations into possible corruption in procurement was made public in January this year, after it was submitted to the Presidency in late 2021, Daily Maverick’s Ufrieda Ho reported. However, not all investigations were finalised, necessitating a supplementary “final” report on outstanding matters being handed to the President in July 2022.
Reard in Daily Maverick: “Latest SIU report reveals billions more rands of unlawful and dodgy Covid-19 spending exposed”
Lejweleputswa District Municipality
The Lejweleputswa District Municipality area is in the northwestern part of the Free State and is made up of five local municipalities: Matjhabeng, Masilonyana, Nala, Tswelopele and Tokologo.
The Auditor-General’s (AG) report on the 2020/21 municipal audit outcomes revealed that Lejweleputswa Municipality received an unqualified with findings audit outcome. This means the municipality was able to produce quality financial statements “but struggled to produce quality performance reports and comply with all key legislation”.
Both the AG and the local governance ratings agency Ratings Afrika (RA), in its annual municipal financial sustainability index (MFSI), have identified Free State municipalities as the worst-run in the country. Not a single municipality in the province has received a clean audit in the past five years. The dire situation in the province has already led to a breakdown in service delivery which has fuelled unrest in many communities, as residents have grown increasingly dissatisfied with pothole-riddled roads, having to go for days without water, and refuse sometimes not being collected for weeks.
Read in Daily Maverick: “AG slams failing Free State municipalities after no clean audit in 5 years”
The SIU investigation into Lejweleputswa District Municipality was triggered by allegations from a whistle-blower who ...

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