Health policy

Primary Health Care Financing and Need Across Health Districts in South Africa

Published by: 
Health Systems Trust
Government health policy emphasises the importance of both decentralisation and equity in the public health sector (NDoH, 2002). The draft National Health Bill establishes a health system with decentralised management (p7) and, in particular, a district health system based on a PHC approach (p38). Concurrently, it states that provinces and municipalities must implement the system with regard to key principles, the foremost being equity (p38). However, it is unclear whether decentralisation and equity exist in harmony particularly in relation to the financing of PHC. This report explores this issue by evaluating the funding of non-hospital PHC services, within the decentralised South African system, against indicators of need. An output of the Local Government and Health Consortium, funded by Health Systems Trust and comprising Health Systems Trust, Centre for Health Policy and Health Economics Unit

WORLD HEALTH DAY

Rich-Poor Gap in Care Persists More than one billion people worldwide are not getting essential health care, according to a report by the Population Reference Bureau (PRB), which calls for international donors to focus more on closing the growing health gap between the world's wealthy nations and its poorest. The 32-page report, 'Improving the Health of the World's Poorest People', finds that per capita health spending in the world's least developed countries, most of them in sub-Saharan Africa and South Asia, comes to only about 11 U.S. dollars a year. To download see http://www.prb.org (438KB)

PRESS RELEASE: NEW CEO FOR LEADING HEALTH NGO

The Health Systems Trust (HST) announced today that Dr Lilian Dudley has been appointed Chief Executive Officer of the organisation. Making the announcement, Chairperson of the HST board, Mr Patrick Masobe said, we are delighted to have somebody of Dr Dudleys professional standing and calibre to lead the organisation.

Questionable assumptions - why health sector reforms have failed to deliver in Kenya

he Kenyan government is committed to providing health services to all its citizens. But despite major health sector reforms, the population’s health status is falling. Researchers from the Tropical Institute of Community Health and Development, Kisumu, Kenya, explore the reasons for this lack of success.

Call for Applicants: Research Grants/Awards Equity in the Distribution of Health Personnel

The Regional Network for Equity in Health in Southern Africa (EQUINET) and Health Systems Trust South Africa (HST) are inviting expressions of interest from individuals or organisations based within the region to contribute to a programme of work on Equity in the Distribution of Personnel in Southern Africa. Equinet is a network of research and advocacy organizations that have a specific concern for equity in health issues based within the SADC region (see www.equinetafrica.org or email admin@equinetafrica.org). This call closes on March 12th 2004 Objectives of programme ----------------------- The programme seeks to promote the equitable distribution of health personnel in southern Africa through: o Exploring, reviewing and harmonising where relevant policy tools for enhancing health equity in personnel distribution in southern Africa o Analysing and identifying mechanisms for strengthening governance arrangements and industrial relations systems for managing negotiations and policy interactions health professional associations and health unions and state authorities on health personnel issues o Facilitating and informing dialogue on policy options for dealing with attrition of health personnel from southern Africa to selected high income countries. The work is supported by an advisory panel of senior personnel working on Human Resources for Health (HRH) in Southern Africa and internationally. Summary of Areas for further Research, Analysis and Advocacy ---------------------------------------------- The background review identified issues for further research, analysis and advocacy that would guide future work. This does not exclude other priorities that are raised and jusitifed in the response to the call. Production of Health Personnel „h Mapping of the burdens of health personnel losses across the region in relation to the capacity to produce and replace personnel. „h Assessment of the appropriate and most effective mix of personnel and the implications for personnel production „h Impact of migration on the quality and output of training institutions. „h Analysis of the merits of various student recruitment initiatives designed to improve the distribution of health personnel Availability and Distribution „h Accurate information on health personnel distribution and movements across private, public and traditional sectors „h Cost-benefit evaluation of the losses and gains of current flows to health workers, to communities, to health systems and to countries „h Evaluation and analysis of information systems and planning capacities within public health authorities „h Mapping of relationship between resource allocation inequalities and capacity to demand and use resources „h Exploration of the role of traditional health personnel in mitigating gaps in western health services Movement and Migration „h Accurate information on the directions and volumes of health personnel movement and their determinants within each of the southern Africa countries, their impact on equity and performance of health services „h Comprehensive indicators reflecting the consequence of the drain on health within each of the Southern African countries „h Mapping of the specific factors affecting internal and external movements and the extent to which they are linked with wider between- and out-of-country flows „h Further exploration of the regional health personnel brain drain, particularly by skills group „h Study of the replicability of the often unique pull and stay factors within missions to the wider health system Field of work --------------- The programme includes: „« Call for and submissions for research and national activities on equity in health personnel in southern Africa „« A three day review meeting from April 15th to 17th 2004 to review the analysis of HRH issues, draw inputs from policy, research and health worker platforms, review of the proposed research and set the research and programme priorities for the HRH programme „« Support of accepted research proposals and implementation of research studies „« Peer review by the advisory panel of the research reports and publication in a as a discussion paper series „« National and regional meetings and consultations to review findings and identify follow up policy or programme issues „« A follow up regional meeting in mid 2005 to present and review the policy and programme implications and to build alliances towards their implementation, including with international research and policy networks on HRH (UK, Australia and Canada). Successful applicants for involvement in this programme of work will be required to: „h Submit an expression of interest in the format below by March 12 2004 „h Attend the regional meeting in April 2004 in South Africa „h Finalise their protocol for a study on a relevant aspect of equity in HRH in southern Africa by end of May 7th 2004 and be ready to begin implementing their study shortly after this „h Present their study at an Equinet /HST Regional meeting in mid 2005 The total funding available to each successful study will be agreed on with EQUINET/HST Submission procedures for expressions of interest Interested applicants should submit a 1-2 page ¡¥expression of interest¡¦ concept note, a personal CV, and a sample document written by the applicant on any relevant theme. The concept note should include information on: „h A potential topic of focus, with justification for the research and its potential use at local, national, regional or international level „h The applicant¡¦s interest in the topic and in the broad field of work in HRH; „h The applicant¡¦s key experiences and skills that have relevance to this work. Applicants should submit this information by 12th March 2004 to ant@hst.org.za or by Fax to 2731-304-0775 (attention A Ntuli). Applicants will be informed by 2nd April 2004 if they have been successful. Successful applicants will be invited to attend the regional workshop to be held in Johannesburg between 15th and 17th April 2004 (with full funding from Equinet). Applicants must, therefore, be available to attend this workshop. Participants of existing Equinet programmes are welcome to apply. Co-ordination and queries ------------------------- The programme of work will be co-ordinated on behalf of Equinet/HST by Antoinette Ntuli of Health Systems Trust, Durban, South Africa. For any queries about the programme please contact her at ant@hst.org.za. For general queries on Equinet please email the co-ordinator at admin@equinetafrica.org or visit the Equinet website (www.equinetafrica.org)

