Health economics

As in other countries, South Africa’s healthcare system comprises a network of health facilities providing primary health care, supported by several higher levels of care. Information on individual facilities allows analysis and reflection on how the country’s health services inputs meet the population’s needs in terms of the type, quantity and quality of the services. This information is essential to identify health system strengths and gaps, to assess current and future needs and for planning investments and future services such as the National Health Insurance.

The global health expenditure database that WHO has maintained for the past ten years, provides internationally comparable numbers on national health expenditures. WHO updates the data annually, taking, adjusting and estimating the numbers based on publicly available reports (national health account reports, reports from the Ministry of Finance, Central Bank, National Statistics Offices, public expenditure information and reports from the World Bank, the International Monetary Fund, etc). The estimates are sent out to the Ministries of Health for validation prior to publication but users are advised that country data may still differ in terms of definitions, data collection methods, population coverage and estimation methods used.

The School of Public Health at the University of the Western Cape is a WHO Collaborating Centre, and has an international reputation as a leading research and teaching institution in Public Health. Its educational and research activities are wide-ranging, with a special focus on health systems research, primary health care, social determinants of health, priority conditions (including TB/HIV and chronic disease) and the implementation of district health systems. The School’s distance learning postgraduate programme, offered through a range of learning media, is unique in Southern Africa.

South Africa’s health system is undergoing a muchneeded strategic review. Both the public and the private sectors are affected. And the role of regulators remains crucial in this changing environment. The Council for Medical Schemes continued to execute its mandate in the financial year under review. By guiding the medical schemes industry into unprecedented stability and performance, Council continued to support e¥orts aimed at strengthening the entire health system of the country.

Health systems strengthening has become a top priority of many global and national health agendas as a way to improve health outcomes. With the global health context becoming increasingly complex, national health systems are beginning to move away from a focus on disease-specific health responses to comprehensive strengthening of health systems. The global community agrees that without a systems approach, population health outcomes will not further improve and health related development goals such as the United Nation’s Millennium Development Goals (MDGs) for 2015 will not be met.

There is widespread consensus that providing universal, sustainable, affordable and quality health services underpins efforts to achieve equitable health outcomes. UNICEF in 2010-2011 conducted a two-phase landscape analysis, funded by the Rockefeller Foundation, to investigate how health insurance and other social health protection mechanisms contribute to achieving universal health coverage (UHC). The work built on previous research examining the protection from impoverishment that health insurance provides to vulnerable groups, the potential for increasing and expanding insurance coverage, and the options for and constraints limiting the use of insurance to attain UHC. 

The field of global health is witnessing a shift in focus from disease-driven initiatives to projects aimed at increasing the sustainability and strengthening of health systems. A crucial component to this is universal health coverage (UHC), which seeks to address financing schemes for health, separate from efforts to provide both adequate numbers of health workers and structures for health-care delivery. UHC may be provided by government or through a combination of private insurance schemes, public-sector planning, and employer-based programs. Countries across the world, from China and India to Rwanda and Mexico, are beginning to implement different universal health coverage schemes, marking a rise in interest and political will for universal health coverage.

This issue of the HST Update examines the information plays a pivotal role in the health care industry and questions if the needs of the health care workers are being met.

Has the process of developing human resource's been geared towards making Primary Health Care a priority?" This is a question to which the previous edition of HST Update drew attention. We continue the debate by focusing on a cadre of health workers operating at the community level of health care.