unified healthcare south africa

Dakar: Harmonization for Health in Africa (HHA); 2013. The object of the White Paper is to present to the people of South Africa a set of policy objectives and principles upon which the Unified National Health System of South Africa will be based. It boasts a relatively high GDP per capita compared with other countries in Sub-Saharan Africa, but it also has extremes of wealth and poverty. So there is a need to spend more on PHC and reduce relatively the expenditure on district hospitals by tackling the social determinants of health (SDoH), which may trickle down to the entire district health system. SARRAH; 2013. Progressively, realizing this right will contribute to a healthy population that benefits the entire nation. Intravenous cardiac inotropes and vasopressors are unavailable. In: Culyer A, Newhouse J, editors. Ashmore J. You are currently offline. Pretoria: The Department of Health; 1997. In: Bulletin of the World Health Organization. Overall, however, more districts have higher levels of availability and readiness. For the present there is encouragement and, financially, it is acknowledged that socio-economically deprived districts in South Africa have been receiving more resources than those less deprived ones as a way of ensuring equity and bridging the inequality gaps as “much more is spent on DHS per capita uninsured in deprived areas” [42] than in less deprived areas. Accessed 15 Aug 2016. For example, Limpopo and North West have the smallest proportions of health professionals except for registered nurses. Can this be through UHC and what is the relationship between UHC and service availability? unified health system” Since becoming the President of South Africa, I have received numerous complaints about the poor quality of health care that people experience in our clinics and hospitals during their moments of vulnerability. Yet ideological and practical issues make its achievement problematic. But the inequities between districts with respect to population health status is well-known. Date of Arrival in South Africa (for non-RSA Citizens) Date of Departure from South Africa City and Country travelling to Flight/Vessel/Bus/ Vehicle Number Seat Number Telephone Number at destination (incl. The South African healthcare system is currently in another period of transition; on the verge of creating legislation, which would enable the creation of a more equitable, unified healthcare sector under the National Health Insurance. Norheim OF. To sustain progress, efficiency and accountability must be ensured; and the main health financing instrument for promoting efficiency in the use of funds is purchasing and more specifically, strategic purchasing” [21]. It is viewed as a solution to health care needs in low and middle countries with growing enthusiasm at both national and global levels. But it has been argued that UHC is likely to remain an empty promise unless it is focused on the provision of quality essential services to everyone by strengthening local health systems [10]. This often results in hospitals being forced to utilize staff in other functions in which they may not be trained as is the case in Tokollo hospital [36]. O’Neill K, Takane M, Sheffel A, Abou-Zahr C, Boerma T. Monitoring service delivery for universal health coverage: the service availability and readiness assessment. Universal health coverage and universal access. Under the NHI, population coverage will ensure all South Africans have access to comprehensive quality health care services. The first author prepared the first draft, while the second author critically reviewed the manuscript. Universal health coverage assessment. NHI will have a single-payer mandatory prepayment mechanism where resources are pooled in a single fund to cater for the health needs of the entire population via a strategic purchaser. Evidence from the data also supports the need for positive discrimination while upholding minimal universal coverage for all South Africans. HealthShare creates a unified, community-wide health record as the foundation for coordinated, value-based care and population health management. Costa-i-Font J. Myths of health care decentralization. Oxford: Elsevier Science BV; 2000. After South Africa left the Commonwealth, it nationalized the missionary health services that had served the poor. For instance, in an antenatal client survey (ANC) conducted in 2012, KwaZulu-Natal (KZN) had the highest prevalence (37.4 %), followed closely by Mpumalanga (35.6 %) and Free State (32.0 %). In addition to these objectives, this document presents various implementation strategies designed to meet the basic needs of all our people, given the limited resources available. 2013;16(1):S39–45. A conscious change in policy direction in favor of pursuing UHC in South Africa can be seen in the development and piloting of the NHI in eleven districts since 2012. Indeed evidence shows that all countries that have achieved UHC have done so with an increase government role in the financing, regulation, and sometimes direct provision of health care services [9, 23–27]. 2011;32(S1):S80–93. The increasing availability of good quality Unified Communications (UC) solutions, with expanded functionality, and growing interoperability between systems, is resulting in renewed interest in the UC product suite. It has emerged as a silver bullet solution to health care needs in low and middle income countries [1]. It can also enhance the accountability of public institutions, improve service delivery, and allow greater political representation and participation of diverse groups in decision making [44]. Saltman R, Figueras J. Analyzing the evidence on European health care reforms. OECD Health Statistics 2014: How does South Africa compare? The report further notes progress in hospital reforms with re-designation of district hospitals. Around 80% of the population uses public healthcare, with the wealthiest 20% opting for private healthcare. 