Health care

Hospital Restructuring and Laboratory Services

Published by: 
Health Systems Trust
Public hospitals continue to account for over 60% of public health sector expenditure. The rationalisation of hospitals has been high in the Department of Healths priorities and this chapter reviews some of the changes that have occurred with respect to expenditure, hospital beds and general efficiency gains with the public sector hospitals. There have been reductions in the number of beds in use in most provinces, and in particular in the Western Cape and Gauteng. These reductions have not been accompanied by significant increases in bed occupancy rates. Expenditure on hospitals since 1992/93 has increased at a rate slower than that of the public health sector as a whole, but in the last three years increases in funding to tertiary hospitals have outstripped those for other hospitals. There continue to be large inter-provincial variations in spending, bed availability and staffing of hospital services.

Social Health Insurance

Published by: 
Health Systems Trust
Social health insurance was first proposed in the 1980s. It was seen as a key mechanism for extending health care coverage and promoting equity in South Africa. Lack of policy action has meant that the SHI has not been implemented and wide disparities between health care in the public and private sectors remain untouched. This summary brief explains why consensus was never reached on the exact form social health insurance should take, and suggests strategies for building support amongst important stakeholders. The chapter critiques features of the governments most recent proposal, published in 1997.

Improving health care to the farming community in the Bothaville district

Published by: 
Health Systems Trust
The Centre for Health Systems Research & Development (CHSR&D) was approached by the Health Systems Trust (HST) to assist with research to improve the delivery of health care to the farm community in the Bothaville magisterial district.

Introducing the Initiative for Sub-District Support

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Health Systems Trust
The Initiative for Sub-District Support (ISDS) aims to demonstrate improved standards of primary health care by providing sustained, systematic and comprehensive support to selected sub-districts. In other words, ISDS hopes to improve service delivery by identifying those factors which affect health care at local level, and developing practical ways of changing these factors for the better.

The development of the District Health System in South Africa: Lessons Learned from the Experience of ISDS: Technical Report 5

Published by: 
Health Systems Trust

Will districts become effective vehicles for improving the quality of care, or expensive paper-shuffling machines? Will district management teams walk an interminable treadmill, or slowly, but surely improve the quality of care? These are the niggling and uncomfortable questions that motivate participants in the Initiative for Sub-District Support (ISDS).

Over the past year, the ISDS has tried to develop systematic processes of support to management teams in selected districts in South Africa, aimed at strengthening their ability to improve the quality of health care. Through this experience, we hope to be able to share lessons with other districts to create a positive spin-off effect, demonstrate the process of district development, and pinpoint persistent obstacles.