What are the particular health challenges for South Africa’s large youth population? The biggest problem is HIV/AIDS, especially among young adolescent women who are affected more than their male counterparts. That is why we look forward to the new preventive drug lenacapavir. The second biggest problem is teenage pregnancy. And the third one is massive unemployment among youth, because it affects people’s health status, especially mental health. What are the key political choices for health at the G20 Johannesburg Summit? The biggest achievement that could ever be delivered for health is for countries to reach universal health coverage. That is an equaliser between rich and poor. You can deal even with pandemics when there is universal health coverage. I have never met anyone who says they are against universal health coverage. In South Africa, six court cases are challenging the national health insurance programme, which is for the whole population. Each, in its affidavit, said it supports universal health coverage but not national health insurance. In other words, the concept is widely accepted but people define it differently. That is where the problem is. If we can agree that universal health coverage means everyone having access to good quality health care and should not experience financial hardship, then we understand exactly what universal health coverage is. In South Africa, the people who oppose it believe there must be healthcare financing for those who are well to do and who have higher salaries, and other healthcare financing for the poor, unemployed, elderly and marginalised. That is not universal. I don’t know a medical or nursing textbook that says here are two people with diabetes: one is a domestic worker and should get this treatment, and the other is a billionaire and must get better treatment. Or this person is rich, so we treat their cancer like this, and that one is poor, so we treat it like that. Such textbooks do not exist. ▪
aid or health insurance, takes care of only 14% of South Africa’s population, who are well to do and employed. The rest pay out of pocket. Some argued we needed to differentiate so people on medical aid pay for themselves. I argued that if you are fighting a huge pandemic and money is a factor, you will not win. Eventually we agreed that whether you are a billionaire or a pauper, employed or unemployed, a public servant or a gardener – if you test for HIV/AIDS it must be free; if you test positive you should receive antiretroviral treatment provided by the state. Let people be equal in fighting that disease. That’s where our success lay. And that is why we believe that universal health coverage is very important, because we have seen it in action. If you treat people equally, they all come to access health care. We went to far rural areas and offered testing, and people came in large numbers, knowing that if they test positive they are given treatment.
PAKISHE AARON MOTSOALEDI Pakishe Aaron Motsoaledi was appointed South Africa’s minister of health in June 2024, having previously been health minister from 2014 to 2019. He was minister of home affairs from 2019 to 2024. He is also a member of the African National Congress National Executive Committee. He chaired the board of the Stop TB Partnership from 2013 to 2019. A medical practitioner, he practised in various hospitals in KwaZulu-Natal, Gauteng, Mpumalanga and Limpopo until 1994, before becoming a member of the Limpopo Legislature, leading several commissions and task teams, and a member of the ANC’s Provincial Executive Committee in Limpopo. health.gov.za
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Health: A Political Choice – The Future of Health in a Fractured World
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