In an attempt to measure in part the progress (or lack of progress) towards equity one step would be to measure the quality of service provision at the community (primary care) level. This would give an overview of the disparities between as well as in provinces, and between rural, urban and peri-urban parts of the country.
The South African Health review is a recognised barometer of the progress of reform in the health service. This years health review is frank in its assessment of successes and failures, but expands its scope of information by including a survey of the realities in clinics in every province in the country.
While previous reviews have focused on the development of new policies as part of the restructuring in the health sector, this Review concentrates on trying to assess the extent to which new policies have been translated into real improvements in the quality of life of South Africans. The Review found that while major steps forward have been made in the arena of policy, much remains to be done in order to implement these policies.
The clinic survey highlights the fact that despite the commitment to providing primary health care for everyone there is continuing disparity between service provision in rural and urban areas, with rural people, and poorer provinces still losing out. For example, the survey showed that only 41% of rural clinics have an ambulance at their door step within an hour of an emergency call compared with 74% in urban clinics. The move towards more equitable provision has become even more uncertain now that funding for health is at the discretion of provincial cabinets, (from the beginning of the 1997/98 financial year each province received a block grant from the national Treasury).
In contrast with 1996 which saw only one new piece of legislation, in 1997 a number of pieces of legislation with the potential to reform the health services were introduced to parliament, nonetheless problems remain with implementation. The possibility for women to exercise their constitutional right to reproductive choices improved dramatically when termination of pregnancy legislation came into effect in February 1997, but service provision has proved to be patchy at best with a number of provinces doing much less than their proportional share of terminations. The clinic survey reveals that only just over 60% of rural clinics and about 85% of urban clinics offer family planning services on a daily basis.
With South Africa facing one of the worst TB epidemics in the world, there has been commitment at national and provincial level to implementing a new control programme. However many barriers still exist, and despite remarkable improvements in some provinces, the clinic survey demonstrates that only 10% of rural and 25% of urban clinics receive results within the time recommended by the Tuberculosis Control Programme.
In the hospital sector detailed baseline studies have resulted in clear plans for what needs to be done to achieve physical improvements and work towards reducing inequalities as well as make changes in a range of other fields. The challenging task of implementing these plans remains.
In the field of human resources there have been efforts to re-shape an urban centred, hospital based and doctor dominated service. However there has been uneven progress and a comprehensive strategy which will attract personnel to work in currently under resourced predominantly rural areas has still to be developed.
The Review found it was difficult to measure what has really changed for a poor person in need of health care. One thread running through the Review is that more reliable up-to-date information is needed in order to assess, evaluate, plan, prioritise and improve. This information is required in every part of the health system.
Health care and welfare services in the Ngwaritsi-Makhudu-Thamaga-Tubatse-Steelpoort (NMTTS) district, Northern Province - A situational analysis
Description and evaluation of Primary Health Care services delivered Alexander Health Center and University Clinic
Since the first group of nurses was trained in clinical health assessment, treatment and care in 1982, South Africa has come a long way. Not only has the government policy declared nurses the backbone of the health care system in South Africa, but also there has been a major shift in health care from a mainly hospital based to a mainly primary health care focussed health care service.