For the past 10 years, however, the health ministry has, and perhaps inevitably, been a controversial one. Both Nkosazana Dlamini-Zuma, who was health minister from 1994 until 1999, and Manto Tshabalala-Msimang, the present incumbent, have been in the headlines more than they?ve been out of them, usually for their response, or perceived lack of it, regarding HIV/Aids.

With an estimated 5.3 million South Africans testing positive for HIV, this is the single biggest health issue of the past decade and is likely to present a serious challenge for the health sector in years to come.

The two health ministers and President Thabo Mbeki himself have been widely criticised for their stance on HIV/Aids, with Mbeki?s apparent ?dissident? stance on the disease coming in for particular criticism from most major political parties, Aids lobby groups and civil society at large.

This decade has also seen the rise of the Treatment Action Campaign, a movement lobbying for greater access to HIV/Aids medical treatment and increased public awareness and understanding of HIV/Aids issues.

In response, Tshabalala-Msimang and Mbeki have cited concerns over drug-resistant strains of the disease, possible toxicity and harmful side effects, and have suggested that the real issues that need to be addressed are poverty and nutrition.

The controversial diet

Controversially, Tshabalala-Msimang has also recommended African potato, olive oil, lemon and garlic be used by HIV/Aids patients and has promoted the use of traditional medicine, while it was widely reported that Mbeki had allegedly denied the link between HIV and Aids.

Government received a 2002 Constitutional Court order, which backed previous high court orders, to make available ARVs meant to stop mother-to-child transmission, already offered by many clinics and hospitals in the Western Cape, Gauteng and KwaZulu-Natal.

An ARV rollout plan was announced earlier this year and aims to provide at least one drug service point in every health district within a year. Over the longer term, the plan aims to give all South Africans access to treatment in their local municipal area within five years.

However, government said the emphasis would remain on prevention. It said 270 million male condoms had been distributed in 2003, as well as 1.4 million female condoms.

In less than 10 years Aids spending has risen from R22-million to R660-million, and an extra R2.1-billion for HIV/Aids programmes including antiretroviral treatment was announced in the Budget speech this year.

Achievements in other areas

Progress has been made in other areas. Free primary health care was first made available for children under seven and pregnant women but this was extended to everyone in 1996. South Africa is also in line with WHO guidelines for child immunisation, and vaccines against Hepatitis B and Haemophilus influenza are readily available.

Headway has been made in providing adequate sanitation and clean water. Before 1994, 16 million people had no access to clean water and 22 million people were without adequate sanitation. Now, nine million can access clean water and 63 percent of households have access to sanitation, according to government figures.

The Choice on Termination of Pregnancy Act, implemented in 1997, made it possible for all women to undergo legal abortions during the first trimester, without first requiring approval from doctors, psychiatrists or magistrates.

While much has been done in the last 10 years, priorities identified by government are to accelerate the revitalisation of health facilities to reverse apartheid planning, the implementation of a school health programme, and the achievement of equity between the rich and poor.

Key pieces of legislation due to be promulgated include the controversial Certificate of Need, which will regulate the doctor-patient ratio by area, in an attempt to redistribute medical services to under-resourced areas. Comprehensive health insurance is planned for all South Africans by 2006, and new regulations are aimed at providing medicines at lower cost to all.