50 million South Africans access the under-funded public health system while just over 8 million have access to well-resourced private care that is steeped in corruption. At the Ellisras Hospital in Limpopo, the report indicated the lack of sufficient doctors as there is poor infrastructure and a poor living environment. Birth rate > Crude > Per 1,000 people: Crude birth rate indicates the number of live births occurring during the year, per 1,000 population estimated at midyear. Universal Health Coverage (UHC) has emerged as a major goal for health care delivery in the post-2015 development agenda. Financial and Fiscal Commission. Government Notice 1230 | File Size: 1.9 MB. Claire Keeton reports. DoH, Republic of South Africa. municipal services project. Strategic documents-annual performance plan 2014/15 - 2016/17. Thus full-time CEOs are in post in 60 % of all hospitals. PubMed Central  It was reinforced in later National Health Acts and expressed well by Van Rensburg, et al. Van Rensburg H, Heunis J, Steyn F. Human resources for health and the health professions in South Africa. Oracle Healthcare cloud solutions support the complex needs of healthcare payer and provider organizations—and their patients—to improve outcomes. Durban: Health Systems Trust; 1999. Durban: Health Systems Trust; 2008. p. 51–69. In their case study of 11 countries, Maeda et al. Pretoria: Van Shaik Publishers; 2012. p. 433–82. Private GPs were to be contracted in the 2013/14 financial year [53, 54]. Health Systems Trust. News about South Africa, including commentary and archival articles published in The New York Times. Strengthening South Africas Response to HIV/AIDS. Health experts said testing and tracking would help contain the virus. Several countries, including Ghana and Vietnam, are at various implementation stages and while much response is positive, there remain issues of population coverage and out-of-pocket expenses in Ghana [6] and capitation payments and hospital operational autonomy in Vietnam [7]. We also reviewed and examined documents including text books, annual reports of the DoH, consultancy reports, health sector independent reviews, technical reports, websites and other grey literature. Other issues noted included infrastructure, generally poor emergency medical services in all the districts due to insufficient ambulances, where response times often range between one and four hours. Part of In the Amajuba district in the KwaZulu Natal Province, the recruitment of the District Clinical Specialist Team (DCST) has proved daunting with the district only being able to recruit the advanced midwife and PHC nurse out of a total membership of seven by the end of 2013. As a health financing system, the NHI is designed to pool funds to provide access to quality, affordable personal health services for all South Africans based on their health needs, irrespective of their socioeconomic status. In 2015/16, it is estimated that while South Africa spends 8.5 % of Gross Domestic Product (GDP) on health, 4.1 % of the GDP is spent on 84 % of the population, the majority utilizing the public health sector whilst 4.4 % of its GDP is spent on only 16 % of the population [8]. Journal of Health Politics, Policy and Law. 2003;22(3):377–88. The politicking behind the scenes for the formation of the Union of South Africa allowed the foundations of apartheid to be laid. Organization WH. Washington: Banque mondiale; 2004. Additionally, blacks faced much higher maternal, infant and child mortality rates which reflects access and quality to health care. The reality of local service availability is then discussed, showing variable provision (inequities) between districts. The surge in spending occurred only after the DoH revised its grant criteria. Broadly defined, it means all people receiving the health services they need, including health initiatives designed to promote better health (such as anti-tobacco policies), prevent illness (such as vaccinations), and to provide treatment, rehabilitation, and palliative care (such as end-of-life care) of sufficient quality to be effective while at the same time ensuring that the use of these services does not expose the user to financial hardship [2, 14, 15]. We conclude that in South Africa the DHS is pivotal to health reform and UHC may be best achieved through minimal universal coverage with positive discrimination to ensure disparities across districts in relation to disease burden, human resources, financing and investment, administration and management capacity, service readiness and availability and the health access inequalities are consciously implicated. The National Health Act, 61 of 2003, provides a framework for a single health system for South Africa. It remains fundamental in the re-engineering of primary health with ward-based teams and district clinical specialist teams [33]. Health systems decentralization: concepts, issues and country experience. In the Pixley ka Seme District in the Northern Cape, for example, four out of thirty-six clinic committees are described as “functioning optimally” in the report. Yet since 2011 there has been a fierce ideological debate between public health support and the large private sector, in which over half of all health expenditures occur for about 16-18 % of the population. But the transformation will be costly with Treasury estimating 6 billion Rand are required for roll-out each year [57]. “The implementation of the compact is expected to contribute significantly towards improving the healthcare system in the country leading to many more South Africans having access to quality health services. Article  Experience in a number of countries, particularly in post-communist Europe, shows that when these preconditions are not met, decentralization has negative consequences such as service fragmentation, increased inequity, political manipulation by powerful interests, and a weakening of public-sector regulatory functions [46]. 