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on the state of health in South Africa
incorporating the NSP Review
Edition #4 – December 2017
A STATE of
capture
Why state capture
is a fundamental
health issue in SA
+A worrying Global Aids & TB response + Spotlight on
the eastern cape+ TB realities + Prep in South Africa
www.spotlightnsp.co.za
In this issue Contents @SpotlightNSP
Spotlight nsp
Published jointly by the Treatment
THE STATE OF OUR BROKEN BONES, GLOBAL HIV & TB RESPONSE Action Campaign and SECTION27
FUNDING BY FAITH
RESPONSE BROKEN STATE The state of the global HIV and TB response in December 2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Editors: Marcus Low & Anso Thom.
STATE CAPTURE Journalists: Ufrieda Ho, Ntiski Mpulo.
MARK HEYWOOD, SECTION27 Photographers: Ntsiki Mpulo, Thom
State capture threatens the right to health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Pierce, Ufrieda Ho, Roger Sedres.
PEPFAR FALLOUT Contributors: Mark Heywood,
UFRIEDA HO, SPOTLIGHT Ufrieda Ho, Lotti Rutter, Nora Mathe,
Funding by faith . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Ngqabutho Nceku Mpofu, Marije
Burden of the generations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Versteeg-Mojanaga, Elin Hem Stenersen,
Ntsiki Mpulo, Thuthukile Mbata, Professor
SPOTLIGHT ON MECS FOR HEALTH: FREE STATE Quarraisha Abdool Karim, Nomnotho
UFRIEDA HO, SPOTLIGHT
Ntsele,Vuyokazi Gonyela, Luvo Nelani,
Heading for the rocks?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Zain Rizvi. & Joyrene Kramer.
FREE STATE HEALTH Design: Karien van der Westhuizen, the
ANSO THOM, SPOTLIGHT earth is round
Broken bones, broken state. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Proofreading: Dave Buchanan.
Another World AIDS Day. What The news tells us that The Free State health system KWAZULU-NATAL HEALTH
is the state of affairs in 2017? money for HIV is scarce and is broken and people are LOTTI RUTTER & NORA MATHE, TREATMENT ACTION CAMPAIGN Cover image: South Africans march on
We ask a group of people who diminishing. While many suffering and dying. In Hospital horrors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 parliament in April 2017 to protest state
are at the coal face in different of these conversations this issue we revisit theHO regions and capture and corruption. Story on page 7.
s, W LIFE ESIDIMENI ARBITRATION
the state of health in South Africa
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response or non-response. communities are the ones an2016update
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incorporating the NSP Review
BEST E INTE
143+ and counting? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 support of the South African
Edition #16 – December 2016
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Page 13 Page 21
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Priority-setting, social justice and human rights in the Eastern Cape. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 EDITORIAL INDEPENDENCE
29 00
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113–
14 8 20 Fifteen years without a wheelchair – who pays?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Bangla
Brazil
16 00 0
2.7
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130
16 5– 363 14
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not always reflect the views of TAC or
5 00 0 0.02–0
50 8 254 245 NTSIKI MPULO, SECTION27 SECTION27.
SPOTLIGHT ON THE MOMENT OF 1.7– 4.
MILLIONS OF
dia 0.05 5 128– 87 8
Cambo Republ
ic 00 0 4.0 –1 182 0 21–7
rican 1 40 4 3.1 –4 57
Two steps forward, three steps back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
l Af 6. 8– 16 5 44 0 45 9
8. 4 1
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2 79 0 460
EASTERN CAPE TRUTH IN TB TB DEATHS
11 0
in a 0 31–8 4.0 –1 9 660 –1 53 3– 17
Ch 00 6 7.
6. 1 020 0
Lifesaving programme under threat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
25 53 7 3–25
16 –3 10 12 .2
Congo 79 00
0 12
6.2–23 169 3 1.4 –3
Ko rea 0
26
32 4 –534 13 6 10 –2 2.2
–104
R –3
Philani Clinic – A timeline of failure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
DP 00 14 46
102 42 3 –1 52 16
2– 20
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48 00 1.1 20 –4 191
ne sia 1.6 –4
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.5 THUTHUKILE MBATHA, SECTION27
o 16 –3 0.87 335– 3.6 11
Le so th
29 00
0 23 –5 8
518 –42
2. 5–
The state of PrEP access in SA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
spotlight
25 48 –1.1 28 6. 0 6
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55
PROFESSOR QUARRAISHA ABDOOL KARIM, CAPRISA
Myanm
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186 00
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44
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Age, gender and cycles of transmission The Treatment Action Campaign (TAC)
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54 .1 THUTHUKILE MBATHA, SECTION27
Pakist
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New G
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119
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75 4.2
3.4 –5
treatment, care and support services for
Papua 4 00 0
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2
PrEP in higher-education institutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Ph ili pp ines
ration
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755–
986 NOMNOTHO NTSELE, STUDENT reduce new HIV infections. Learn more
Le one 13 –50 0. 85 8 24 –4 86 6
–8 76
ra
Why I take PrEP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
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Africa
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3 about the TAC’s work at www.tac.org.za.
ai la nd 0 2.8–7. 4.4 36 9 2 310 30
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SPOTLIGHT ON TB
.7 9.9
nzania 0.71–1 317 372 255– –42
UR Ta 17 00
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5
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6 MARCUS LOW, SPOTLIGHT @TAC
4 710 417 –18 0 –6 44
e 29 150
Moment of truth for global TB response. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
ba bw ie s 0 16 3. 0 .4 3 19 1
Zim countr 1 020
00 3.9 –6 4 670 –2 13
0 915–
burden 17
69 –9
5
5.1 1 50 0 1 030
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99 1 80 0 –12
Who funds TB research?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
82 –27
a 0 25 35 .3 8 77
Afric 669 00 3.0 –7 0 /2019.
