Health care

Health Care in Eastern Cape - Implications for planning

Published by: 
Health Systems Trust
The report is intended for health managers in the Eastern Cape Province managers at Provincial level but especially for Regional managers as the information is set out in a format which defines and compares the resources and services of the five regions. The information was obtained from ReHMIS (Regional Health Management Information System) by the Eastern Cape ReHMIS team and some additional sources were also used. Data was collected from all public (provincial and local authority) health facilities using national definitions. Maps and tables of population distribution are provided. These assist in defining the problems of reorientation from the previous administration (of South Africa and two so-called independent states Transkei and Ciskei) to a unified, integrated, decentralised, equitable health service based on Primary Health Care, and the health priorities of the Reconstruction and Development Programme.

The Second Equity Gauge - Monitoring Fairness in Access to Basic Services Essential for Health

Published by: 
Health Systems Trust
The second Equity Gauge seeks to place the goal of equitable health care within a broader framework that links socio-economic disparities with health outcomes. This publication highlights the fact that people do not get sick at random and that health is intimately tied up with living and working conditions. In focusing on this interdependence of socio-economic determinants with health outcomes, the document also points to the relationship between health status and geographical, racial and gender-related issues.

Cost-Effectiveness of Antiretroviral Treatment for HIV-Positive Adults in a South African Township

Published by: 
Health Systems Trust
Introduction: This study aims to establish the costs and effectiveness of antiretroviral therapy (ART) for HIV positive adults in a resource-constrained public-sector setting. The research compares ART to the current status quo for HIV-positive adults who are dependent on the public sector for care in South Africa i.e the treatment of opportunistic and HIV- elated infections and events (e.g. wasting) in the absence of ART. This research is clearly important in the developing country context, where the HIV epidemic is expected to have a dramatic impact on life expectancy and to lead to early mortality for a large proportion of the population (Dorrington, Bourne et al. 2001). This study presents the first cost-effectiveness results derived from a public sector clinic-based treatment programme. Cost, effectiveness and quality of life data have been collected from a single cohort receiving care in three HIV-dedicated clinics in Khayelitsha, a township on the outskirts of Cape Town. This setting is similar to what will be encountered in the public sector ART rollout.

The role of ISDS in the Rural District Health Support Programme (RDHSP)

Published by: 
Health Systems Trust
The Integrated Sustainable Rural Development Programme (ISRDP) is an initiative driven from the Presidents office. The ISRDP is a ten-year programme emphasising the integration of planning for services and is a major new developmental role for local government. Thirteen of the most disadvantaged rural district municipalities in South Africa have been identified for this programme. These following district councils have been identified as the pilot sites or 'nodal' points in the programme: Chris Hani, Oliver Tambo, Ukhahlamba, Alfred Nzo, Zululand, Bohlabelo, Central Karoo, Kgalagadi, Umzinyathi, Sekhukhune, Thabo Mofutsanyane, Ugu, and Umkhanyakude.

Internship Information Booklet - Research Programme

Published by: 
Health Systems Trust
The internship programme is one of the skills development initiatives developed by the research programme of the Health Systems Trust (HST). Since it was founded in 1992, HST has been concerned with the need to develop research and planning skills for health care delivery. The internship programme aims to develop a pool of health systems re-search skills in South Africa by attaching novice researchers to institutions with established research record.

South African Health Review 2001

Series Name: 
South African Health Review
Published by: 
Health Systems Trust

Among significant events that affected the health system during 2001 are the process of decentralisation of health services, greater attention to proper corporate governance especially with regard to financial reporting, and the increasingly profound impact of HIV/AIDS. Decentralisation of health care, the treasured policy goal of health services being managed by the sphere of government closest to the people, is, albeit slowly, becoming a reality to South Africans. The 2001 South African Health Review reflects on this process of transformation, including the necessary enabling legislation and funding of local government for health care delivery at this level. A series of chapters commissioned for this Review, based on qualitative research with managers working in the health system, provide insights to some of the day-to-day pleasures and frustrations in managing the South African health service. Many health sector developments during 2001 were overshadowed, at least in the media, by the contested nature of our response to HIV/AIDS. Understanding that HIV/AIDS is but one of the important priority programmes in a comprehensive health care system, the Review singles out financing of HIV/AIDS and implementation of the national HIV/AIDS and STD strategic plan for comment. Providing an informative and reliable review of progress in the health sector year-by-year is a demanding task. It would indeed be impossible without the assistance provided by numerous health workers who although overburdened by the day-to-day responsibilities of providing quality health care, still managed to pause and reflect on the important questions that the Review sought to answer.

Table of Contents

  1. Health Legislation
  2. The District Health System
  3. Financing Local Government Health Services
  4. Private Sector Financing
  5. Public-Private Partnerships
  6. Using Information for Health
  7. Annual Reports and the Public Finance Management Act
  8. HIV/AIDS Financing
  9. Mainstreaming HIV/AIDS: Progress and challenges
  10. Voices of Service Users

    Voices of Health Policy Makers and Public Health Managers: An Introduction

  11. Voices of Facility Managers
  12. Voices of Hospital Superintendents/Managers
  13. Voices of District Managers
  14. Voices of National and Provincial Managers
  15. Voices of Parliamentarians
  16. Voices of Health Policy Makers and Public Health Managers: Key Themes
  17. Health and Related Indicators

Briefing note on local government health service financing and expenditure and moving towards monitoring equity in local government health services

Published by: 
Health Systems Trust
At present, some (but not all) municipalities provide health services. There is considerable diversity between municipalities in relation to the range and extent of health service provision. Historically, local government health services have been restricted largely to the provision of preventive, promotive and rehabilitative primary care services, with particular emphasis on communicable disease control and environmental health. In addition, some municipalities provide ambulance services on an agency basis for the respective provinces (i.e. ambulance services have historically been a provincial responsibility, but in most cases provinces pay municipalities to provide these services on their behalf). In an effort to reduce fragmentation of health services, some municipalities are increasingly providing integrated preventive and curative primary care services.

Bringing Health Closer to People - Local Government and District Health System

Published by: 
Health Systems Trust
Bringing health closer to people has long been a goal for us in South Africa. Putting this idea into practice means that health care should be provided by local government, the sphere of government closest to people. The demarcation of the municipal boundaries, and the local government elections in the year 2000, signaled a critical step towards achieving this goal.

Poverty Hearings

Series Name: 
HST Update
Published by: 
Health Systems Trust
This issue of Update is an attempt to reinforce the findings of the Speak Out on Poverty Hearings, recently held throughout South Africa. Our health sector still mirrors the anomalies described above. Most health care resources in South Africa are still directed towards the wealthiest 30% of the population who can afford private medical services. While efforts are underway to redirect public resources, rural areas - where most poor people live - still have least access to effective services.

Drug Pricing

Published by: 
Health Systems Trust
Improving access to necessary drugs requires attention to all four component parts of the access equation ensuring rational selection, providing sustainable financing and efficient systems to distribute and use the drugs and making sure that prices are affordable. However, comparing drugs prices across countries and health systems is not always easy. Methodological pitfalls abound, and have in the past ensnared the South African Ministry of Health. The National Drug Policy contains a variety of proposed strategies to reduce the price of medicines in South Africa. This chapter considers the complex issue of drug pricing, the policy options outlined and available, and provides recommendations on steps that will advance the implementation of such policies.