Health policy

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.

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.

The theme of this month's "Update" is greater integration of the public and private health sectors in South Africa. It explores ways in which convergence of public and private health care in South Africa can be used to increase people's access to health care, and to ensure both greater efficiency and equity in the provision of health care. Some of the suggested mechanisms are complex, controversial and may take time to implement. Other steps may be simpler and should be introduced now - if only to prevent the situation described above happening again.

The use of ‘co-payments’ to deal with possible ‘over-utilisation’ of health care services is a key point of contention in policy debates related to South Africa’s National Health Insurance proposals.

Over-utilisation occurs when health care provision (in instances when it is free at the point of service), leads to inappropriate and excessive utilisation.  Co-payments mean users still receive health services that are heavily subsidised (from public funds in the case of the proposed NHI), but have to pay something towards the cost of services – this aims to curb the frivolous use of services and avoid over-utilisation.

The focus of the National Health Insurance Conference, themed “Lessons for South Africa”, was to create a national consultative health forum as a platform for South Africans to engage with local and international experts in the areas of health financing and health systems reforms and how these have been undertaken in other contexts to ensure that universal coverage to quality health services is achieved for the entire national population. The Conference was organised as part of the Department’s strategy to consult as many stakeholders as is possible on the contents of the Green Paper on National Health Insurance (NHI) which was published in Gazette Number 34523 on 12th August 2011 to initiate a process of eliciting comments from the public.

The Green Paper on National Health Insurance (NHI) was published on 12th August 2011 and it indicates that NHI will be implemented gradually in three phases over a fourteen year period. The implementation of NHI is aimed at ensuring universal access to quality healthcare on a more sustainable and equitable basis than currently exists for the entire population. The implementation of NHI is a priority of Government as articulated in Government’s Programme of Action as well as the Negotiated Service Delivery Agreement. In order for the health sector to contribute towards achieving A Long and Healthy Life for All South Africans, the Minister of Health has committed to the following NSDA outputs:
a) Increased life expectancy