Forder A A
Department of Medical Microbiology, University of Cape Town, Medical School, Observatory, South Africa.
J Hosp Infect. 1995 Jun;30 Suppl:15-25. doi: 10.1016/0195-6701(95)90002-0.
South Africa's new health policy embraces the primary health care (PHC) approach for all its peoples and will include good primary, secondary and tertiary care. The policy will hope to provide the highest possible standards of care, yet be of a scale and complexity that the country can sustain into the future. There will almost certainly be rationalization of many of the tertiary teaching hospitals, with inevitable cut-backs in their budgets. This in turn could carry the risk of damage to the fabric of these institutions, which might be impossible to repair. Medicines offer a simple, cost-effective answer to many health problems in Africa, provided they are available, accessible, affordable and properly used. A looming problem in African drug markets is inefficiency and waste. The use of counterfeit medicines has reached unparalleled heights. It is vital that there should be a competent, honest, accountable and independent national drug regulatory authority, secured in law, to provide the necessary infrastructure for the acquisition of sound medicines. Medicines are central to a sound national health policy, but there is great public concern about their costs. Anti-infective drugs are amongst the most widely used class of drugs in the world. Inappropriate use of these agents is widespread and guidelines need to be established for their correct use. The control of all medicines in South Africa is governed by the Medicines & Related Substance Act of 1965. The Medicines Control Council is mandated to ensure that all medicines (including antibiotics) available to the public are efficacious, safe and of high quality. An informally-constituted Antibiotic Study Group has been established in order to monitor aspects of antibiotic therapy that impinge on more general issues of public health, country-wide. The Antibiotic Study Group has instituted an Antibiotic Surveillance Programme to monitor the development of antibiotic resistance nationally. In addition the majority of the tertiary teaching hospitals have comparable in-house antibiotic control policies to help prevent such resistance and to cut costs. These issues need to be debated and resolved. Once in place and working effectively, they will in the long-term supply the most cost-effective means of providing health care for all.
南非的新卫生政策采用初级卫生保健（PHC）方法服务全体民众，并将涵盖优质的初级、二级和三级医疗服务。该政策希望提供尽可能高的医疗标准，同时规模和复杂性要在国家未来能够承受的范围内。几乎可以肯定，许多三级教学医院将进行合理化调整，其预算也将不可避免地削减。这反过来可能会有损害这些机构架构的风险，而这种损害可能无法修复。药物为解决非洲的许多健康问题提供了简单且具成本效益的办法，前提是药物可得、可及、可负担且使用得当。非洲药品市场一个迫在眉睫的问题是效率低下和浪费。假药的使用已达到前所未有的程度。至关重要的是，要有一个依法设立的、有能力、诚实、负责且独立的国家药品监管机构，以提供获取优质药品所需的基础设施。药物是健全的国家卫生政策的核心，但公众对其成本极为关注。抗感染药物是世界上使用最广泛的一类药物。这些药物的不当使用很普遍，需要制定正确使用的指南。南非所有药品的管理都受1965年《药品及相关物质法》的制约。药品控制委员会的任务是确保向公众提供的所有药品（包括抗生素）有效、安全且质量高。为了在全国范围内监测影响更广泛公共卫生问题的抗生素治疗方面，已成立了一个非正式的抗生素研究小组。该抗生素研究小组已启动一项抗生素监测计划，以监测全国抗生素耐药性的发展情况。此外，大多数三级教学医院都有类似的内部抗生素控制政策，以帮助预防此类耐药性并降低成本。这些问题需要进行辩论和解决。一旦落实并有效运作，从长远来看，它们将提供为所有人提供医疗保健的最具成本效益的方式。
