How best to utilize limited resources

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.