Theme: REFLECTIONS ON THE MDGs AND PERSPECTIVES ON A NATIONAL HEALTH INSURANCE
In only five more years we will reach the target date for achieving the United Nations Millennium Development Goals (MDGs). In the year 2000 a total of 189 countries agreed on targets to reduce poverty and improve health by 2015. How is South Africa faring in this ambitious challenge?
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Health Systems Trusts (HST) much-acclaimed publication, the South African Health Review (SAHR), presents the opinions of experts in their respective fields as they assess the countrys progress towards the MDGs. The 2010 Health Review, the 14th since 1995, was launched in Pretoria on 8 December.
This years SAHR also explores the currently topical issue of Universal Health Coverage. A National Health Insurance scheme is envisaged as the mechanism to achieve this similarly ambitious, but necessary, goal. In the absence of an official policy document the authors use available information to debate the plans and illustrate various options. The Review contributes much to ensuring that the NHI debate does improve the countrys health system for all South Africans.
HSTs Chief Executive Officer, Jeanette Hunter said, The release of this years Review is timely in that it corresponds with the release of the World Health Report 2010, which deals with universal health coverage. The Director-General of the World Health Organization explains that, this is an argument for solidarity. In solidarity with the countrys health needs, we in HST are committed to improving the health system for all South Africans and have thus sought to provide a wide range of perspectives on universal coverage and on NHI so that we can develop a common understanding of where we need to go as a country and how we are going to get there.
The South African Health Review has rapidly become a flagship product that is widely read and quoted as an authoritative reference source. It provides a South African perspective on prevailing local and international public health issues. This edition again promises to be a useful resource for public health practitioners both nationally and locally as they grapple with the issues of the day.
With over 40 authors and 21 chapters, some of the highlights of this years Review relating to the achievement of the MDGs are as follows:
In MDG 5 (maternal health) it appears that South Africa is not on track to meet the goal, namely to decrease the maternal mortality ratio by 75%. A particular feature of maternal mortality in South Africa is that non-pregnancy-related infections, mainly HIV-related, are a significant cause of maternal deaths in South Africa.
MDG 4 deals with child mortality and the authors have found that after five successive years of increasing childhood mortality, the under-5 mortality rate (using 2007 data) appears to have levelling off at an estimated 62.1 deaths per 1000 live births. They caution, however, that poor data quality could be influencing the picture.
The Review has found that South Africans face challenges and obstacles in accessing comprehensive treatment, prevention and care for sexually transmitted infections, including HIV, and in sexual and reproductive health, family planning, pregnancy and delivery.
The intertwining of HIV and TB has seriously affected the countrys ability to make progress towards achieving the MDGs. The Review locates health and health outcomes within a broader socio-economic context and depicts the social gradient upon which health and illness are located. The average TB cure rate, for example, is 55% in the most deprived districts while it is 71% in the least deprived districts.
The latest World Health Report highlights the need to move towards universal coverage. In exploring options for introducing National Health Insurance, South Africa is in keeping with international trends.
The envisaged reform of the health system towards universal coverage of health services is necessary, albeit ambitious. The reform must be accompanied by improvements in the general management of the public health system. Changes could include increasing staffing at primary health care clinics, introducing task-shifting and improving the capacity of hospital managers.
The Review shows that there is neither doubt nor dispute that the South African health system is in need of significant reform. Private sector perspectives on national health insurance reflect the sectors willingness to engage in developing a NHI for the country. The theme is reiterated in a civil society contribution suggesting that a NHI policy that increases access to quality health care will be welcomed and supported. An issue in recent media debates, albeit in the absence of an official policy document, was the affordability of a universal system to the country. One commentator in the Review points out, however, that it is not the universality of a health system that makes it unaffordable but rather inappropriate design and inefficiencies. Another chapter considers the financial feasibility of implementing NHI in South Africa.
The Review has endeavoured to put together a compendium of arguments and counter-arguments on the NHI. As HSTs Chairman correctly reflects in the Foreword, for to listen only to the voices that affirm one viewpoint, is to deny the fundamental contradictions that exist in our society and, indeed, in our health system. Improved health care for all South Africans remains both a prerogative and a responsibility of every citizen of the country.
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