772 10 40
This province is always on A high level ministerial We unpack the findings,
ericas 26 2018
542– 5.0 427 d for
The Am ean 916 00
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00 0
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23
374 ise. evalen
ce su
rvey
1.7 million TB deaths in 2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
our radar. We reveal that all meeting took place in Moscow the numbers, from the 103 44 0 ot herw TB pr
–1 es nal
1 160
ur
Europe 00 0 ant fig-10. e natio
sia 1 89 0 1 30 0 signi fic D om th
East A thre e rding to IC results fr
is not well and below the where the delegates focused
South-
Weste
rn Paci
fic
latest WHO TB report. It is
7 44 0
00 0
ur
unde
and to
es if fied as HIV rim in na
co
r 10 0 deat hs acture, pend
ing
AIDS COUNCILS
t fig assi inte
GLOB
AL ni fican ses are cl India are
VUYOKAZI GONYELA, SECTION27
breathtaking natural beauty on TB and what needs to be a report that reveals that
show
two sig
n to ositive TB or talit y
bers ong HIV-p nce and
m
ca for
SECTION27 is a public interest law centre
a N um
s am TB incide Let’s make AIDS councils work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
there is a story of collapse and done to turn the tide. Read b D ea th
c Es tim
ates
too many people are still
of
that seeks to influence, develop and use
suffering and empty promises. this report from the frontline. dying of TB worldwide, and INTELLECTUAL PROPERTY the law to protect, promote and advance
Page 32 Page 52 specifically in South Africa. LUVO NELANI & ZAIN RIZVI, SECTION27 human rights, particularly the right to
Overdue IP reform process crucial for healthcare in South Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 health. Learn more about SECTION27’s
Page 56 work at www.section27.org.za.
@SECTION27news
GLOBAL HIV & TB RESPONSE
In 2017, it is very encouraging to see
The state of
I am tired – to the point of A bittersweet trajectory: We are in an
despair – of all the congratulatory epoch in which the HIV epidemic continues in an expansion of life-saving antiretrovirals
public raptures about the progress unremitting manner, eradicating the promise of a to 21 million individuals worldwide; however,
in order to get the full impact of this treatment
the global
against HIV and AIDS. How could we better tomorrow from our families and communities.
not have made progress? It’s been In our country, more than seven million people are expansion, we also need to ensure that all 21
thirty-six years, for heaven’s sake: HIV-infected; and it is estimated that there are 1 000 million stay on their treatment and become
we were bound to move forward. new infections every day. Science continues to push virally suppressed. Sadly, we are not doing well in
HIV and TB Instead indulging in an orgy of the boundaries: progress new HIV treatment and tuberculosis and without a doubt more emphasis is
self-hypnotic success, we should be care interventions, movements to control paediatric needed worldwide on improving primary prevention
demanding to know how it’s possible HIV by reducing maternal-foetal HIV transmission. of both HIV and tuberculosis. This will require
response in that up to 19 million people still These have translated into reductions in infant that we also address structural determinants of
don’t have treatment; that women and under-five mortality rates, and increased life universal health: a much harder challenge to meet.
and adolescent girls continue to expectancy. In the HIV-prevention arena, progress Professor Linda-Gail Bekker, president of
December
bear the brunt of the pandemic’s in long-acting antiretrovirals for use in pre- the International AIDS Society & Deputy
assault; that key populations are exposure prophylaxis may translate into a powerful Director and CEO of the Desmond Tutu HIV
demonised by fossilised governments, prevention intervention. As we advance three HIV Foundation at the University of Cape Town.
2017
so that prevention and treatment vaccine concepts into efficacy studies, we start to
are never available; and that we’re in think that we may have the kind of tools that have
a staggering funding crisis, the sure the potential to curb the HIV epidemic globally.
outcome of which is even greater However, the biggest hurdle to overcome in our
On the eve of World AIDS Day 2017, morbidity and mortality. Where is the fight against HIV is the stigma and discrimination
political and multilateral leadership
Spotlight asks a series of activists, that HIV-infected people face every day of their
that can decisively and forever turn the lives. The true test of beating this epidemic will
researchers, doctors and powerful tide? We should all be raging against be whether we as a people have the ability to
persons in the HIV and TB worlds what the profusion of fatuous voices. overcome our prejudices against people living
Stephen Lewis, co-director, with HIV. While we have at our disposal a series
they think. AIDS-Free World. of proven prevention tools to afford us safer The world has made great strides in
sexual choices, it is evident that science and tackling HIV/AIDS, but we are in danger of
biomedical interventions alone will not help heal coming to a standstill. Progress has slowed, for a
HIV and TB continue to be major global public-health issues, our communities and families. Structural factors variety of reasons; but a major roadblock is our
#4 – December 2017
#4 – December 2017
with an estimated 37 million people living with HIV and an estimated 10.4 such as poverty and unemployment, in addition failure to listen to young people. The largest-ever
million with TB. The vast majority of people living with HIV and TB are from to biological factors such as genital inflammation generation of adolescents in sub-Saharan Africa
the low and middle-income countries, and the majority of them are public and viral load, and behavioural factors such as lack is at risk of HIV – in 2015, nearly 7 500 young
healthcare users. We can’t afford to lose this battle; political rhetoric without of condom use and age-disparate relationships, women aged 15 to 24 years acquired the infection
action won’t win this battle. The only revolutionary step towards ending have combined to make our battle against HIV each week. Stigma, poor education, and services
HIV and AIDS is to invest more resources in public health care, and have the all the more challenging. If we are to grow the that are out of touch. We must understand what
political commitment and will required to overhaul public healthcare systems. momentum of our battle strategy against HIV, young people are going through, and react
Only a functional, well-maintained, well-resourced public healthcare system then we must not define people by their living
spotlight
spotlight
quickly and effectively, if we are to end HIV/AIDS.
that will serve the people – irrespective of their class, sexual orientation, financial status and of other with HIV; but rather, by the lives they fulfil. Professor Peter Piot, Director of the London
discriminatory laws – can take us to where we want to see ourselves with our global response to HIV and TB. Professor Glenda E. Gray, President School of Hygiene & Tropical Medicine and
Anele Yawa, General Secretary, Treatment Action Campaign. of the Medical Research Council. former Executive Director of UNAIDS.
