The 2001 South African Health Review (SAHR) has made a priority in its annual report card of reflecting what South African patients, politicians and health workers have to say about health services and delivery.
Produced annually by the non-governmental organisation, the Health Systems Trust, the review has dedicated significant space to the voices of service users, facility managers, hospital superintendent/managers, district managers, provincial managers, parliamentarians and policy makers.
The 'voices' of parliamentarians and managers bear testimony to their optimism and dedication, as well as to the strains that arise from being part of a large and publicly accountable organisation undergoing a prolonged period of transformation, said SAHR co-editor Antoinette Ntuli.
She said that, worryingly, many health service managers had a low sense of personal accomplishment.
Huge demands, difficulties in prioritising, inadequate management skills, lack of rewards for competence or sanctions for incompetence, and hierarchies that are too rigid all impact upon their ability to deliver quality health care, Ntuli said.
On the issue of equity (fairness), the review noted that it remained a cherished, but elusive policy goal in South Africa.
The greatest health sector inequity continued to be the imbalance of resources available to the public and private sectors.
Despite the introduction of community service, the number of key personnel available to care for patients in the public sector has decreased since 2000.
In 2001 there were 19,8 medical practitioners per 100 000 population as compared with 21,9 in 2000.
For professional nurses the ratio reduced from 120,3 in 2000 to 111,9 in 2001. There was a small improvement in the number of pharmacists available - the ratio increased from 3,1 in 2000 to 3,4 in 2001.
The review noted that current mechanisms for funding local government health services were problematic. From the provincial perspective they did not allow for adequate monitoring, while local governments were concerned about the cash flow problems resulting from payments paid quarterly in arrears.
There was no doubt that HIV/AIDS was impacting on health service delivery in a myriad of ways, some positive and some negative, the review said.
Steering away from the politics and controversies surrounding the epidemic, the review said that programmes such as the prevention of mother-to-child transmission were increasing the workload of primary health care staff.
In addition, staff brought to work their own needs arising from being personally affected by the epidemic and/or finding their jobs increasingly stressful as they felt themselves to be helpless in the face of the growing incidence of HIV/AIDS.
On a positive note, the review said that primary health care users found the increase of HIV counsellors and support groups linked to primary health care facilities as being of great importance.
Finally, the review acknowledged that the health sector had been undergoing major transition and transformation since 1994.
This has clearly taken its toll on staff many of whom, despite being excited about their role as agents of change, fell that it could be managed more effectively.
The review said that one of the reasons underpinning the inadequate response to the HIV/AIDS epidemic was the high turnover of staff within the health sector, affecting continuity.
Perhaps the most critical need of all is to ensure that leadership capacity, especially the fostering of openness and sensitivity among health managers, is developed and strengthened, said Ntuli.
Source: Health-e, 26 March 2002