While previous reviews have focused on the development of new policies as part of the restructuring in the health sector, this Review concentrates on trying to assess the extent to which new policies have been translated into real improvements in the quality of life of South Africans. The Review found that while major steps forward have been made in the arena of policy, much remains to be done in order to implement these policies.
The clinic survey highlights the fact that despite the commitment to providing primary health care for everyone there is continuing disparity between service provision in rural and urban areas, with rural people, and poorer provinces still losing out. For example, the survey showed that only 41% of rural clinics have an ambulance at their door step within an hour of an emergency call compared with 74% in urban clinics. The move towards more equitable provision has become even more uncertain now that funding for health is at the discretion of provincial cabinets, (from the beginning of the 1997/98 financial year each province received a block grant from the national Treasury).
In contrast with 1996 which saw only one new piece of legislation, in 1997 a number of pieces of legislation with the potential to reform the health services were introduced to parliament, nonetheless problems remain with implementation. The possibility for women to exercise their constitutional right to reproductive choices improved dramatically when termination of pregnancy legislation came into effect in February 1997, but service provision has proved to be patchy at best with a number of provinces doing much less than their proportional share of terminations. The clinic survey reveals that only just over 60% of rural clinics and about 85% of urban clinics offer family planning services on a daily basis.
With South Africa facing one of the worst TB epidemics in the world, there has been commitment at national and provincial level to implementing a new control programme. However many barriers still exist, and despite remarkable improvements in some provinces, the clinic survey demonstrates that only 10% of rural and 25% of urban clinics receive results within the time recommended by the Tuberculosis Control Programme.
In the hospital sector detailed baseline studies have resulted in clear plans for what needs to be done to achieve physical improvements and work towards reducing inequalities as well as make changes in a range of other fields. The challenging task of implementing these plans remains.
In the field of human resources there have been efforts to re-shape an urban centred, hospital based and doctor dominated service. However there has been uneven progress and a comprehensive strategy which will attract personnel to work in currently under resourced predominantly rural areas has still to be developed.
The Review found it was difficult to measure what has really changed for a poor person in need of health care. One thread running through the Review is that more reliable up-to-date information is needed in order to assess, evaluate, plan, prioritise and improve. This information is required in every part of the health system. |
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