Health Systems Trust released the findings of two of its most prominent publications, the District Health Barometer (DHB) and the South African Health Review (SAHR) on the 23 February 2012.
Covering 52 districts, the DHB contains a total of 36 financial, health and socio-economic indicators. The report paints a mixed picture showing significant gains in some areas as well as issues that need further attention. For example, HIV testing in ante-natal clinics is at 100% with PCR coverage up from 26% in 2009 to 52% in 2011. The TB cure rate for new smear positive patients has also increased from 51% in 2004 to 71% in 2009. Severe malnutrition has decreased as has diarrhoea in children under five-years of age. However, 14% of all recorded deaths are due to “ill-defined causes”, pointing to the need for attention to be given to our death registration process. TB and HIV-related diseases still constitute the main causes of “years of life lost” with other contributors being transport injuries, strokes, hypertensive heart disease, inter-personal violence and diabetes and ischaemic heart disease.
With its focus on strengthening health system effectiveness, this 15th edition of the South African Health Review focuses on a variety of basic health system building blocks from the perspective of the NSDA and PHC re-engineering, and provides an opportunity to assess how far SA has progressed with regard to transforming its health system since 1994.
Noting that SA spends an average of 8.6% of its GDP on health, but still has poor outcomes, the Review sketches some of the reasons why SA’s health system provides low value for money. These include the large gap between good health policies and implementation of these policies, poor supervision of PHC services, and inadequate systems for oversight and governance of clinical care.
The stagnation and decline in public sector clinical posts during 1997-2006 has been reversed with a steady increase in the numbers of people being employed in the public sector. The number of public sector doctors increased from 10 878 in 2009 to 12 014 in 2011 while the number of enrolled nurses in the public sector increased from 23 039 in 2009 to 27 526 in 2011.
Despite this, the inequity of access to health professionals per 10 000 members of the population between rural and urban areas and between the public and private sectors has persisted over the past 15 years. Gauteng for example has 69 health professionals per 10 000 population, compared with the Eastern Cape which has 44 per 10 000 population. An overarching message emanating from the Review (given the recent policy documents such as the Green Paper on NHI, the 10 Point Plan, the NSDA and the Human Resources strategy) is that there is clearly significant political will to transform the health system based on the principles of fairness, equity and accessibility. As each of the chapters repeatedly point out, the stage has been set for a historic moment in the transformation of SA’s health sector. The editors however, caution that policies without adequate resources, committed leadership and stewardship together with regular engagement with key stakeholders will remain mere aspirations. Apart from implementing new policies and developing fair financing arrangements, there is also a need to focus on softer issues such as leadership and management, and to ensure that we build and nurture a cadre of health managers who are able, empowered and motivated.
The initial findings of the National Facilities Audit and the Facility Improvement Teams, both of which are designed to facilitate the effective implementation of the NHI, were also announced at the launch by the National Minister of Health, Dr Aaron Motsoaledi.
The DHB and SAHR can be viewed on our website: www.hst.org.za
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