State health plan shock for medical aid funds

Government is investigating a proposal to create a single compulsory medical aid scheme for its 1,1-million employees, which would have major implications for the healthcare sector and the medical aid industry. Private medical aid funds would potentially lose thousands of their members while medical aid brokers, who rely on state employees as a major source of their commission income, would be forced to find new markets. Also, a significant shift of medical aid funding from the private health sector to public hospitals and clinics would occur, as the scheme would be structured in a manner to make optimal use of the public health sector. An interdepartmental task team has been investigating the proposals, and final research by outside experts is under way. The public service and administration department is expected to finalise its recommendations for submission to the cabinet later this year and, if accepted, it will enter into negotiations with trade unions in the hope of implementing the plan from next year. High-income employees, who would be forced to leave their chosen private medical aid to join the state scheme, have already expressed resistance. Details of the proposals were presented yesterday by the department's chief negotiator and senior manager of labour relations and negotiations, Kenny Govender, to Parliament's public service and administration portfolio committee. About 400 000 of all government employees and their families have no medical aid cover because they cannot afford it. The rest belong to 61 private sector funds of their own choice, to which the government as employer pays a contribution. Govender said uncovered employees posed a financial risk to government, which never knew when these employees would take on medical cover, at which point government would have to start making contributions. The continual rise in private medical aid costs was also a drain on government and had to be contained. (Source: Linda Ensor: Business Day, 28 January 2004) Link \//\ HEALTH INSURANCE AND THE POOR IN LOW INCOME COUNTRIES http://www.hospitalmanagement.net/ihfdocs/health_insurance_in_low_income... Government is investigating a proposal to create a single compulsory medical aid scheme for its 1,1-million employees, which would have major implications for the healthcare sector and the medical aid industry. Private medical aid funds would potentially lose thousands of their members while medical aid brokers, who rely on state employees as a major source of their commission income, would be forced to find new markets. Also, a significant shift of medical aid funding from the private health sector to public hospitals and clinics would occur, as the scheme would be structured in a manner to make optimal use of the public health sector. An interdepartmental task team has been investigating the proposals, and final research by outside experts is under way. The public service and administration department is expected to finalise its recommendations for submission to the cabinet later this year and, if accepted, it will enter into negotiations with trade unions in the hope of implementing the plan from next year. High-income employees, who would be forced to leave their chosen private medical aid to join the state scheme, have already expressed resistance. Details of the proposals were presented yesterday by the department's chief negotiator and senior manager of labour relations and negotiations, Kenny Govender, to Parliament's public service and administration portfolio committee. About 400 000 of all government employees and their families have no medical aid cover because they cannot afford it. The rest belong to 61 private sector funds of their own choice, to which the government as employer pays a contribution. Govender said uncovered employees posed a financial risk to government, which never knew when these employees would take on medical cover, at which point government would have to start making contributions. The continual rise in private medical aid costs was also a drain on government and had to be contained. (Source: Linda Ensor: Business Day, 28 January 2004) Link \//\ HEALTH INSURANCE AND THE POOR IN LOW INCOME COUNTRIES http://www.hospitalmanagement.net/ihfdocs/health_insurance_in_low_income...