oa South African Health Review - Health legislation and policy : context, process and progress : reflections on the Millennium Development Goals
The current health leadership in South Africa has committed to a substantial overhaul of the public health sector to address the complex burden of disease; meet the Millennium Development Goals (MDGs); improve health-care outcomes, access and affordability; and ensure responsiveness to population health needs.
Using a contemporary policy analysis framework, this chapter reviews health and health-related legislation, key health policy initiatives and progress with implementation for an 18-month period from December 2008 until May 2010. The methods include a literature review and interviews with ten key informants.
The review found that there is an enabling legal, policy and fiscal environment and context that facilitates the achievement of the MDGs in South Africa. However, there is potential overlap, fragmentation and lack of co-ordination of the various laws and policy initiatives. Progress with the implementation of the National Health Act remains slow and both the National Health Amendment and Medical Schemes Amendment Bills have lapsed. The review of three policy initiatives: the Health Sector Road-map; the Integrated Support Teams; and the Advisory Committee on National Health Insurance - all aimed at improving the functioning of the health system - illustrates that the process and timing of many policy initiatives appear to be flawed, often resulting in alienation of many stakeholders, particularly those responsible for implementation. Although the proposed National Health Insurance system is welcomed and supported by many, to date a transparent process and meaningful public participation have been largely absent.
Three key recommendations arise out of this review: the need for focus and prioritisation; careful attention to process and actors when developing or implementing legislation or policies; and improved monitoring and evaluation to enhance accountability to the public and to achieve health outcome goals.
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