Government's priority is to improve the health status of the
entire population and contribute to the vision of a long and
healthy life for all South Africans. To accomplish this vision,
government has identified four strategic outputs which the
health sector must achieve. These are:
- increasing life expectancy
- decreasing maternal and child mortality
- combating HIV and AIDS and decreasing the burden of
- strengthening health-system effectiveness.
The Department of Health's 10-Point Plan for the health sector includes the following priorities:
- providing strategic leadership and creating a social contract for better health outcomes
- implementing the National Health Insurance (NHI) system
- improving quality of health services
- overhauling the healthcare system and improving its management
- improving human-resource (HR) management, planning and development
- revitalising infrastructure
- accelerating implementation of the HIV and AIDS and Sexually Transmitted Infections Strategic Plan 2007 – 2011 and increasing focus on tuberculosis (TB) and other communicable diseases
- reviewing the drug policy
- improving the effectiveness of the health system
- strengthening research and development.
The budget of the Department of Health grew by 15,3% from R21,7 billion in 2010/11 to R25,7 billion in 2011/12. Policy areas that received additional funding included:
Several areas of progress have been identified, especially in
terms of reducing the effect of childhood illnesses.
Improving immunisation coverage ranks high among
renowned strategies for improving child health. Immunisation
campaigns have been markedly successful in preventable
diseases, including polio and measles.
Carefully planned and systemic interventions, based on
the Negotiated Service Delivery Agreement objectives, have
been adopted for child health.
Postnatal and newborn interventions include:
- early and exclusive breastfeeding
- warmth provision
- infection control
- provision of vitamin A to the mother when indicated.
Community-based interventions include:
- increasing home visits by community workers to within
10 days of delivery for normal birth-weight babies and an
additional three in the subsequent three weeks for lower
- improving referral channels between community health
workers and midwives
- expanding the Perinatal Problem Identification Programme
to include more facilities.
In August 2011, the Minister of Health, Dr Aaron Motsoaledi,
announced that government would no longer distribute free
infant formula at health facilities, in an effort to promote
Maternal and women’s health
The fifth Millennium Development Goal requires countries to improve maternal health and reduce their Maternal Mortality Ratio by 75% by 2015.
The data based on reported live births from the District Health Information System (DHIS) (2010) shows that the percentage of women in South Africa whose live birth occurred in a health facility increased from 76,6% in 2001 to 94,1% in 2009. This indicates a significant improvement in the extent of services provided at healthcare facilities in South Africa.
Access to and utilisation of antenatal care services has an impact on pregnancy outcome, child survival and maternal health.
According to the DHIS, 97% of pregnant women utilised antenatal care during 2009 (Department of Health, 2010).
The data shows that South Africa has demonstrated commitment to reducing maternal mortality. It is evident that expanded health infrastructure, enhanced access and
increased usage are beginning to translate into improved health outcomes for women.
Women tend to have a higher burden of disease than men
and therefore need more services. The package of interventions
for women's health includes:
- family planning and contraceptive services
- care following sexual assault
- treatment of sexually transmitted infections (STIs)
- a focus on diseases specific to women such as cervical
Sexual and reproductive health interventions include contraceptive
information services, safe termination of pregnancy
and reproductive health education and services.
Communicable disease control
HIV prevalence in South Africa appears to be stabilising after peaking in the 1990s and early 2000s. South Africa has the largest Antiretroviral (ARV) Therapy Programme in the world.
In April 2010, the upscaled HIV and AIDS Prevention and Treatment Plan was launched. Measures include that:
- All children under one year of age receive ARV treatment if they test HIV-positive, irrespective of CD4 level
- All patients with both TB and HIV get ARV treatment if their CD4 count is 350 or less
- All pregnant HIV-positive women with a CD4 count of 350 or less are started on ARV treatment
- all other HIV-positive pregnant women not falling in this category are put on treatment at 14 weeks of pregnancy to protect the baby
- A massive counselling and testing campaign has been launched, and all 4 300 public health institutions in the country are ready to receive and assist patients. By February 2012, more than 17 million people had been
tested for HIV and more than eight million had been
screened for TB.
The department's Prevention of Mother-to-Child Transmission (PMTCT) Programme is yielding results, with sustained declines observed in transmission rates while programme
coverage is increasing. There is a high uptake of
treatment for PMTCT – 98% of HIV-infected mothers tested
were put on treatment.
Nationally, mother-to-child transmission of HIV has
declined from about 8% to 3,5%.
Government has increased capacity to care for people
living with HIV and requiring ARV treatment. Facilities providing
ART increased to 1 668 by June 2011. More than 1 750
nurses have been trained in Nurse Initiated and Managed
ARV Treatment, making it possible for professional nurses to
put people onto treatment.
