South Africa is one of 12 countries that has failed to reduce child mortality since 1990, according to the 2009/10 SA Child Gauge released on Tuesday.

Children were paying the price for the country's failure to progress towards the Millennium Development Goals (MDGs), which aimed to reduce poverty, hunger and disease by 2015 and to ensure children's rights to survival, health and development, it said.

The gauge is produced annually by the Children's Institute, University of Cape Town, to monitor government and civil society's progress towards realising the rights of children.

The 2009/10 issue was hosted jointly with Unicef South Africa.

The report found that while South Africa was making progress on a number of MDGs, the targets for reducing child hunger, HIV, tuberculosis and child mortality were not being met.

Unicef deputy country representative Malathi Pillai said that child and maternal health outcomes were worse today then in 1990.

Unicef estimated that under-five mortality had risen from 56 deaths per 1000 live births in 1990 to 67 in 2008.

Pillai said that integrated primary healthcare services were key to addressing health needs of children.

The South African Institute of Race Relations has warned that any proposed National Health Insurance (NHI) system would threaten the excellence of South Africa's private healthcare sector.

The warning was contained in a report released by the Institute this week via its monthly Fast Facts.

The report featured reviews of:

1. The status of South Africa's public healthcare sector

2. The standing of the private healthcare sector

3. An assessment of the viability of a National Health Insurance scheme

4. A review of the uptake of health insurance by the black middle class

The Institute's Deputy Chief Executive, Mr Frans Cronje, said that it was problematic to introduce a NHI scheme at a time when much of the available evidence suggested that the public healthcare sector was in disarray.

The report directly identified financial mismanagement, centralization, poor general management, inappropriate appointments, poor hospital conditions, staff shortages, shortages of supplies, limited medical research, and crime and security at hospitals as weaknesses confronting the public healthcare sector.

The 10th Summit of Nobel Peace Laureates took place in Berlin on 10 and November in conjunction with celebrations to mark the 20th anniversary of the fall of the wall.  One of the highlights of the Summit was the presentation to the singer Annie Lennox of a special award for the work that she is doing to combat AIDS in South Africa and to help AIDS victims.  Annie Lennox presented a heart-wrenching video that she had made of the reality of AIDS in South Africa: emaciated bodies; faces scarred by lesions; dismal funerals; pinewood coffins with string handles.  She also showed what could be achieved with well-directed AIDS programmes.  For a brief moment, in a far-off corner of the world, opinion was focused on South Africa’s dominant tragedy.

Earlier that day I had watched the Sky News coverage of the funerals of six British servicemen who had been killed in Afghanistan the previous week.   There were photos of each of the victims and extensive interviews with their grieving families.  Their deaths brought the number of British troops who had died in the war to 229 - each of them covered by the media, each of them mourned by the nation.

The same week 5 000 people died of AIDS in South Africa.  There were no reports in the media and no interviews with grieving relatives.  AIDS deaths are no longer news - because 5 000 people have been dying each and every week since the beginning of this decade.  And yet each death is a tragedy.  Each death brings with it suffering and pain - not only for the victim but for the children, parents, brothers, sisters and friends that they leave behind.

In a few years, South Africa is going to have a greater number of older people as a proportion of the total population. This means that there will be a much higher instance of chronic diseases such as diabetes and cancer. If government proceeds with the proposed National Health Insurance (NHI), the cost of these medical bills will fall on the shoulders of SA’s taxpayers. With the high number of HIV/AIDS cases, TB and other communicable diseases, which, frequently, are only manageable as opposed to curable, the cost on SA’s healthcare sector of treating chronic disease is already a heavy burden.

According to statistics compiled by the US Census Bureau for SA, in 2000 the majority of SA’s population fell into the lower age cohorts, typical of developing nations. Indeed, more than one-third of the population was younger than 15 and less than 7 per cent was older than 60. They project that by 2025, the percentage of the population younger than 15 will decline from 33.8 per cent to approximately 26 per cent and the percentage of the population older than 60 will increase to 12 per cent. This means that approximately 24 per cent of the population will be in the 45 to 60 year age bracket. By 2050, the percentage of the population younger than 15 will drop to less than 23 per cent, the percentage older than 60 will increase to 16 per cent and the proportion of 45 to 60 year olds to more than one-third.