2010. In the North West, it was reported that at the Brits Hospital, there was no doctors’ quarters. Even when new financial mechanisms are brought into play as in Burundi [12], the district is seen as a necessary component allowing the local implementation of new service delivery models. However, it has been shown that South Africa is some way away from UHC [13]. Background paper for the technical consultation on effective coverage of health systems. But this research is important as it shows that availability and readiness varies over time and requires close attention. 2008;18(2):104–6. Nsengiyumva G, Musango L. The simultaneous introduction of the district health system and performance-based funding: the Burundi experience. Davis K, Schoen C, Schoenbaum SC, Doty MM, Holmgren AL, Kriss JL, Shea KK. But the WHO and the World Bank see financial protection, service sustainability and equity as defining features [5]. Approximately 12 months after their inception, the Strengthening South Africa’s Response to HIV and Health (SARRAH) conducted an independent review of the current status of the eleven NHI pilot districts and some progress has been made. Thus materials were collected from different and multiple sources including documents, policy briefs, reports, bulletins and academic papers as a way of triangulation so as to give credibility and dependability [18] to the study. the bases for UHC) [53], which the NHI piloting scheme has largely failed to do so far. Savedoff WD, de Ferranti D, Smith AL, Fan V. Political and economic aspects of the transition to universal health coverage. In Africa, the DHSs’ strategy has become the backbone of nearly every national health system. This article draws upon:  WHO Africa Regional Office news report  Commentary on the launch of the Presidential Health Compact   Speech of the President. Centre for Health Policy/MRC Health Policy Research Group, School of Public Health, University of the Witwatersrand, Private Bag X3, Wits, 2050, Johannesburg, South Africa, School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada, You can also search for this author in Health human resources vary enormously between provinces. Inadequate budget spending guidance from the NDoH was also noted. George G, Quinlan T, Reardon C. Human resources for health: a needs and gaps analysis of HRH in South Africa. Measuring the extent of em-igration of South African health professionals remains a challenge. Human resource distribution across the districts is perhaps the outstanding constraint. Recentralization may occur [47]. New York: Rockefeller Foundation; Save the Children; UNICEF; WHO; 2013. The Lancet. The aim is to roll out nationwide in a fifteen year period. McIntyre DD, Doherty J, Ataguba J. Both authors read and approved the final manuscript and AF worked on the comments of the reviewers for re-submission. 2013;19(5):257–62. Local involvement is seen as central for this and thus the district health system is a key component in reform efforts at UHC. South Africa endured many years under apartheid policies, fortunately F.W.de Klerk ended apartheid of Feb 2, 1990 and allowed organization like ANC and PAC to officially run again. In terms of cost, a preliminary policy paper issued by the government estimated that NHI will cost R255 billion (~US$30 billion) per year by 2025, if implemented as planned over a 15-year period [17]. In South Africa, Deloitte is one of the leading professional services organisations. The complaints include inadequate access Stuckler D, Basu S, McKee M. Drivers of inequality in millennium development goal progress: a statistical analysis. The disparities across districts in relation to health profiles/demographics, health delivery performance, management of health institutions or district management capacity, income levels/socio-economic status and social determinants of health, compliance with quality standards and above all the burden of disease can only be minimised through positive discrimination by paying more attention to underserved and disadavantaged communities. In general, the South African market trails behind more developed markets in terms of adoption of UC products. Correspondence to Sachs JD. However, in some respects it is more progressive through […] Cite this article. The health care services will be accessed at the appropriate level of care and will be delivered through certified and accredited public and private providers using the NHI Card [8]. In South Africa, Deloitte is one of the leading professional services organisations. PubMed  Ditlopo P, Blaauw D, Bidwell P, Thomas S. Analyzing the implementation of the rural allowance in hospitals in North West Province, South Africa. Government. But testing stalled because international supplies did not arrive. In South Africa, little is known about access barriers to health care for the general population. District health systems comprising primary health care and first referral hospitals, are key [31] to the delivery of basic health services in developing countries [32]. Anne M, Vaughan JP, Smith DL, Tabibzadeh I. 2015. I appreciate the contribution made by all these Government Departments and the stakeholders who have committed themselves to improve the quality of the health system. The journal of field actions Special Issue 8; 2013. Is its policy attraction ideologically different from that of UHC and are they reconcilable? Value in Health (Supplement). The pilot districts selected are situated in the nine provinces and specifically in areas with high levels of underserved communities. In The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. JE proof read and edited the final re-submitted manuscript. Available at SSRN: http://ssrn.com/abstract=2186445. This has primarily been on procuring equipment and refurbishing health facilities (prior to December 2012, equipping and refurbishing facilities fell outside the remit of the conditional grant; NDoH revised these conditions). Geneva: World Health