South African Health Review - Volume 2011, Issue 1, 2011
Volume 2011, Issue 1, 2011
Author Rene EnglishSource: South African Health Review 2011, pp vii –ix (2011)More Less
The years 2010 to 2011 were characterised by numerous health-related legislative and policy changes which, if successfully implemented, will serve to change the prevailing South African health system irrevocably. Many of these changes are firmly embedded in the ruling party's increasing focus on the 'outcomes approach', whereby 'improving outcomes means doing things differently in order to increase the impact we have on improving the lives of citizens'. In order for Government to collectively address its main strategic priorities, 12 outcomes - each with its own measurable outputs, sub-outputs and clear targets - were identified as areas of focus for the period 2010 to 2014. All Government Ministers subsequently signed performance agreements with the President of South Africa (SA) to show their commitment to realising these 12 Cabinet-approved outcomes.
Author Welile ShashaSource: South African Health Review 2011 (2011)More Less
It gives me great pleasure to introduce this, the 15th edition of the South African Health Review (SAHR). SAHR 2011 provides valuable policy and empirical information on a range of issues that are related to and impact on the Negotiated Service Delivery Agreement and primary health care re-engineering as envisaged by the National Department of Health (NDoH). A range of experts provide commentary on topics ranging from rural health, health technology to human resources. SAHR 2011 also contains a section on core health issues, where developments in health information systems, financing health care, and health legislation and policy are discussed. The Review concludes with the Indicators chapter which presents a selection of the best available data on the functioning and performance of the health system.
Source: South African Health Review 2011, pp 1 –15 (2011)More Less
Although the statute books reflect no new health-related Acts passed in 2010-2011, and no important amendments to existing legislation, this period has been marked by a flurry of secondary legislation. Many draft Regulations have been issued in terms of the National Health Act (Act 61 of 2003) and some have been issued in final form. The 2008 National Health Amendment Bill has been allowed to lapse, but a draft Bill which introduces an autonomous Office of Health Standards Compliance was published for comment and then tabled.
The various statutory health councils have also issued new Rules, some of which are still open for comment. However, the slow pace of implementation of the Nursing Act (Act 33 of 2005) is still a problem, not least in relation to the ability of nurses to prescribe and dispense medicines. A final dispensing fee for pharmacists that was acceptable to all parties was published in 2010. However, a number of elements of the medicines pricing landscape are still under consideration, including a cap on the logistics fee and a method for international benchmarking, and the first annual review of the dispensing fee for pharmacists has commenced. Draft regulations to allow for regulation of medical devices and complementary medicines have also been published.
Outside of the health sphere, other legislation such as the Children's Act (Act 38 of 2005) and the Consumer Protection Act (Act 68 of 2008) also impact on healthcare workers. In August 2011 a draft National Environmental Health Policy was released for comment. The major policy focus remains the planned introduction of National Health Insurance, for which a Green Paper was released for comment in August 2011. Although missing many critical details, this draft policy document lays out a pathway to implementation of universal coverage by 2025.
Source: South African Health Review 2011, pp 17 –28 (2011)More Less
South Africa (SA) is regarded as one of the economic powerhouses of Africa and spends about 8.6% of gross domestic product (GDP) on health. However, SA does not have the health outcomes that would be expected from such investment, and some countries that spend less of their GDP on health have better health outcomes. SA's poor showing has been attributed to the rapid escalation of HIV and AIDS and tuberculosis together with a weak primary health care (PHC) system. Other health system challenges include inadequate access, coverage and quality of services; limited governance and management capacity; and limited human resources. This chapter describes development of PHC in SA from 1994 onward. The recently adopted national PHC re-engineering strategy and its implications are also discussed, particularly in terms of implications for leadership, governance and management; human resources for health; service delivery, information management and the social determinants of health. We conclude that the PHC re-engineering strategy is an essential - but not a sufficient - condition to achieve improved health outcomes; it has to be accompanied by a change of culture that incentivises system-wide planning and implementation to achieve desired outcomes and maximise strategic partnerships.