2 3
GLOBAL HIV & TB RESPONSE
The political momentum for the fight
against TB is now garnering the same type of global
South Africa has the largest HIV attention that HIV achieved in 2000, when the UN
treatment programme in the world General Assembly hosted a Special Session on AIDS,
with 4.2-million patients on treatment. This the Global Fund was created, and investments shifted
has been achieved through a combination from the millions to the billions. It’s not before time.
The state of the intertwined,
of factors including high levels of activism by global HIV and TB response is
Still lagging behind is any serious attention being paid characterised by two signature themes.
civil society formations, political leadership to the plight of women and girls. In fact, things are
from Minister Aaron Motsoaledi, funding from In the first instance, we have a global
going into reverse: in January 2017, US President Trump community unified in strategic intent to
national Treasury in the form of a conditional used his first days in the White House to expand the
grant, training of nurses to initiate patients Thanks to anti-retrovirals, AIDS is Global Gag Rule to all $8.8 billion allocated to US global
achieve epidemic(s) control, as encapsulated
on first line treatment (NIMART) and support no longer an inevitably fatal condition, but by the UNAIDS 90-90-90 strategy. This
health – including funds dedicated to HIV and TB. This unified focus needs to be bolstered even
from development partners. However with an a chronic, manageable one; rates of infant
is likely to have a devastating impact on the lives of further, as the impact of a successful 90-
estimated 270 000 new HIV infections in 2016 transmission have been reduced to about
girls and women, especially girls and women impacted 90-90 strategy will be healthy, HIV positive
as well as 7.1-million living with HIV and AIDS, 1.5%; and their impact on prevention – directly
by these two diseases. NGOs registered outside the US persons living long, productive lives, while
it is clear that we have much more to do in both through viral suppression of infected persons,
can no longer provide information or advice about transmitting the virus at far lower rates.
preventing new HIV infections as well as reaching or through prophylactic use by infected persons
safe abortion, even with their own or other people’s
the 90-90-90 targets by 2020. The recently – is starting to emerge. Though with nearly 20 The second signature theme relates to
funds, if they want to retain funding flows from the US.
launched Global HIV Prevention Coalition’s HIV million people still to be initiated on treatment generalised insecurities globally, and the
globally, a million deaths, and 1.8 million new All of the hard work done so far to address the emerging dominance of more conservative,
Prevention Roadmap proposes a target of no
infections still continuing to occur, we can hardly human rights of girls and women, and to break inward-looking views among donors. This
more than 88 000 new HIV infections by 2020. In
claim to have turned the corner or the tide! through silos, has been endangered. Many HIV directly affects the HIV/TB programmes
addition, reaching the 90-90-90 targets means
We do have sufficient knowledge to achieve programmes have worked hard to address the needs that support the poorest and most
that we should have 6.2-million patients on
epidemic control, however in sub-Saharan and rights of the women and girls they serve, so marginalised of communities. Efforts
ART by 2020 as well. To meet these targets we
Africa, the HIV and TB epidemics are closely that they can access the full spectrum of sexual and should be amplified towards lobbying
will require that all stakeholders fully commit to
intertwined; failure to integrate HIV and TB reproductive health services alongside their HIV and wealthy countries to increase donor
them, find additional resources as well as work
services is resulting in continued high mortality TB services. Given the heavy reliance of HIV and TB support to developing countries, while
collaboratively. It will also require changes to how
rates – as are stigma and discrimination, through programmes on US funding, catastrophic impacts developing countries should find greater
we provide services to reach the treatment targets
creating a barrier to accessing services. are predicted that will be counted in the lives and internal resources to support the same.
and how we support patients to ensure high levels
well-being of women, girls and their communities.
of viral suppression. We also need to more rapidly Stigma remains a major barrier to access to HIV/TB epidemic control requires
Brave politicians – initially from the Netherlands and
#4 – December 2017
#4 – December 2017
decrease new HIV infections by being more services. We need to partner with infected long-term, global, sustainable
creative and fully implementing combination and affected communities much earlier, and other European countries, and now from Canada, support by – and for – all.
prevention strategies. Our strategies must include across all stages of developing, evaluating Afghanistan and a range of African countries –
Dr Tim Tucker is CEO of SEAD Consulting
dealing decisively with the TB epidemic as well and implementing new interventions. have mobilised. Around the world, thousands
and specialist Clinical Virologist
– preventing new TB infections, finding those of individuals and organisations are standing
Getting to this point has required a lot of
that have TB and successfully treating them. together under the banner of SheDecides to fight
teamwork, political commitment, global
We have the political will, the motivation, and for a ‘new normal’, in which every girl, every woman, RELATED STORIES:
solidarity and innovation – and the next phase
the means to reach epidemic control by 2020! everywhere decides for herself what to do with her
is going to be a lot more challenging. But can ++ Pages 10-13 looks at the
spotlight
spotlight
body, her life and her future. And you can join them,
Dr Yogan Pillay, Deputy Director General, we afford to reverse the gains made to date? imapct of PEPFAR 2017 on one
by signing the manifesto at www.shedecides.com.
South Africa, National Department of Health Professor Quarraisha Abdool Karim is the Associate orphanage in South Africa.
Robin Gorna co-leads SheDecides.
Scientific Director of CAPRISA in South Africa. ++ Pages 47- 53: Spotlight on TB
4 5
STATE CAPTURE
State capture threatens
the right to health
Mark Heywood, SECTION27
“In a sector that is scarce and expensive to begin with, corruption can mean the difference
between life and death.” – Viva Dadwal, Deputy Editor of Globalisation and Health
“Making corruption a research subject and a responsibility of health systems researchers in South Africa
and elsewhere allows us to name the problem, measure it, and develop and test ideas about how to
address it. Such research also allows the global community of health system researchers to contribute
towards improved efficiency, effectiveness and social accountability of health systems.” – L Rispel et al,
‘Exporting corruption in the South African health sector’, Health Policy and Planning, 2015, 1–11
In 2017, a debate raged at the Treatment Action Campaign’s (TAC) National
Congress about how to respond to corruption across the country. As the levels of
scandal and shock around President Jacob Zuma’s behaviour have risen, TAC’s allies
have often called on it to take to the streets and join organisations such as the Save
South Africa campaign that are calling for Zuma to step down.
