The 19th edition of the SAHR was launched at the HST conference in Gauteng on 4 May 2016 where diverse stakeholders in all tiers of the public and private health sector are gathered to discuss how to improve health outcomes in South Africa, especially in the context of the Sustainable Development Goals.
Some of the key findings and conclusions of the Review include:
Notwithstanding the progress made since 1994, the performance of the South African health system has been suboptimal compared with other countries of similar income level, and in the light of the country’s quantum of healthcare spending. Greater attention should be given to improving management and governance, developing a fully-functional district health system and resolving the health workforce shortage.
Trauma constitutes approximately 25% of the emergency workload at most public hospitals in KwaZulu-Natal, and this burden has arguably been under-estimated. Existing resources at regional and tertiary public facilities are strained; there is limited capacity for rehabilitation and a lack of intensive care facilities. Data from numerous studies provide insight into options for establishing systems of quality trauma care and accreditation programmes for hospitals and systems.
Evidence suggests that introducing the UNAIDS HIV 90-90-90 targets, while hard to achieve, is likely to be affordable and cost-effective, provided that this is done in a phased way and that annual increments to government HIV/AIDS budgets are sustained. South Africa’s HIV Investment Case finds that the most cost-effective set of interventions can still massively affect outcomes such as mortality and HIV incidence. If Government spends more now, the impact over 20 years will be greater, resulting in improvements in outcomes along with reductions in total spending over the long run, whereas if Government delays this investment, it will ultimately be required to spend more in total.
Water-related health issues are emerging in conditions of water stress and climate change. Constraints on supply require greater water re-use and better management of treatment plants to ensure river health and safe drinking water. With climate change, existing microbial diseases could become more prevalent, with reports of water treatment plants discharging insufficiently treated effluent into rivers. All of these factors require improved water and health management, with greater surveillance of water quality and the delivery of universal water services to determine priorities and prevent disease outbreaks.
Creating an enabling environment to practise breastfeeding has huge potential as an investment in the future health of mothers and the healthy life-course of their children. However, in South Africa, very few babies are exclusively breastfed during the first six months of life and many babies receive complementary foods during that time. The country’s sub-optimal early nutrition profile predisposes South Africans to poor health outcomes in both their infant and young child years as well as in adulthood. Intersectoral, multilevel commitment is needed for optimum breastfeeding practices to succeed.
South Africa is no exception to non-communicable diseases (NCDs) becoming one of the leading causes of death. One of the factors implicated in this is the change in the food environment. This change, dubbed the ‘nutrition transition’, is characterised by a shift from traditional diets based largely on staple grains or starchy roots, legumes, vegetables and fruits but minimal animal foods, towards more energy-dense, processed foods, more foods of animal origin and more added sugar, salt and fat.
During her address at the launch, SAHR Managing Editor Ms Ashnie Padarath commented: “The chapters in this Review give meaning to the health needs and rights of South Africans who play a critical role in the healthcare system, either as a user or a provider”. Echoing the call of the global health community that no-one be left behind in the quest for equitable health systems that provide continuous, comprehensive and co-ordinated care, she concluded: “The facts and recommendations compiled in the 2016 South African Health Review are testament to our commitment to this enquiry, and to the millions of us who can use and benefit from this work.”
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Electronic copies of the South African Health Review will be accessible via the HST website (www.hst.org.za) after 18h00 on Wednesday 4 May 2016.
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