How can we strengthen the health system performance in South Africa?
Well functioning and high performance health systems working in harmony is built on having trained and motivated health workers, a well-maintained infrastructure, and a reliable supply of medicine and technology, backed by adequate funding, strong health plans and evidence-based policies.
The six building blocks of a health system as described by WHO:
How can we strengthen the health system performance in South Africa?
In South Africa’s health system, the major driver of a low national life expectancy is a complex disease burden, made up of HIV/AIDS, TB, diseases related to poor nutrition and exercise habits, and trauma from violence and road accidents. And the country’s struggle to cope with these issues can be seen as having a “collapsing” health system. Here are possible reasons and solutions to improving the country’s health system:
Public sector reforms:
Additional human resources are required
South Africa has low densities of the major health resources relative to its disease burden, and relative to other developing countries. World Health Organisation statistics from 2010 indicate that SA has 5.2 physicians per 1000 people, while Brazil has more than triple that, and Mexico five times. To address this:
A massively increased training pipeline is needed:
- Nursing schools should be reopened by the government as by closing nursing schools, the government contributed largely to the mass production of inadequately skilled and unqualified nurses in the country.
- To cut through immigration and certification bureaucracy as this prevents many willing, foreign trained health professionals from working in South Africa.
Improve cost-effective management of chronic conditions
South Africa’s disease burden is weighted heavily towards conditions requiring long-term treatment, such as TB, HIV, diabetes, hypertension, obesity, etc. This requires prevention strategies such as education on disease and lifestyle changes, which can significantly reduce these growing epidemics. Immediate campaigns to encourage healthy adult lifestyles are also required.
Additional funding is required
Health outcomes and access are certainly not equitable between rich and poor. However, public health financing in SA is already progressive, with richer citizens supplying most of the taxes which pay for a public health sector they make relatively little use of; and they fund their private health care largely themselves. This would suggest that the solution to SA’s healthcare problems is less one of redistribution of funds but primarily one of utilizing existing funds (in public and private sectors) more efficiently.
Private sector reforms:
Regulate medical schemes so they can contribute to national health objectives
Medical schemes are the primary source of income for private providers and cover medical risks for over 8 million South Africans. An incomplete regulatory environment interferes with the ability of schemes to control costs and render private healthcare cover more affordable. If these regulatory issues are effectively dealt with, private healthcare can become more affordable and accessible to millions of working families in South Africa.
Improve tax regulation
The National Treasury has already come up with an idea to convert the current medical scheme tax deduction into a tax credit. This is fairer and can enhance the affordability of scheme coverage at lower income levels. To add , the SA government could also provide an additional, explicit subsidy for low income employees, possibly matched by their employers.
To conclude, while there are significant challenges facing the country’s overall health system, both public and private sector reforms can start to address inequalities and issues within the system, focusing on delivering accessible and high quality primary health care, making private health care more affordable to the general population, and linking the two into a sustainable, effective and integrated South African health system.
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