However, within TAC, some activists have health outcomes. That is why “access to weaves in and out of another. Looked
asked: ‘What does health have to do with health care services” was included as a at from afar, they compose a picture
party politics?’ They argue that TAC should right for “everyone” in our Constitution. that promises everyone in our country
stick to its mission – the right to health Today, the Constitution is our supreme equality, dignity and social justice.
– and avoid being caught in a morass of law. But South Africa’s Constitution However, very few of the threads can
political mudslinging. There is a level of started its life as a political agreement exist independently. The right of access to
truth in this argument; however, the very between parties to mark the dawn of healthcare services, for example, cannot
birth of organisations such as TAC was democracy. The Constitution is like be realised in a silo. It is dependent
in response to a failing political strategy, a finely woven tapestry; it has many in many ways on good governance,
#4 – December 2017
#4 – December 2017
government and healthcare service, threads and many strands. Each one accountability, and a government
responsible for the deaths of millions of
people when they refused to provide
adequate treatment for patients with HIV.
Our struggle for the right to health
The very birth of organisations such as
has always been political, and will always TAC was in response to a failing political
remain political. Everywhere in the world,
Photo: Karien van der Westhuizen
the quality of health has everything to do strategy, government and healthcare
with politics. South Africa is no exception.
spotlight
spotlight
South Africans showed up in their thousands for a day of national
action on 7 April 2017 organised by the Save South Africa coalition. Under apartheid, the majority of the service, responsible for the deaths of millions
Pictured here are protesters outside the South African parliament,
one sporting a placard showing the face of a horned President
population were denied access to quality
health services. When apartheid ended
of people when they refused to provide
Jacob Zuma and that of his friend Atul Gupta, member of the
infamous Gupta family, who is strongly linked to state capture. in 1994 there were gross inequalities in adequate treatment for patients with HIV.
6 7
STATE CAPTURE However, while we can point to specific instances of corruption in the health system
that is diligent in the performance of by providing the public with timely, and provincial health departments
(as I do below), there has not been enough investigation of the overall levels of
public functions. These too are parts of accessible and accurate information.” now around R190 billion per year, corruption – or its impact. But it is large. In 2011, for example, SECTION27 and
the Constitution. For example, Section Section 237 says: the health system also offers rich
195 of the Constitution says that: “All constitutional obligations must be pickings for those intent on theft. In
Corruption Watch commissioned research (Corruption in the South African Health
“Public administration must be performed diligently and without delay.” this context, the capture of big health Sector, Benguela) that concluded that up to R20 billion a year was being lost to
governed by the democratic What this means is that where tenders, ambulances and institutions
values and principles enshrined government is bad, access to health such as hospitals is also common. corruption in the public and private health sector. It warned that: “If the current
in the Constitution, including services fails. Without access to healthcare corruption risk remains and is not appropriately addressed, it will inflate the cost of
the following principles: services, people’s health will deteriorate. How corruption
a. A high standard of professional ethics Very few people now deny that we manifests itself in the health care, limit access to services, and negatively impact on the quality of care.”
must be promoted and maintained. have a very bad government. In the healthcare system
b. Efficient, economic and effective last two years our country has been in Corruption is a serious threat to More recently, research by Laetitia Rispel Rispel et al attempt to quantify the financial years between 2009 and
use of resources must be promoted. the throes of a crisis caused by what the majority of the population and others recorded that the majority cost of corruption in health by studying 2013, the total amount of irregular
c. Public administration must is now known as ‘state capture’. Theft who rely on public hospitals and of people they interviewed “were of the levels of “irregular expenditure” that expenditure within provincial health
be development-oriented. by people such as the Gupta family clinics. Not only does it make opinion that corruption is pervasive, are recorded in reports of the Auditor departments was over R24 billion.
d. Services must be provided impartially, has been facilitated by President it difficult for them to receive particularly in the public health sector. For General. Irregular expenditure is This is a huge amount of money!
fairly, equitably and without bias. Zuma and other Cabinet members. proper treatment when they are example, commenting on corruption in money that is spent without proper It is the equivalent of the annual
e. People’s needs must be responded Unfortunately, the story of state vulnerable and cannot pay a bribe, the public sector, respondents note that authorisation and outside of the legal budget for the HIV conditional grant,
to, and the public must be encouraged capture has been told in a one-sided but when funds, medicines and it is ‘rampant’ (Private Hospital Manager) framework. It is not automatically or twice the amount currently spent
to participate in policy-making. way. Most of the focus has been on equipment are stolen or misused and has ‘reached uncontrollable levels’ corrupt – but a very large part of it is. on Emergency Medical Services (which
f. Public administration institutions such as SARS, Eskom, SAA, by officials, it can have devastating (Provincial Department of Health Director).” They found, for example, that in four we know to be woefully inadequate).
must be accountable. PRASA and now the Treasury. But with effects on communities at large.
g. Transparency must be fostered the combined budget of the national Total amount assessed by Auditor-general as irregular expenditure, 2009/10-2012/13, by
province. Nominal ZAR ‘000 – with real ZAR ‘000 December 2012 in brackets.
Type of corruption Examples Province 2009/2010 2010/2011 2011/2012 2012/2013
Informal payments Unofficial payments given to healthcare providers which are more than the Western Cape 27 168 (30 803) 119 194 (128 719) 74 000 (75 665) 86 700 (83 849)
official cost of a service, or for services that are supposed to be free
Mpumalanga 0 (0) 15 281 (16 502) 285 061 (291 473) 123 100 (119 052)
Selling of government posts A senior official in a position of power demands a payment from
government agents to secure or keep their positions
Eastern Cape 1 327 628 (1 505 247) 278 320 (300 562) 436 000 (445 808) 304 000 (294 004)
Moonlighting Healthcare professionals abusing leave policies or conducting their private practice during work hours
KwaZulu-Natal 637 725 (723 044) 562 329 (607 267) 2 038 000 (2 083 845) 2 719 200 (2 629 787)
Bribes Money or something of value promised or given in exchange for an official action
Procurement corruption Includes many types of abuse, such as bribes, kickbacks, fraudulent invoicing, Limpopo 159 (180) 401 477 (433 560) 625 600 (639 673) 571 200 (552 418)
collusion among suppliers, failure to audit performance on contracts, etc.