Source: South African Health Review 2011, pp 29 –48 (2011)More Less
An overview of healthcare financing in South Africa (SA) is presented, reviewing policy developments and expenditure trends with a focus on the public sector. Despite SA spending around 8.6% of Gross Domestic Product on health, overall health outcomes of South Africans remain inadequate. Although the private-public differential reveals a narrowing trend, with provincial health spending overtaking medical scheme spending for the first time in 2009, inequity in health access, quality of care and spending remain major challenges. It is envisaged that current policy developments, including National Health Insurance (NHI), the Negotiated Service Delivery Agreement and re-engineering of primary health care, will narrow the health equity gap.
There has been a significant increase in spending on primary care and health infrastructure, with a steady rise in human resources for health in the public sector. Spending on expanding HIV-related services through the HIV and AIDS conditional grant has grown by 46.4% per annum over the past three years. It is projected that the total number of antiretroviral therapy clients will increase to 3 million from the current 1.4 million by 2015/16. With the phased rollout of GeneXpert®, more resources will be required for the treatment and management of tuberculosis (TB) and multidrug-resistant TB patients as the detection rate increases.
On average, hospital spending has increased by 15.4% per annum over the last three years. NHI will significantly change the landscape of health financing over the decade ahead, with increasing levels of funding, greater access and equity and improved quality being key objectives.
Source: South African Health Review 2011, pp 49 –58 (2011)More Less
This chapter provides the context for development of South Africa's (SA) Human Resources for Health (HRH) Strategy for the Health Sector 2012/13 - 2016/17, a brief description of some of the key trends and challenges for HRH in SA, and the strategic priorities of this strategy.
An overview of trends in and challenges for HRH for SA is grouped into three themes in which key issues are highlighted and brief recommendations which informed the HRH strategy are made. These themes are supply of health professionals and equity of access; education, training and research; and the working environment of the health workforce.
Eight priorities were identified which form the framework for the HRH strategy: leadership, governance and accountability; health workforce information and health workforce planning; re-engineering of the workforce to meet service needs; upscaling and revitalising education, training and research; creating infrastructure for workforce and service development - Academic Health Complexes and nursing colleges; strengthening and professionalising the management of human resources (HR) and prioritising health workforce needs; ensuring professional, quality care through oversight, regulation and continuing professional development; and improving access to health professionals and health care in rural and remote areas. Each of these are discussed.
The strategy document is a guide to action and requires participation of all stakeholders to make it a 'living' document which enables improvement in HRH. The long-term future of the health sector will be determined by our actions in relation to HR in the short term, specifically in the next five years.
Source: South African Health Review 2011, pp 59 –67 (2011)More Less
This chapter traces the development of quality standards and associated methods for bringing about improvements in healthcare facilities across the globe, with a specific focus on their development in South Africa.
The evolution of State legislation and programmes to improve the quality and safety of health care is described, with a focus on development of the National Core Standards (NCS). The genesis and functions of the South African Office of Health Standards Compliance are discussed, as are possible complementary interactions between accreditation standards and the proposed NCS. Different definitions of accreditation are considered, while fast-tracking as a strategy to expedite the establishment of functional quality improvement programmes is described.
Source: South African Health Review 2011, pp 69 –80 (2011)More Less
The importance of health management has long been noted in South Africa (SA). Most recently, the 2010-2014 Negotiated Service Delivery Agreement identified health management strengthening as a core element of health system strengthening, and the 2010 health management competency assessment was an important first step in this effort.
However, there has so far been limited open discussion about the nature of leadership required within the South African health system, or sustained engagement about how to develop leadership across the system. Both sets of issues are addressed in this chapter.
Leadership is a necessary element of strong health systems, and so it is vital that SA nurtures and sustains leaders who can work strategically within their complex environments to develop a rights-based health system that promotes health equity.
Source: South African Health Review 2011, pp 81 –89 (2011)More Less
A health information system (HIS) provides the foundation for the generation of good-quality data, and is a major building block of the health system. It integrates collection, processing, reporting and use of information required for improving effectiveness and efficiency of health services through enhancement of management at all levels within the health system. A robust, integrated information system is thus the foundation for building a successful national healthcare delivery system.
