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Since Alma Ata, with its call for Health for All by the year 2000, governments of the world, including South Africa, have signed up to the Millennium Development Goals (MDGs). These ambitious MDGs include a number of key health related targets, which are dependent on Primary Health Care (PHC) for their achievement. It has become increasingly clear that South Africa will not achieve the goals in relation to child and maternal mortality, nor in relation to goals set in relation to HIV and TB.
Some of the key factors, which impact on PHC and the achievement of the MDGs are outside the scope of the health sector and are collectively known as the social determinants of health. There has been a significant improvement in access to water from 59% in 1994 to 94% in 2007. Improvements in the delivery of sanitation have been slower. Despite these improvements, isolated outbreaks of cholera, typhoid and diarrhea in many provinces serve as a reminder that more needs to be done. Additionally, there are inter-provincial inequities with KwaZulu-Natal, Limpopo and the Eastern Cape having the lowest levels of access to water and sanitation.
There has been increased provision of social grants especially in the area of child grants. Despite this, there are still extreme wealth inequalities and high levels of unemployment, which play an important role in poor health outcomes. The nutritional status of most South Africans has not improved in the last 14 years and malnutrition continues to affect the lives of millions of children in South Africa. Nationally, the percentage of children who are underweight has remained relatively static at 9% since 1994.
There has been an unprecedented threat to the health sector brought about by the twin diseases of HIV and TB. Over the past 20 years there has been a massive rise in these diseases, which have directly impacted on the MDGs. They are currently compartmentalised into separate boxes, but need to be seen as two sides of the same coin with interventions against them needing to be holistic and integrated.
Within the formal health sector there have been a number of factors which impact on PHC. Substantial resources have been moved into PHC and spending on public sector PHC services amounted to R297 per capita uninsured in 2006/07 and Treasury budgets indicate an increase to R395 per capita by 2010/11. The health workforce is now substantially weaker in some areas than it was in the mid 1990s, despite a range of excellent health policies. In 1994, there were approximately 2.5 nurses for every 1000 persons, while in 2007 there were only 1.1 nurses available for every 1000 persons. In addition, the nursing profession faces a serious shortage as the professional nursing population ages, because production to keep pace with attrition and retirement has lagged behind.
Outside the public sector there has been increased activity within both the private for-profit and not-for-profit sectors in PHC. However, there is a need for a greater co-ordination of resources and activities within this growing sector, particularly with regard to the geographical spread of activities.
These are some of the findings of the 2008 South African Health Review (SAHR).
The 13th edition of the widely acclaimed SAHR was launched in Pretoria today (10 December 2008). This edition of the SAHR focuses on PHC in South Africa, 30 years after the historic Alma Ata Declaration, which famously linked health and health status to broader social determinants of health. At Alma Ata delegates affirmed that health is a fundamental human right and that the attainment of the highest possible levels of health requires action from social and economic sectors in addition to the health sector.
The 2008 SAHR focuses on critical issues in PHC. The Review includes a national and international perspective of PHC and focuses on areas such as policy and legislation, determinants of health, lifestyle, infectious diseases, mental health, maternal and child health, nutrition and environmental health. The SAHR also reviews issues around human resources, finance, and information and concludes with the Indicators chapter which presents a selection of the best available data on the functioning and performance of the South African health system.
This years Review reflects on the policies of the past and some of the major components of PHC and attempts to learn from the lessons and mistakes of the past so that there is improved implementation in the future, said the CEO of the Health Systems Trust, Dr Thobile Mbengashe.
Dr Mbengashe added that, the release of the findings of the SAHR was timed to co-incide with the 40th anniversary of the Universal Declaration of Human Rights. This years SAHR confirms the indivisibility of health as a human right and reinforces the need for multi-sectoral, collaborative initiatives which take a more broader view of the determinants of health outcomes such as water, nutrition and education, all of which need to work together if the health of vulnerable populations is to improve remarked Dr Mbengashe.
We commit ourselves to assisting the Department of Health to strengthen and support the health system in South Africa so that the goal of Health for All is not merely a hollow battle cry concluded Dr Mbengashe.
For more information please contact:
Fiorenza Monticelli (083 299 3899)
Ashnie Padarath (031 307 2954 or 083 299 7129)