Free State 273 615 (310 221) 318 543 (343 999) 45 300 (46 319) 143 700 (138 975)
Theft or misuse of property Theft or unlawful use of property such as medicines, equipment or vehicles for personal
use, for use in a private medical practice, or for resale or renting out
Gauteng 455 643 (516 602) 2 246 121 (2 425 617) 1 100 000 (1 124 744) 1 524 200 (1 474 081)
Fraud Includes false invoicing, ‘ghost’ patients or services (billing for patients who do not actually exist
or services that were not rendered), and diversion of funds into private bank accounts
Northern Cape 100 872 (114 367) 1 074 860 (1 160 756) 942 000 (963 190) 1 064 500 (1 029 497)
#4 – December 2017
#4 – December 2017
Embezzlement of funds Officials, healthcare providers or other individuals stealing or deliberately
diverting national funds allocated for healthcare services North West 513 759 (582 493) 949 487 (1 025 364) 1 726 000 (1 764 826) 971 300 (939 362)
Nepotism Employment opportunities are given to friends and family members
TOTAL 3 336 569 (3 782 958) 5 965 613 (6 442 347) 7 271 961 (7 435 543) 7 507 900 (7 261 025)
based on personal connections instead of merit
Improper healthcare accreditation Individuals or groups approve a healthcare professional’s qualifications due to personal Base 100 = December 2012. Source: Auditor-Genreal of South Africa, 2014.
or political connections with the professional or the receipt of a bribe
Inappropriate healthcare Officials provide unwarranted certification to a healthcare facility, due to personal or When such massive amounts are misspent became president; and in the dying table. It unashamedly smirks at us while
facility certification political connections with the facility operators or the receipt of a bribe and stolen, there is bound to be an impact days of his rule, the rot within the health its wickedness creeps into all corners of
spotlight
spotlight
Inappropriate healthcare Officials provide unwarranted certification to a healthcare training facility, due to personal
on the availability and the quality of system has become increasingly evident. the public and private sector, infecting
training facility certification or political connections with the college owners or the receipt of a bribe care in the health system. Much of this Corruption is no longer the hidden hand many with the desire to plunder the
corruption was intensified after Zuma passing brown envelopes under the public purse for self-enrichment.
Source: Corruption Watch/SECTION27
8 9
STATE CAPTURE b. C
orruption in the Free State Conclusion: AIDS activists must be anti-
Department of Health corruption and social justice activists!
Below are some examples of corruption that have been confronted by SECTION27 But Gauteng is not the only provincial The examples I have given above are Unfortunately, it doesn’t seem that the
health system where thieves rule. For reasons that AIDS activists must also be national and provincial health departments
and TAC. several years, TAC and SECTION27 have political and social justice activists. take corruption seriously, or that it is being
tried to spotlight corruption in the Free Politicians are the gatekeepers of the seriously investigated by bodies such as
State Department of Health. Dr Benny resources allocated to and spent on the Hawks or the NPA. Their responses
a. G
auteng Health Department: It has been nine years. But there is no of rands. There is also some evidence Malakoane, who was the MEC for health healthcare services. When their greed are usually reactive to reports by civil
a rogue unit case.” Looking at the current state of that they benefited from the patients’ between March 2013 and October 2016, supersedes the needs of the people, society and the media, rather than part
affairs and the political puppets in charge disability grants and life insurance. had already learnt his thieving ways by and results in the crippling of our health of a proactive plan to root out corruption
The Gauteng Health Department of the National Prosecuting Authority, But Life Esidimeni is not just the time he became MEC. He is on trial institutions – and in many instances, leads in the health sector. Until there is political
is possibly one of the most corrupt it seems unlikely that Hlongwa will be about a few corrupt individuals. The for charges of corruption related to his to the deaths of our most vulnerable – commitment to really fighting corruption,
provincial health departments in the brought to justice for crippling the GDoH. Gauteng healthcare system has been past employment, but every time he is we must then admit that we are indeed civil society will have to fill the gap by
country. Its irregular expenditure for In 2009 Hlongwa was replaced by corrupted. Instead of being managed due in court he and his accused seem a sick society. The president might not exposing and reporting corruption.
the period of 2010/2011 to 2016/2017 disgraced MEC Qedani Mahlangu. as a system for health care, it is seen able to engineer a postponement. have had direct involvement in cases On a day-to-day basis this requires
was calculated by the Auditor General Between the two of them they have by politicians and public servants as a In 2015 a whistle-blower contacted such as Life Esidemeni and the crumbling strengthening of community oversight
to be a massive R6.9-billion. managed to bankrupt the GDoH. get-rich-quick scheme. And the most SECTION27 to tell us that Benny of the NHLS; but the system of thievery through participation in hospital
The rot appears to have started As a result the price of corruption senior officials in government – like Malakoane had introduced a programme that festered under his leadership allows boards and clinic committees. It means
about ten years ago, with then-MEC is being felt in collapsing services; president Zuma – turn a blind eye to for unproven stem-cell treatment of for a Qedani Mahlangu, and makes the organisations that monitor health-service
for Health Brian Hlongwa. Hlongwa is community health workers go unpaid this, because the individuals involved geriatric patients at two hospitals in call for his removal all the stronger. delivery (such as the Stop Stock-outs
facing charges of corruption. Due to because of corruption; babies die or are usually part of a political faction Bloemfontein. The programme was The fact that access to healthcare Project) are vital. Re-establishing bodies
the capture and collapse of our criminal are disabled because there are not whose support they depend upon. costing the Free State DoH R3 million a services is a constitutional right does such as the Budget, Expenditure and
justice system, Hlongwa has not yet enough midwives and nurses; people One significant casualty of corruption month, and would run for three years. It not mean we should think that health is Monitoring Forum (BEMF) is also essential.