Organization; 2013: 546–546A. PubMed  Headquartered in Johannesburg, South Africa, we are driven by a moral obligation to ensure that quality healthcare services are made available to all. 11 Dec 2015: Police White Paper: Draft. Afrohouse, Afrotech and other connected styles have been exported around the world capturing the … Nationally, financial sustainability of UHC must be ensured. The Compact originated from months of extensive consultative deliberations between key stakeholders following the Presidential Health Summit in October 2018. Health. Health should be considered within the broader context of direct and indirect links between wealth and health, although these relationships are complex. G. 39721. unified health system commonly known as S.U.S, which provides health coverage for all citizens, particularly low income earners, there is evidence of growing and persistent social disparities in health. 2014. Decentralization and centralization in a federal system: the case of democratic Brazil. In 2017, South Africa spent 8.1% of GDP on health care, or US$499.2 per capita.Of that, approximately 42% was government expenditure. Challenges to reaching universal health coverage in Vietnam. District Health Barometer 2013/14. Establishing the district health system. As yet there is little research on these district differences with more attention being paid to racial and provincial ones [13]. Department of Health. This also ensured verification and cross checking of the information gathered. Preliminary estimates also indicate that the contribution by government to medical schemes (open and restricted) in 2015 is well-in-excess of R20 billion annually and these funds are mostly spent within the private health sector [8]. In this regard and in light of state DoH policy, UHC through NHI implies a move towards equity of access and financial risk protection, especially, by which the most excluded and vulnerable populations rise to the same standards of health enjoyed by the more privileged in society. PubMed Google Scholar. So given this background, how is UHC evolving within a district-based system? Throughout the world, however, the paths of countries to UHC have differed. Eagar D. The National Health Insurance Pilot Programme. Overall, there are reports of uneven progress across the districts. The key for any healthcare organization is to enable patient-centered, value-based care with a unified and secure cloud solution. Durban: Health Systems Trust; 2014. p. 201–346. The surgical ward nurses are not trained in the postoperative care of patients after major procedures. Does selection (and an emphasis on particularity) limit the significance of national solidarity and communitarianism in providing health care services? We explore National Health Insurance (NHI) pilot districts as an attempt at practical reconciliation, with the district as a potential element for positive discrimination. In terms of population coverage, NHI will extend coverage to all South Africans irrespective of their socio-economic status. Other factors such as availability and location of facilities and their readiness to render services; human resources and their equitable distribution across and within districts; population health status, the health system itself among others are crucial to UHC potential to reducing inequality. In: Bulletin of the World Health Organization. It traces the origin of COHSASA (The Council for Health Service Accreditation of Southern Africa) which began as a pilot programme in 1992, to its current status as the only accreditation body in the country. Occasional Paper No 20. We specialise in providing Assurance, Tax, Consulting, Risk Advisory and Financial Advisory services. Major databases searched using Keyword Identifiers were ProQuest Central, Applied Social Science Index and Abstracts (ASSIA), MEDLINE, International Bibliography of the Social Sciences (IBSS), and Web of Science. Variations in readiness for service delivery are mirrored by management challenges. District health barometer. Geneva: WHO; 2013. p. 923–931. 2012. p. 867–8. [52–54]. By December 2015, a total of 555,139 patients were registered in 118 facilities in the selected pilot districts. Sengupta A. Its defining feature is a prescription of a clear split between health financing and health provision, allowing for the entry of private insurance companies, private health providers and private health management organizations [1]. No universal health coverage without strong local health systems. In South Africa, private and public health systems exist in parallel. “The Department of Health will work collaboratively with the other sectors to achieve the targets in the Compact. Skip to content. contention, financial risk protection, which is at the heart of UHC, has the potential of reducing the vulnerabilities of poor people and strengthening household resilience if the overall system is adequately funded and sufficiently redistributive [61]. Desmond Tutu danced with joy as he cast his ballot. Thus, the NHI is intended to ensure that the use of health services does not result in financial hardships for individuals and their families [8]. Vega J. According to the Council for Medical Schemes annual report, OOPs increased by 11.9 % to R20.7 billion between 2013 and 2014. Whether the financial and ideological challenges will undermine this intent is not known. Van de Ven W, Ellis R. Risk adjustment in competitive health plan markets. Articles published in the post-2015 development agenda have access to health care delivery the... 16.9 and 17.8 % respectively Africans have access to comprehensive quality health services between the national level perceived of! | File Size: 200.99 KB these are questions and concerns that need further exploration Africans have to. Proquest databases Foundation for coordinated, value-based care with a unified, community-wide health record as the Foundation for,. 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