This year, 2022, is perhaps most notable for what didn’t happen. While SARS-CoV-2 continued to mutate rapidly, we did not see another devastating wave of Covid-19 deaths, as some feared. To what extent we remain vulnerable to future mutations is hard to gauge. Most people in South Africa have either been infected with SARS-CoV-2, vaccinated against it, or both. The vaccination rate slowed to a trickle and by the end of the year only a little more than half of South Africa’s adult population had been fully vaccinated. Updated vaccines that provide greater protection against new variants have not yet been made available in the country.

With the threat from Covid-19 waning, much of the focus in 2022 was on recovering from Covid-19-related disruptions. In some areas, such as tuberculosis (TB) testing, the recovery has been impressive. But as is apparent from recent measles outbreaks predicted earlier in the year, significant gaps remain.

The big picture remains bleak when it comes to South Africa’s public healthcare system.

As noted in several reports this year from community healthcare monitoring group Ritshidze and confirmed in several government reports, healthcare facilities remain beset by staff shortages. There is little sign that the government has a grip on the situation as a promising strategy document on the issue appears to be gathering dust, while the nurse population is ageing and nurse training in the country has hit several snags.

The National Health Insurance Bill will be tabled for approval in the National Assembly in 2023. (Photo: Rosetta Msimango / Spotlight)

Question marks also remain over the government’s commitment to support healthcare workers, especially after steps were taken against Dr Tim de Maayer at the Rahima Moosa Mother and Child Hospital when he spoke out about conditions there.

Read in Daily Maverick: “Rahima Moosa hospital problem ‘has metastasised throughout the healthcare system in South Africa’”

Apart from healthcare worker shortages, most provincial health departments also remain beset by mismanagement and corruption. The Gauteng health department dominated headlines this year for the botched rebuild of Charlotte Maxeke Johannesburg Academic Hospital following last year’s fire, the attack on De Maayer, Covid-19-related corruption, and a still-unfolding web of corruption first exposed by Babita Deokoran who was assassinated last year – News24’s coverage of this affair was one of the year’s journalistic highlights.

It came as little surprise when Dr Nomathemba Mokgethi was axed as Gauteng’s health MEC in October. She was replaced by Nomantu Nkomo-Ralehoko. The new MEC responded to 10 questions from Spotlight, but whether she actually has the stomach for the extensive reforms needed in the province remains unclear.

Meanwhile, more than three years after it was first introduced in Parliament, work on the National Health Insurance Bill is being wrapped up in the National Assembly. Following the clause-by-clause deliberations and the department’s responses last week, the state legal adviser now has to respond to the recommended amendments in the bill. When Parliament resumes next year, the bill will be tabled before a full sitting of the National Assembly and if adopted will be referred to the National Council of Provinces for further consultation. For now, questions about how NHI will be funded, the changing role of provinces, and the powers of the minister remain largely unanswered – with the majority party in Parliament seemingly intent on ramming the bill through in roughly its original form.

Read in Daily Maverick: “The NHI is not a perfect piece of legislation, but is critical for universal health coverage”

Though it went somewhat under the radar compared with the NHI, a new Public Service Professionalisation Framework adopted by Cabinet this year offers significant potential for improving the public service, including healthcare services. The framework contains a set of concrete reforms, including some legislative amendments, that together amount to much more than just Batho Pele 2.0. Unfortunately, it seems unlikely that the framework will get the political backing it will need to make a real impact.

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Away from the corridors of Parliament, it was an exciting year for TB. Pilots of mobile X-ray screening and the testing of asymptomatic people thought to be at high risk of TB suggested these new TB detection strategies may warrant a wider roll-out. Early findings from a landmark study confirmed that for many people drug-susceptible TB can be cured in as little as two months, compared with the standard six. Several studies, most notably one called TB-PRACTECAL, confirmed that drug-resistant TB can be cured in six months with a treatment regimen that does not require any injections – plans are already afoot to introduce this regimen in South Africa. There are also plans to start treating most children with TB for four rather than six months.

The biggest HIV news of the year came two weeks ago when the South African Health Products Regulatory Authority approved the first HIV prevention injection in South Africa. Pilot projects assessing how to best provide the every-other-month injection are set to start early in 2023, but the price of the injection seems likely to stand in the way of a mass roll-out. Less headline-making is the fact that HIV prevention pills have steadily become more widely available at clinics in South Africa over the past two years. This is one of several positive developments in the country’s HIV response, although much remains to be done. A draft National Strategic Plan (NSP) for HIV, TB and STIs 2023-2028 was published for public comment late in November. The draft plan makes much of mental health support. The Department of Health’s new mental health framework, however, remains unpublished – the prior one having expired in 2020.

In terms of numbers – the MRC estimates more than 52,000 excess natural deaths in South Africa in 2022 (about a quarter of the 2021 number). The WHO recently estimated that there were about 56,000 TB deaths in South Africa in 2021 (2022 estimates will only be published next year). According to the latest estimates from the Thembisa model, there were about 52,000 HIV-related deaths in 2021 (we also saw the Thembisa team producing their first TB estimates this year). The MRC also published an intriguing study this year into underlying causes of illness and death in South Africa – unsafe sex was the leading cause, but the researchers also identified a concerning shift towards non-communicable diseases such as diabetes and hypertension. DM/MC

This article was published by Spotlight – health journalism in the public interest.