faced the consequences of his corrupt acquire TB and MDR-TB because there in the GDoH is the National Health was alleged that Malakoane had a direct automatically protected. It is contested Civil society needs to constantly monitor
behaviour. Hlongwa is currently facing are no systems for infection control. As Laboratory Services (NHLS). The relationship with the company that was by the everyday behaviour of officials institutions such as SANAC, from where
charges of corruption and money we saw recently, hospitals treat dead NHLS can be thought of as being the providing the ‘service’. Fortunately, on who steal from funds intended to realise there have been reports of corruption
laundering relating to two tenders bodies like the carcasses of animals. arteries of the public-health system, the basis of the information provided by that right. If we don’t root out corruption involving civil society leaders. We also need
worth R1.4-billion. It is alleged that in The worst example of the results of and particularly of the response to the whistle-blower SECTION27 was able in the public-health system, the health to investigate tenders worth hundreds
2007, Hlongwa fraudulently rigged two corruption is the Life Esidimeni disaster, HIV and TB. It is like the Eskom of to inform the Director General in the system will collapse. According to Rispel of millions of rands, such as that given
tenders so that they could be awarded which caused the death of at least 143 health. Controlling AIDS and TB is DoH, who quickly investigated and then and others: “Poor governance and to the controversial company Sadmon
to 3P Consulting and Boaki Consortium, mental-health patients. The arbitration totally dependent on laboratory tests closed the programme down. Tens of corruption share a reciprocal relationship for a health communications strategy
and that he received various kickbacks in currently under way aims to find the for HIV such as CD4 count and viral millions of rands were saved from theft. and negatively impact on the morale that is mostly invisible and ineffective.
return. 3P was initially paid R120 million truth. At this point, the real reasons load, and on technologies such as of healthcare providers, the majority Finally, on a political level it means
to establish a project management unit patients were moved out of Life Esidimeni GeneExpert. However, the GDoH owes c. Theft of medicines of whom are committed to service that TAC should join forces with
for the department, but they ended up and dumped into unregistered ‘NGOs’ over R2.5 billion to the NHLS… but excellence”. They go on to say that: those challenging corruption at the
earning R392 million by the time their where most of them died must still come says it can’t afford to pay its bill. As we know, South Africa now has the “Although legislation seems adequate, highest level, including that of the
contract was cancelled in 2009. Boaki out. But some of the evidence seems To make matters worse, people who biggest anti-retroviral (ARV) programme initiatives by government to identify and President and the ruling party.
was awarded a tender worth R1.2 billion to suggest that senior officials such as work in the NHLS allege that there is in the world. Billions of rands are spent ameliorate vulnerabilities to corruption within If state capture and corruption is not
to set up a health information and Dr Makgabo Manamela, the head of rampant corruption and mismanagement on medicines every year. This is also the health sector need to be further developed. investigated and punished, South Africa
health records system. By the time mental-health services, may have had by senior officials. In the latest financial an area vulnerable to corruption. For Proactive mechanisms to detect corruption will end up with a public-health system
their contract was cancelled in 2008, corrupt relationships with some of the year, the NHLS incurred nearly R1 billion example, when the issue of major stock- and the enforcement of negative sanctions as broken and dysfunctional as that
they had been paid R400 million, but ‘NGOs’ to which they sent patients. in irregular expenditure. If the NHLS outs first became a concern in 2013, against those found guilty of corruption in other African and Asian countries.
no infrastructure had been set up. These ‘NGOs’ profited from patients collapses as a result of its burden of one of the reasons was rampant theft are important interventions to create That, surely, is something we must
#4 – December 2017
#4 – December 2017
In 2010, the Special Investigating Unit the GDoH sold them to care for, several debt and corruption, large parts of the at provincial medicine depots such as disincentives for engaging in corrupt activity.” do everything we can to avoid.
(SIU) was given a mandate to investigate of them making hundreds of thousands health system will go under with it. that in Umtata. A report produced by
these matters by a Presidential TAC and MSF at the time noted that at
Proclamation. It has been seven years,
and still no-one has been brought to
any one time, the Umtata depot would
have medicines in stock worth up to
When [the] greed of politicians supersedes
book. Hlongwa is currently serving as The rot [in the Gauteng Department R40 million – and noted how much the needs of the people, and results in the
the ANC Chief Whip in the Gauteng of this was at risk of being stolen. In
Legislature, and has continued to operate of Health] appears to have started recent years – in part because of TAC crippling of our health institutions – and
with impunity. He recently noted: “I was and SECTION27’s activism, and the
spotlight
spotlight
once a minister, an MEC of health from about ten years ago, with then-MEC monitoring of the Stop StockOuts Project in many instances, leads to the deaths
2006 to 2009 in Gauteng. There is a cloud
hanging over my head. I am supposed
for Health Brian Hlongwa. Hlongwa (SSP) – the management of provincial
medicine depots has improved,
of our most vulnerable – we must then
to be somebody who is corrupt as well. is facing charges of corruption. reducing the risk of corruption. admit that we are indeed a sick society.
10 11
PEPFAR FALLOUT
Funding by faith
Ufrieda Ho, Spotlight
A community caregivers project for rural KwaZulu-Natal AIDS orphans and
vulnerable children hangs in the balance as donor money from the United States
dries up.
