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Health
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.
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Funding
The budget of the Department of Health grew by 16% from R18 billion in 2009/10 to R21,5 billion in 2010/11. Policy areas that received additional funding included:
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Health status
Child health
Immunisation coverage is a significant element in the prevention of child mortality as it is associated with child survival and infant and under-five mortality rates.
Immunisation against measles in South Africa increased between 2001 and 2009, from 68,5% of children aged under one year in 2001 to 98,3% of children of the same age in 2009. There was an increase in the proportion of children under one year of age who had received all their primary vaccines for TB, diphtheria, whooping cough, tetanus, polio, measles, hepatitis B and haemophilus influenza from 2001 to 2009. The immunisation rates for primary vaccines increased from 66,4% in 2001 to 95,3% in 2009.
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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.
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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 March 2011, six million people were tested.
Since April 2010, government had also begun to expand the Prevention of Mother-to-Child Transmission Programme.
In the drive to prevent HIV and AIDS, government aims to increase the provision of male condoms from 450 million per year to more than 1,5 billion. The Department of Health is also revitalising its male sexual reproductive health programme by increasing the provision of medical male circumcision services.
A characteristic of AIDS in South Africa is the interlinkage with the prevalence of TB.
The HIV/TB co-infection rates exceed 70%, with TB being the most common opportunistic infection among them in 2010.
Drug-resistant forms of TB, MDR-TB (multi-drug-resistant) and extensively drug-resistant (XDR-TB) have increased significantly, with about 5 000 and 500 diagnosed respectively in 2009.
In keeping with the targets in the outcome-based approach, the Department of Health aims to increase the TB cure rate from 64% to 85% by 2014/15. Based on a review of the TB Control Programme, led by the World Health Organisation, the department developed concrete and clear strategies to strengthen this programme.
During the 2010 financial year, the department trained 3 000 health workers in the management of TB. It also expanded its Tuberculosis Directly Observed Short-Course
(TB Dots) Programme and trained 2 500 community healthworkers as Dots supporters. This will assist in reducing the defaulter rate of TB patients from 8,5% in 2010 to less than 5,5% by 2012/13.
The number of deaths due to malaria decreased from 360 per year in 1999 to 54 in 2008, which represents a decrease of 85% over the period. An increase of 12,4% in the number of houses or structures sprayed with insecticide was witnessed during the 2004 to 2009 period.
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Policy
Improving quality of service
A draft information and communications technology strategy has been produced. The national core standards for health facilities, which were first produced in 2008, and used to assess 27 hospitals, were revised in 2009.
These standards were expected to be finalised in 2010/11 and used to audit 75% of health establishments by 2013.
Quality improvement plans will be developed in 70% of all public-sector facilities by 2013, focusing on improving six key areas, namely patient safety, infection prevention and control, availability of medicines, waiting times, cleanliness and staff attitudes. By 2013, 90% of public-sector hospitals will be conducting patient satisfaction surveys.
National Health Insurance
By mid-2010, a solid foundation was laid for the introduction of the NHI. A dedicated NHI technical support unit was established within the Department of Health to steer the implementation.
Through the NHI, the Department of Health will ensure access to good quality and affordable health services for all South Africans. The major objective is to put into place the necessary funding and health service-delivery mechanisms that will enable the creation of an efficient, equitable and sustainable health system.
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Nutrition
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 department continued to implement strategies to improve the nutritional status of communities.
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Health team
By November 2010, the core team of practising medical practioners in South Africa consisted of:
- 36 000 registered medical practitioners
- 54 673 emergency care personnel
- 464 dental therapists
- 946 oral hygienists
South Africa has a shortage of certain health professionals such as physiotherapists, dieticians and radiographers.
Over the nine-year period 2000 to 2009, there was an increase in the total number of nurses on the registers - from 171 645 to 221 817.
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.
Medical schemes
The total number of registered medical schemes dropped from 110 in January 2009 to 105 in January 2010 (4,5% decrease). The number of open schemes reduced from 32 in 2009 to 30 in 2010 (6,3% decrease), with restricted schemes falling from 78
to 75 (3,8% decrease) during the same period.
These figures include schemes which affect their contributions mid-year.
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Integrated Management of Childhood Illnesses (IMCI)
Integrated Management of Childhood Illnesses (IMCI) promotes child health and improves child survival as part of the National Plan of Action for Children. It is being instituted as part of the Department of Health's policy on the National Health System for Universal Primary Care.
South Africa's nurses and doctors are well trained to treat all diseases by using the IMCI Strategy. Diseases such as pneumonia, malaria, meningitis, diarrhoea and malnutrition are easily managed. In South Africa, the IMCI Strategy has been adapted to include HIV assessment and classification.
The strategy tries to integrate all interventions relating to children to ensure that a package of care is offered to each child.
Source: Pocket Guide to South Africa 2010/11
Editor: D Burger. Government Communication and Information
System
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Last modified: 15 August 2011 09:41:44.
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