The theme of this 13th edition of the Review, launched in December 2008, is Primary Health Care in South Africa: A review of 30 years since Alma Ata. The SAHR 2008 chapters focus on critical issues in Primary Health Care. The Review includes a national and international perspective of Primary Health Care, and focuses on areas such as policy and legislation, determinants of health, lifestyle, infectious diseases, mental health, maternal and child health, nutrition and environmental health. The SAHR reviews issues around human resources, finance, and information. It also looks at research on health systems, the role of the private and non-governmental organisations in Primary Health Care, and ends with the relevant health and related indicators chapter.
Full SAHR 2008 [pdf 10.5MB]
Primary Health Care: In Context
1 International Perspective on Primary Health Care Over the Past 30 Years [pdf 599Kb]
2 A Perspective on Primary Health Care in South Africa [pdf 570Kb]
3 Health Legislation and Policy [pdf 616Kb]
4 Determinants of Health and their Trends [pdf 311Kb]
Primary Health Care: Programme Areas
5 Chronic Non-Communicable Diseases [pdf 637Kb]
6 STIs, HIV and AIDS and TB: Progress and Challenges [pdf 624Kb]
7 Community Access to Mental Health Services: Lessons and Recommendations [pdf 541Kb]
8 Maternal, Newborn and Child Health: 30 Years On [pdf 595Kb]
9 Nutrition: A Primary Health Care Perspective [pdf 668Kb]
10 Developments in Environmental Health [pdf 1.32Mb]
Primary Health Care: Systems Support
11 Strengthening Human Resources for Primary Health Care [pdf 676Kb]
12 Primary Health Care Financing in the Public Sector [pdf 614Kb]
13 Information for Primary Health Care [pdf 629Kb]
14 A Review of Health Research in South Africa from 1994 to 2007 [pdf 600Kb]
15 The Role of Private and Other Non-Governmental Organisations in Primary Health Care [pdf 590Kb]
16 Health and Related Indicators [pdf 5.88Mb]
Improved Service Delivery in the Absence of Fully-Fledged District Management Structures:Experience of the Greater Tzaneen Sub-District Mopani District -Limpopo Province
The 1998 Review concentrates on equity and attempts to highlight progress that has been made as well as identify blocks to providing equitable public sector services throughout South Africa. Research commissioned specifically for the Review sheds light on the health status of South Africas population and key areas of the health system including finance and expenditure, human resources, information systems, pharmacy, and service delivery in clinics and district hospitals. This is provides a comprehensive, authoritative and independent review of South Africas health system.
In 1998 the greatest inequity remains the difference between those who predominantly use private sector health care and those who do not. Just under one fifth of South Africas population belong to a medical aid scheme, yet this group has access to 85% of pharmacists and 60% of medical specialists working in South Africa.
In the field of public sector spending comparisons of provincial health budgets indicate that great steps forward were made in the years 1995/6 and 1996/7 with most budgets coming closer to the national average. However since that time progress has stagnated, with the gap between expenditure per person in the North West, Mpumalanga and Northern provinces and the national average remaining a cause for concern. Comparisons of spending within provinces indicate that disparities are greater even than those between provinces. In Potchefstroom and Grahamstown Districts for example, for every R4 spent on health services in the public sector, R1 was spent in the Odi and Mount Frere Districts.
With regard to the distribution of health sector personnel, disparities tend to occur between the more urbanised and historically better funded provinces and those which are predominantly rural. For example there are forty nurses per 10,000 population in the Western Cape whereas in the Northern Cape and Mpumalanga there are only 20 and Gauteng has 2000 people to every pharmacist while the comparable figure in the Northern Province is 16000.
A survey of 294 clinics and 84 regional and district hospitals provides information about service delivery and indicates the variations that exist between provinces and between rural and urban facilities. While 100% of clinics in the Northern Cape have all TB drugs available this is true for only 20% of clinics in the Northern Province and HIV testing is available in less than half of clinics in the Eastern Cape, North West, KwaZulu-Natal, and Northern Provinces. The investigation of maternal deaths was used as one of the indicators to measure the quality of care in hospitals and it was found that less than half of hospitals have meetings where infant and maternal deaths are investigated and discussed.
Results of this survey are compared with a survey of clinics undertaken in 1997 and the findings indicate improvements in some areas. Seventy one percent of all clinics have a functioning telephone in 1998 as compared with 63% in 1997 and 83% of clinics provide family planning services on a daily basis in 1998 as compared with 72% in 1997.
The South African Health Review is accompanied by Technical Reports that provide more detail in the areas of financing, the private sector, pharmacy and service delivery in hospitals and clinics.