Even for a woman of faith, breaking bad heavily on this source of income. the small projects around the country
news is never an easy thing to do. The project that started in October especially now have to find their own
When Sister Krystyna Ciarcińska 2015 focuses on supporting children way to fund their programmes or they’ll
called a meeting for the 30 caregivers in vulnerable households, many are have to shut them down,” she says.
of the Koinoina Orphans Project AIDS orphans. It’s part of the Catholic At this point, Pepfar will continue to
in rural Umzimkhulu, KwaZulu- Church’s response to HIV/ Aids that was fund projects in South Africa till September
Natal at the end of winter this year, officially started in the country in 2000. next year. In May, the US Embassy in
she did so with a heavy heart. Withdrawal of PEPFAR funds Pretoria announced that Pepfar would
“I was so sad and I didn’t know what The SACBC has been a beneficiary of support South Africa’s HIV/AIDS and TB
I was going to say to them,” she says, the United States’ Pepfar (President’s programmes till September next year and
remembering that day. In her hand Emergency Plan for Aids Relief ) funding would support the National Strategic Plan
was the letter from the South African since the fund came into being officially (NSP)’s 2017-2022 programmes for HIV,
Catholics Bishops Conferences (SACBC) in 2004. The shift in foreign policy under TB and Sexually Transmitted Infections.
notifying the Lourdes Mission, where Sr the Trump administration has however, An additional U$51-million in funding
Krystyna is a consecrated sister of the sparked concern for critical long-term was approved to support South Africa’s
Koinonia John the Baptist community, financial support from Pepfar. voluntary male medical circumcision
that funding for the two-year-old Koinonia According to Mrudula Smithson, programme. Since 2004, Pepfar has
Orphans Project she headed up, would director of the SACBC AIDS Office, Pepfar invested over U$5.6-billion in South Africa.
run out by the end of September. funding to the SACBC has been reduced A million realities away from
“Sometimes when we call special by around half for the next financial decisions made in boardrooms in
meetings it’s because we have been year. While Smithson says they don’t capital cities, Koinonia Orphans Project
given unexpected donations of blankets, disclose the actual amounts, she says caregivers must still get on with
mattresses or something, so the caregivers their projects have been hit badly. visiting families under their care.
were very excited. But instead I had bad “We receive three streams of
news to tell them; it was terrible,” she says. Pepfar funding for our projects that Giving care
That official funding has dried up and it all focus on orphaned and vulnerable With basic training in nutrition, hygiene
has been a blow. But the Lourdes Mission children – all three have been severely and counselling, caregivers help make
has fought to continue with the project affected while our target of the number sure people adhere to their medicine
even though for the past few months of children we want to reach has regimes and have food to eat, often they
paying the R35 000 a month bill it costs to increased significantly,” she says. share from their own meagre provisions.
#4 – December 2017
#4 – December 2017
run the project has never been a certainty Smithson adds that the SACBC Aids They cook and clean, fix homesteads,
“Prayers and providence,” says the Office programmes currently reaches 45 and help plant food gardens. They also
irrepressible Sr Krystyna with a smile, at 000 children. “We are very concerned that help register children for birth
how donations have materialised. Still,
she’s only too aware that the long-term
sustainability of the project is in jeopardy.
The Koinonia Orphans Project has
over the last two years become a vital A million realities away from decisions made
lifeline for over 900 children registered
spotlight
spotlight
in boardrooms in capital cities, Koinonia
Photo: Ufrieda Ho
in the project and their families from the
Sporting their blue golf shirts are some of the Koinonia Orphans caregivers who have 13 villages that surround the mission
station. The 30 caregivers who receive
Orphans Project caregivers must still get
changed the lives of at least 900 children in 13 villages in Uzimkhulu. From left are
Ntombovuyo Langa, Bongekile Dlamini and Gloria Tsezi. In front is Lodiwe Ndzimande. a stipend for their service also rely on with visiting families under their care.
12 13
PEPFAR FALLOUT
certificates and identity documents. A difficult life own, there are even little girls bearing
They do school monitoring, help with A few villages away in Riverside, a mother her name – spelt the Polish way – the
homework and ensure that children tells of her trials of living with HIV and mothers and the nun say with a laugh.
have school uniforms, without which the devastation of some years ago when It was in 2010 that the arduous
they’re not allowed to attend school. she found out that one of her children, an process of rebuilding the Lourdes
Another prong of the Koinonia 11-year-old girl, is also HIV positive. The Mission and their cathedral first started
Orphans Project has been twice child has also suffered from TB, she says. under invitation by the local bishop
yearly voluntary HIV/AIDS testing They have a vegetable garden but to Father Michal Wojciechowski, who
and counselling days targeted sometimes there isn’t enough food now heads the Koinonia John the
at children but also reaching for a square meal – essential for those Baptist community in Lourdes.
adults who live in communities taking ARVs. Riverside was also without The mission station and cathedral date
surrounding the Lourdes Mission. water for nine months this year. back to 1895. They were built by Trappist
In their last testing campaign held in In another village Tryphina Mkalane monks but had been given over to neglect
August they were able to test 400 people, is grieving for her daughter who and abandon for decades. Brick by brick
working in collaboration with local clinics died just months ago. It’s added two the community has worked to rebuild the
that provided the pin-prick test kits. more grandchildren under her care, twin-towered cathedral and the living
TOP LEFT: The Lourdes Mission has
suffered from neglect, abandon “Knowing their status early is bringing to five the number of young quarters for the handful of nuns and
and fire for over one hundred years. important so that they can start ones who live in her rondavel. brothers who keep the mission alive.
Goats graze where the remains of the treatment early,” says Gloria Tsezi, One of the children turns 18 soon. There’s still a mountain of work to be
convent that the Koinonia John the one of the Koinonia caregivers Mkalane worries she will not find a paying done, like restoring a burnt out convent
Baptist community hold to rebuild.
in the village of Moyeni. job. At the same time it will mean she’ll lose and an adjoining boarding school.
ABOVE: The home headed by Christina
Tsezi visit homes where the burdens a social grant that goes towards paying for Every day there are new needs that
Mtolo (far right), her daughter Gloria
Mbhele (far left) and with them facing families is heavy. At the home groceries, transport and school supplies. present at the Lourdes Mission’s doors.
