South African Health Review 2000

The year 2000 was a significant one in terms of developments affecting the health sector. Local Government elections in December heralded the beginning of the final stage of the transformation of Local Government, paving the way for the full implementation of the District Health System.

The National Health Accounts were undertaken, providing an overview of financing and expenditure in both private and public sector care. And, as can be evidenced by the frequent references to HIV/AIDS in many chapters of this Review, the impact of the epidemic began to be felt in almost every aspect of the health system. This first South African Health Review of the millenium aims to provide a combination of detailed information on health status and health care coupled with in-depth analysis of policies and practices affecting the provision of health services in South Africa. Recent Reviews have been characterised by a particular focus on policy implementation and this is maintained, as is an emphasis on equity, especially in regards to financing and expenditure.

In 1997, again in 1998, and most recently in 2000, the Health Systems Trust commissioned a survey of primary health care facilities. The survey forms part of an ongoing monitoring of progress in implementing Primary Health Care. Key findings from the Survey are provided in the Review, and they provide a unique insight to quality of care in public sector clinics in South Africa.

The HIV/AIDS epidemic does not only affect those with living with HIV, their families and carers, it also places a huge burden on staff in clinics and hospitals who are providing care, often in less than ideal circumstances, and on health service planners and managers faced with competing demands for resources. The successes identified in this Review are testament to the commitment, dedication and hard work of health service staff.

Producing a Review of substance on an annual basis is not an easy task. The Board of Trustees of the Health Systems Trust wishes to thank the many researchers, writers and reviewers, as well as the staff of the Health Systems Trust who have dedicated time and effort to the 2000 South African Health Review.

Contents

Begining
Acknowledgements
1 Primary Health Care Facilities Survey
2 The Health Sector Strategic Framework: a review
3 Health Legislation
4 Health Status and Determinants
5 Public Sector Financing
6 District health expenditure reviews
7 Social health insurance
8 Impact of Changes to the Medical Schemes Act
9 Drug pricing
10 Developments towards a district health system
11 Hospital Restructuring
12 Transformation of laboratory services
13 Transformation in Nursing Education
14 HIV/AIDS - current issues
15 HIV/AIDS - facts, figures and the future
16 Models of community-based HIV/AIDS care and support
17 Tuberculosis
18 Malaria
19 Child Health
20 Youth Health
21 Women’s Health
22 Tobacco Control
23 Alcohol and other drug use
24 Disaster Management
Health and related indicators
References
Glossary
Index

Briefing Summaries:

• Drug Pricing
• Hospital Restructuring and Laboratory Services
• Public Health Sector Financing
• The Medical Schemes Act