oa South African Health Review - Primary health care in SA since 1994 and implications of the new vision for PHC re-engineering
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.
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