At a time when SADC countries are committing a lot of human and financial resources to improve women's health care, the situation seems to be deteriorating.

Access to proper and affordable health care for women is among the Beijing PFA commitments that are guiding the operations of countries that have identified health as a national priority area.

The PFA notes that women should be given decision-making powers in matters concerning their health. As a strategy to meet the demands of the commitments, Angola, Botswana, Lesotho, Mauritius, Mozambique, Namibia, Swaziland and Zambia have identified health as one of their national critical areas of concern from the 12 issues identified as obstacles to women's empowerment at the Beijing conference.

Several SADC countries have adopted guiding policies such as Health for All by Year 2000, and Primary Health Care.

Lesotho has responded by adopting a primary health scheme, which aims to ensure that every Mosotho has access to health facilities. In places where facilities are far away, the government has stationed community based health workers and birth attendants within the area.

Zimbabwe has introduced free treatment for the unemployed and those earning less than US$40 per month. More hospitals have been built although not yet enough. A great deal of decentralisation has taken place resulting in the construction of several district hospitals.

In Malawi the government's efforts to provide health to its citizens have enjoyed donor and non-governmental organizations' support. In Mozambique preventive and curative services to treat the main endemics are free of charge.

Regionally, the situation is not very healthy due to economic problems and Economic Structural Adjustment Programmes (ESAPs) that have shifted the cost of health service provision from governments to families. This has resulted in governments withdrawing subsidies on health expenditure thus further affecting the health conditions of most women and children in the region.

Most of the hospitals and clinics are concentrated in towns and cities, beyond the reach of rural women. The few facilities in the rural areas are either under-staffed or under-equipped or both, a situation that leaves rural women without proper health care facilities which are a basic need for every human being.

In Swaziland deaths resulting from birth complications are on the increase, a situation that could be prevented if proper health care was accessible to all women.

In Mauritius, despite the availability of an integrated health system, dangerous diseases like breast and cervical cancer are on the increase. This is because private health providers who offer specialist services are very expensive and therefore beyond the reach of the general public and especially women, most of whom are not employed.

Further barriers have been created by the privatisation of health systems, which has made health care very expensive. In Tanzania for instance, accessibility to health has further been reduced as the health system is now in private hands.

The situation is even worse in Angola where limited facilities, apart from being concentrated in urban areas, are also poorly equipped and grossly under-staffed.

Women infected with HIV/AIDS are particularly those in their reproductive years. Women aged 20 - 24 constitute the largest age group among the reported HIV/AIDS cases in the region. In 1995 16 percent of HIV/AIDS positive women were below 19 years. Research shows that more than 10 percent of women attending ante-natal clinics in Tanzania, Zambia and Zimbabwe were infected with HIV/AIDS. The Ministry of Health figures in Botswana show that 43 percent of women attending ante-natal clinics in Gaborone and 34 percent in Francistown were HIV positive.

One goal of the Beijing PFA is that women should be empowered to make decisions on policies and programmes that have to do with AIDS. In all the SADC countries women constitute more than 80 percent of health workers, and at home they take care of the sick without protective gear thereby being exposed to HIV/AIDS.

Some husbands' promiscuous behaviour has further worsened the effect of AIDS on their wives, physically, mentally and economically. Physically as when they are victims themselves, mentally as a result of what they experience when their loved ones are affected; and economically as they are forced to abandon their productive roles.

In many countries, economic difficulties resulting from the economic reforms are forcing women to enter the commercial sex industry thereby exposing themselves to HIV/AIDS and other related diseases.

Meanwhile, some countries in the region work closely with some international organisations to draw plans to prevent the spread of HIV/AIDS.

Namibia and The World Health Organisation have drawn up a five-year National AIDS Plan to monitor the spread of the disease in the country.

The plan will offer educational programmes for people living with HIV/AIDS, as well as counsellors and the public.

In Mozambique, the Mozambican Network of AIDS Service Organisation (MONASO) has established a telephone help line in its offices in central Maputo, where callers can seek advice about the lethal disease, AIDS.

The line which is initially intended to function three days a week will deal with simple requests for information, and with the more complex needs of AIDS sufferers or their relatives who require counselling.

The operators will be able to deal with topics ranging from how to use a condom, to tests for the HIV virus that causes AIDS, to how to "live positively" with AIDS.

In South Africa, a special anti-AIDS cabinet committee was set up in October 1997. The committee which is under the chairmanship of Deputy President Thabo Mbeki has developed an R80-million "government AIDS plan", which includes a mass mobilisation campaign, an advisory council and an inter-governmental co-ordination forum.

While family planning messages have reached the majority of southern African women, many of them do not use family planning methods because of cultural barriers.

Many women in the region are not able to space their children and little care is available for both mother and child because of lack of resources.

• Introduction to the SADC Gender Monitor
• Global, Regional and National Commitments
• SADC Countries' National Priority Areas of Concern