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December 22
South African Health Review editor reflects on 23 editions of the Review

By: Ms Ashnie Padarath (SAHR Editor-in- Chief)

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Looking back at how we started

The first edition of the South African Health Review (SAHR) was launched on 4 October 1995. Comprising 18 chapters and over 30 authors, The Star newspaper described it "as the first of what is to be expected to become the standard annual reference work on the health sector." Twenty-five years later, the SAHR has lived up to this prediction and continues to chronicle the progress and challenges in transforming the health system.   

The SAHR is recognised as one of the most authoritative sources of commentary on the South African health system. It is widely used in teaching public health at undergraduate and postgraduate level in South Africa, and by scholars, donors, journalists, policy makers and policy implementers at various levels of the health system.     

The origins of the SAHR can be traced back to a meeting held in the modest setting of an orphanage on the south coast of KwaZulu-Natal in August 1994 where a group of thought leaders in the health field identified the need to document the transformation of the health system in a democratic South Africa.  Now in its 23rd edition, the aims of the Review are to advance the sharing of knowledge, to feature critical commentary on policy implementation, and to offer empirical understanding towards improving South Africa's health system. 

Chapters in the Review comprise a mix of specifically commissioned work reflecting on core health systems' issues as well as current issues of particular importance and findings from topical research.  Chapters go through a rigorous peer-reviewed process and each edition is guided by an Editorial Advisory Committee consisting of wide range of leaders in their respective fields.

The Wonder Years: 1995–1999

Earlier editions of the Review reflected the national optimism pervading the country at the time and focused on the need for policy development and a gathering of evidence that would be needed to inform policy-making. During this period chapters in the Review were consistent and focused on imperatives for health systems reform.    Some of the key issues flagged  were the need to revisit the recommendations of the Gluckman Commission with regards to universal coverage, the development of human resources for health, the development of a National Health Insurance Scheme (NHIS), quality assurance, and the need for comprehensive health care for people living with HIV and AIDS.

Reality Check: 2000–2004

The turn of the century brought with it a change in the political milieu with a new President and new Minister of Health. Chapters in the Review started to move away from broad principles and began to provide an analysis of implementation – looking at issues as diverse as community service, quality and patient rights. Chapters also become wider in their scope and begin to interrogate how the private-for-profit sector, religious communities and traditional healers interact and intersect with the health system. Reviews begin to address the growing burden of disease and attendant decline in life expectancy and the perspectives of people interacting and working within a health system undergoing a prolonged period of transformation. 

Growing Pains: 2005–2009

The 10th edition of the SAHR in 2005 marked the beginning of a thematic approach to the publication. While cross-cutting health system issues such as legislation and financing and health and related indicators were still featured in the Review, the lion's share of the publication was devoted to specific thematic issues. The Reviews were produced against the backdrop of the promulgation of the National Health Act, the introduction of antiretroviral (ARV) programmes, the publication of the TB strategic plan and the reports of the Integrated Support Team. These sparked a series of policy reforms and government's commitment to strengthen health systems and reduce inequities which the Review then sought to cover.

Winds of Change:   2010–2014

Material in the Review reflected the wide scope of topics that characterised the terrain of health systems strengthening and began to locate health systems development in within a broader international public health agenda. The 2010 edition entitled Reflections on the MDG's and Perspectives on a National Health Insurance focused on  universal health coverage as articulated in the 2010 World Health Report and SA's progress towards meeting the Millenium Development Goals.  The 2011 edition focused on the Negotiated Service Delivery Agreement and health systems strengthening using the World Health Organization's six building blocks framework.

In 2012, HST introduced the Emerging Public Health Practitioner Award in recognition of the best article submitted by a young and emerging public health professional for inclusion in the SAHR.     This capacity building initiative was followed the introduction of the Healthcare Workers Writing Programme, which offers writing skills training and ongoing coaching throughout the publication process for identified first time authors.  

The profile of the SAHR was significantly raised in 2014 when it was officially accredited as a peer-reviewed publication by the Department of Higher Education and Training.  This had the effect of broadening the pool of potential contributors and introducing more robust and refined work flow processes.

Leaving no-one behind:  2015–2020

Following the adoption of the Sustainable Development Goals and the release of South Africa's White Paper on National Health Insurance in 2015, chapters in the Review began to reflect on key challenges in implementing universal health coverage and the development of an equitable and inclusive national health system that leaves no-one behind.  Data-driven chapters capturing the complexities and possibilities of measuring progress in the implementation of NHI towards UHC became more frequent and provided insight into the calculation of a South African UHC service coverage index.     Chapters also foregrounded the country's burden of non-communicable diseases and the health system responses to long-term acute and chronic conditions and diseases.       

Building back better:  2020 and onwards

Ensuring that persons with disabilities are not left behind in the country's progression to universal health coverage is addressed in the 2020 edition of the Review. Which provides critical insights into barriers and facilitators, good practices, and successful service delivery models for disability inclusion and rehabilitation.  Chapters also reflect the need for South Africans to move away from an overwhelmingly medicalised and individualised approach to disability which focuses on fixing impairments, to a rehabilitation service-delivery model that facilitates the development of holistic well-being and greater socio-economic inclusion for persons with disabilities.  

As 2020 draws to a close, the challenge facing South Africans is to reflect on how we can 'build back better' and best use the experience, lessons, and innovations of responses to COVID-19 to build a stronger and more resilient health service.  The 2021 edition of the Review is dedicated to unpacking this issue and will consider the impact of Covid-19 on existing health services and programmes; the impact of socio-economic disparities on prevention and treatment; the rationing of health care services, emergence of innovative collaborations and partnerships and the impact of measures taken to balance saving lives with saving livelihoods.

Conclusion

The past 23 editions of the Review highlight and provide a timely analysis of key issues and challenges that must be addressed if the vision of equitable and sustainable access to quality health services is to be realised, in a manner that eliminates current disparities in access, and that overcomes the inefficiencies and challenges of the current health system.   ​


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