A characteristic of AIDS in South Africa is the interlinkage with the prevalence of TB.
Reporting of TB management, specifically treatment
outcomes, has enjoyed considerable attention. By mid-2011,
the TB cure rate for the year had been achieved. Treatment
completion rates and default rates were on track, while 17
facilities were made available for diagnosing and initiating
treatment for drug-resistant TB patients.
TB control and management is improving, with the national
TB cure rate reaching the 70% mark for the first time, although
work still needs to be done to achieve the 85% recommended
by the World Health Organisation.
Improving quality of service
Six priority areas have been identified for immediate
- staff attitudes and the values underpinning them
- reducing the long waiting times or delays in receiving care
- ensuring all facilities are spotlessly clean and tidy
- protecting the clinical as well as the physical safety of
patients and staff
- taking the measures needed to avoid transmission of
infections and cross-infection
- ensuring that basic medicines and supplies are available
when patients are seen.
In November 2011, Cabinet approved the National Health
Amendment Bill for Office and Health Standards Compliance,
which will accredit health facilities. In preparation, the
department put in place quality norms and standards, which
cover the availability of medicines and supplies, cleanliness,
patient safety, infection prevention and control, positive
attitudes and waiting time in all health facilities.
By August 2011, the department had audited more than
1 600 public health facilities against these standards.
Re-engineering primary healthcare (PHC)
The re-engineered PHC system is one of the Department of
Health's four central interventions of the NHI.
The district specialist task teams each consist of an:
- family physician
- PHC nurse
- advanced midwife
- advanced paediatric nurse.
Every district has a team responsible for supportive supervision
and clinical governance within its defined geographic area.
These task teams need to strengthen existing services and
ensure equitable access to appropriate care for all mothers,
babies and children.
Improving health infrastructure
Over 2 100 individual infrastructure-related projects exist in
health facilities in South Africa – ranging from maintenance
and minor repairs to renovation and major construction works.
As a result, 138 clinics and 38 community health centres were
constructed nationally (an increase of 4% in the total number
of PHC facilities in South Africa).
An infrastructure support model has been implemented, a
component of which includes the appointment of engineers
in each province to provide consistent technical expertise for
managing active projects in the health sector.
Eighteen major revitalisation projects have been initiated
nationwide in hospitals in urgent need of infrastructure development.
Five of these 18 projects are identified as flagship
projects, supported through public-private partnerships.
National Health Insurance
The Green Paper on National Health Insurance (NHI) was released in August 2011 for
comment. The cornerstone of the proposed NHI system is
universal coverage. NHI is a financing system that will ensure
the provision of essential healthcare to all citizens of South
Africa (and legal long-term residents), regardless of their
employment status and ability to make a direct monetary
contribution to the NHI Fund.
This is seen as a 14-year project, with the first five years
being a process of building and preparation.
Although the NHI service package will not include everything,
it will offer care at all levels, from PHC to specialised
secondary care, and highly specialised tertiary and quaternary
levels of care.
The work of the Department of Health is critical in improving children's nutrition levels. Key targets by 2014 include:
- decreasing the percentage of the total population who experiences hunger from 52% to 30%, using national food consumption survey data
- dropping the rate of undernutrition of children from 9,3% to 5%
- keeping the Consumer Price Index stable for poor people (which is heavily dependent on the prices of food)
- establishing more than 67 920 community, institutional and school gardens to enable at least 30% of poor households to produce some of their food and improve income.
In 2010, the team of healthcare practioners consisted of:
- 36 000 registered medical practitioners
- 54 673 emergency care personnel
- 5 185 dentists
- 3 032 optometrists
- 5 624 physiotherapists
- 6 816 psychologists
- 231 086 nurses
South Africa has a shortage of certain health professionals such as physiotherapists, dieticians and radiographers.
Between 2002 to 201, the number of registered nurses increased by 37% from 172 869 to 238 196.
National Health Laboratory Service (NHLS)
The National Health Laboratory Service (NHLS) is the largest diagnostic pathology service in South Africa, with more than 250 laboratories serving 80% of the country’s population. All laboratories provide laboratory diagnostic services to the national and provincial departments of health, provincial hospitals, local governments and medical practitioners.
The NHLS conducts health-related research appropriate to the needs of the broader population, including research into HIV and AIDS, TB, malaria, pneumococcal infections, occupational health, cancer and malnutrition. The NHLS trains pathologists,
medical scientists, occupational health practitioners, technologists and technicians in pathology disciplines.
In September 2011, there were about 110 medical schemes
with around 8 068 505 beneficiaries. These schemes have a
total annual contribution flow of about R84,9 billion.