This chapter reviews progress towards strengthening the South African HIS in light of the current health sector policy initiatives which impact on the structure and functioning of the HIS. An overview of persistent challenges and a summary of recent developments to address these are presented, as well as SA's vision for the HIS. The chapter concludes with an overview of proposed steps for future HIS strengthening.
Author Niresh BhagwandinSource: South African Health Review 2011, pp 91 –98 (2011)More Less
Health technology (HT) is an important part of health systems, the acquisition, assessment, management and costs of which have brought about increasing challenges in delivery of healthcare services. In order to address the high levels and wasteful use of HT, the National Department of Health published a Framework for Health Technology Policies in 2001, following this with a draft National Health Technology Strategy document in 2005. The key outcomes envisaged in these documents are discussed against the backdrop of South Africa's high burden of disease and resource constraints in the public healthcare sector. The imminent piloting and implementation of National Health Insurance and Government's renewed drive for improved access to quality health care for all have placed HT firmly in the spotlight.
This chapter looks at some of the HT challenges and what improvements can be made in the key areas of prioritisation of public HT needs, HT management, HT regulation, HT innovation and public-private partnerships. It is notable that the long-awaited national audit of assets in public health facilities has commenced and is scheduled for completion in 2012. The inventory arising from this audit will provide the basis for effective asset management, including facilitating scheduling of preventative maintenance and providing financial information to support budget proposals and procurement requests. A further development has been the establishment of a Medical Devices Innovation Platform to harness and integrate skills and expertise from a number of universities and research institutions in the country. Promotion and pursuit of HT innovations present South Africa with an opportunity to build capacity to solve health challenges, and thus to have a positive impact on health and development.
Source: South African Health Review 2011, pp 99 –106 (2011)More Less
This chapter explores successes and constraints in terms of the right to access health care in rural areas. We present a case study that provides insight into daily challenges patients from poor rural communities face when accessing health care. While assessment of health and health care in rural areas is challenged by lack of a standardised definition of rurality, marked inequities are noted between health outcomes in more urbanised and rural provinces. Reasons include inadequate efforts to address social determinants of disease such as the levels of deprivation in rural areas. Furthermore, rural communities experience significant barriers to accessing health care, including financial barriers, inadequate transport, and distance to the nearest facility as well as limited services available. Understaffing and the poor state of infrastructure in many rural facilities further entrench existing inequities.
The central role of management in providing adequate care within the healthcare system is emphasized. There are several examples of good practices in rural areas. With good leadership and innovation, access to health care is possible in rural areas - even with limited resources. The rural healthcare context needs to be taken into account during design and implementation of health policies and strategies. A number of questions must be taken into consideration to 'rural-proof' key strategies currently being introduced, such as National Health Insurance and the new Human Resources for Health Plan. From policy development to resource allocation and implementation, requirements for rural populations need to be taken into account to ensure equitable outcomes.
Source: South African Health Review 2011, pp 107 –117 (2011)More Less
This chapter reviews the realities of and challenges to improving human resources (HR) for rural health care in South Africa. The difficulties are serious - and progress towards solutions is slow. The stark reality of a gross shortage of health workers sustains poor health outcomes for rural people, and needs immediate attention. This chapter places current progress in context.
The lack of acknowledgement of the uniqueness of rural health care with respect to HR is evident in different Government policy initiatives. The recent National Department of Health (NDoH) plan to re-engineer the primary health care sector is critiqued, as are the Negotiated Service Delivery Agreement and the recent NDoH Human Resources for Health strategy.
HR interventions in the short term, as well as longer-term recommendations in the categories of education, regulations, finance and personal and professional support, based on international guidelines are suggested.
Source: South African Health Review 2011, pp 119 –248 (2011)More Less
This edition of the South African Health Review (SAHR) coincides with an unprecedented moment in South African health policy, the release of the Green Paper on National Health Insurance (NHI). Not only will accurate data on health status and health services be necessary to inform the design of the NHI, but such data will also be used by those responding to the Green Paper. Arguments about the adequacy and accuracy of health indicator data will therefore be ever sharper as a final policy for the radical reform of the health system in South Africa is decided and implemented.