Labor

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.

To research this report, the Economist Intelligence Unit surveyed the literature and data available on Africa’s current healthcare systems. We also conducted 34 in-depth interviews with leading experts in the different professional roles that make up the healthcare sector: academics, clinicians, healthcare providers, policymakers, medical suppliers, and think tanks. The data and interview comments were then analysed to define trends likely to have an impact on the direction of healthcare over the next decade. Finally, bearing in mind these trends, we developed five extreme scenarios, each a distillation of a possible outcome of the trends identified.

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.

This report was prepared by the UNAIDS Advisory Group on HIV and Sex Work to complement the UNAIDS Guidance Note on HIV and Sex Work (2009). The Advisory Group includes representatives of organisations affiliated with the Global Network of Sex Work Projects, independent experts from academia and civil society organisations, representatives of UNAIDS Co-Sponsors and the Secretariat. The Advisory Group was constituted in 2009 by the Executive Director of UNAIDS to provide advice and guidance to UNAIDS on matters related to HIV and sex work, while paying particular attention to the human rights of female, male, and transgender sex workers and the goal of universal access to HIV prevention, treatment, care and support for sex workers.

Workforce planning for the health service is challenging and complex. Nonetheless, workforce planning is an important process. The health, policy, legislative and economic context influence the task of visualising and implementing improvements in the health workforce. The policy context provides the framework for the development of the HRH Strategy. The Minister of Health, in his Budget Speech in May 2011, announced the re-engineering of the Primary Health Care system and the overhaul of the health system.
Implementing the three main streams for re-engineering Primary Health Care is the short-term priority. These streams are: District Clinical Specialist teams, a School Health Programme and Community Outreach PHC Teams.

The Problem Statement

Health workers are undoubtedly the most important resource that we have in providing and improving the health and chances of survival of children, mothers and their families. In this new report, entitled "No Child out of reach - time to end the health worker crisis", Save the Children calls for urgent action to tackle the problem of the global health worker shortage and to firmly raise the issue on the international agenda. The report highlights the extent of the problem and how the most vulnerable children are denied access to healthcare services and trained healthcare professionals due to a massive shortfall of health workers in some of the poorest countries in the world.

South Africa is in the process of introducing an innovative system of healthcare financing with far reaching consequences on the health of South Africans. The National Health Insurance commonly referred to as NHI will ensure that everyone has access to appropriate, efficient and quality health services. It will be phased-in over a period of 14 years. This will entail major changes in the service delivery structures, administrative and management systems.

World Health Organisation. The World Health Report 2006: Working together for health. Geneva: World Health Organisation; 2006.