Gloria’s children Anelisiwe Mbhele, of Busisiwe Khambula and her three “One of my other daughters is in The sisters, brothers and Father Michal
their friend Thembalethu Tshabalala, children, Tsezi looks on as Khambula Durban. She’s been trying to find a open their arms to it all: a woman and
and Gloria’s other child Senelweko.
cradles in her lap the head of her job for over a year now. We send her her children who have gone three
They are one of the families that are
part of Koinonia Orphans Project. eldest of three children, Olwethu (18). the grant money so she can pay rent days without a meal; the shattering
He is severely disabled and often in Durban,” says Mkalane, speaking news of a teenage suicide; someone
BELOW: When rain sets in in the hills of
Umzimkhulu it brings with it cold and suffers from uncontrollable fits. through her caregiver, Lucinda Dlamini. needing help with homework or just
winds that make tough lives even tougher. “Sometimes the clinic tells me there For Sr Krystyna, who grew up in Poland seeking out comfort and a prayer – and
BELOW LEFT: Wall decoration are no medicines for his fits, then I have and arrived in South Africa from Spain first of course, the on-going question of
inside a rondavel. to go to Rietvlei Hospital. Sometimes I in 2013 then permanently since April 2014, how to fund the Koinonia Orphans
LEFT: Granny Tryphina Mkalane has lost just lie him down flat and wait till the helping to lighten people’s challenges Project for the the long-term.
her daughter and another is in Durban fit is finished – it hurts my heart too bought on by the collision of multiple But the cathedral is a beacon of joy
looking for work. It means she has to look
much,” Khambula says. Transport to miseries has become part of her life’s work. and spiritual light. It’s packed to capacity
after five of her seven grandchildren.
get to the hospital costs her R200. Every sad story breaks her heart, but for Mass each Sunday, the mission’s
Tsezi and Khambula also tell not her faith. Her childhood fascination food garden and orchards now thrive
of Khambula’s allegedly abusive with Africa has turned into the place as a symbol of new hope. Funding
relationship with the mostly absent she now calls home. In return the is sorely needed here; faith in action
father of her children. Abuse is community has embraced her as their though, grows with abundance.
another load that women in this
#4 – December 2017
#4 – December 2017
remote district of KZN must carry.
Tsezi says: “He threw away all her
pots and burnt all the children’s “Sometimes the clinic tells me there are
documents so I had to help get new
identity documents for the children.
no medicines for his fits, then I have
“I come to look after Olwethu and to go to Rietvlei Hospital. Sometimes I
the two smaller children, Jabulile and
Simthanda, when Busisiwe must go out. just lie him down flat and wait till the
I give Olwethu soft porridge and milk,
spotlight
spotlight
fit is finished – it hurts my heart too
Photos: Ufrieda Ho
it’s the only thing he can eat – he likes it,”
she says, proudly wearing the sky-blue
Koinonia golf shirts that have become
much,” Khambula says. Transport to
the uniform of the projects’ caregivers. get to the hospital costs her R200.
14 15
PEPFAR FALLOUT
Burden of the generations
Ufrieda Ho, Spotlight
When the rain sweeps in over the hills of Umzimkhulu and the winds follow, the
rolling hills turn to mud and muck. Mist and chill wrap around rondavels with little
forgiveness.
Gogo Alexsia Njilo (95) calls this Njilo’s is one of the vulnerable of studying to become a teacher.
remote part of southern KwaZulu-Natal households under the care of the She says: “Actually my dream is to
home. On a soggy, cold afternoon, Koinonia Orphans Project, run by open a crèche, I love children.”
the nonagenarian tends a steel teapot the small community of consecrated But both dreams have stalled.
warmed on burning firewood in the sisters and brothers from the Catholic “I’m happy to be a caregiver this
centre of her rondavel. In-between she Church’s Koinonia John the Baptist year, I think I will be able to look after
shoos away chickens pecking on the community, based at the Lourdes Gogo and the two boys, even though
ABOVE: 95-year old Alexsia Njilo can barely look after herself and says here two teenage grandsons don’t give her much assistance. dung-mud floor, also seeking the mercy Mission in a neighbouring village. I don’t know if they’ll listen to me,”
BELOW: Bertha Mia is co-ordinator of the Koinonia Orphans caregivers, with her is Thembile Dzanibe, one of the youngest of warmth. Njilo lives with two teenage The 95-year-old’s Koinonia caregiver is she says, sitting inside Njilo’s hut.
caregivers in the project. grandsons here that she mumbles the newest and youngest in the project: Gogo’s face does light up to greet
are no good and no help to her. They 19-year-old Thembile Dzanibe, who her young caregiver but she’s also lost
come and go as they please, she says. joined them in the middle of November. to tiredness and her own thoughts.
“I won’t cook tonight because they Dzanibe finished her matric in 2016 and For Bertha Mia, the co-ordinator of
will just eat all my food,” she says in Zulu, had been looking for work ever since. the Koinonia caregivers, the role that
I will drink tea for my dinner, she says. “Many young people are in the same Dzanibe has committed to is a big one.
So much adds to Njilo’s hardships: situation as me. Here in the rural areas “You need patience to do this
maladies of old age; few opportunities there are no jobs or opportunities, job; you also need to treat every
or hope for young people in this nobody has work, they just have to person with dignity. You have to work
remote village and little infrastructure sit at home. I applied for bursaries to hard and be honest,” says Mia.
and resources to make life easier study but I wasn’t accepted,” she says. Dzanibe nods as Mia
for a family living in poverty in the Added to this she says there’s a passes on this advice.
Harry Gwala district. The district growing drug problem and a deep-rooted Community caregivers take on an
has been in the news of late for crisis of alcohol abuse that often leads intimate, sometimes almost impossible
political killings, cases of corruption to violence and criminality. Teenage task. They’re a pillar that props up the most
#4 – December 2017
#4 – December 2017
and municipal mismanagement, pregnancy is also common and HIV/AIDS vulnerable in society, yet as in the case
also lack of infrastructure and continue to ravage the community. of the Koinonia Orphans Project they’re
pressing needs for basic services. As a born-free, Dzanibe had hopes also first to fall when funding dries up.
So much adds to Njilo’s hardships: maladies of old age; few
opportunities or hope for young people in this remote village
Photos: Ufrieda Ho
spotlight
spotlight
and little infrastructure and resources to make life easier for
a family living in poverty in the Harry Gwala district.
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