NATIONAL DEVELOPMENT PLAN OUTCOME 2
In 2030, South Africa’s health system works for everyone. It provides quality care to all, has raised life expectancy to at least 70 years, produced a young generation largely free of HIV infection, and has dramatically reduced infant mortality.
Health care – Downloads
Find out more about the National Development Plan.
• National Development Plan – full text
• National Development Plan – Chapter 11: Promoting health
• Medium-Term Strategic Framework 2014 to 2019 – Outcome 2: A long and healthy life for all South Africans
• Department of Health Strategic Plan 2014 to 2019
• Infographic: Promoting health
Health care – The vision
A health system that works for everyone and produces positive health outcomes is not out of reach.
The National Development Plan’s vision is that, in 2030, life expectancy of South Africans is at least 70 years. A new generation of under-20s is largely free of HIV, and the burden of disease on the whole population has been significantly reduced.
The infant mortality rate is less than 20 deaths per thousand live births, and under-5 mortality rate of less than 30 per thousand.
• The health system provides quality care to all, either free at the point of service or paid for by publicly provided or privately funded insurance.
• The primary and district health system provides universal access with a focus on prevention, education, disease management and treatment.
• Hospitals are be effective and efficient, providing quality secondary and tertiary care for those who need it.
• More health professionals are on hand, especially in poorer communities.
Health care – The challenges
After South Africa achieved democracy in 1994, the country introduced progressive policies to create a new integrated and comprehensive national health system. Nonetheless, challenges remain.
• A complex, quadruple burden of diseases
• Serious concerns about the quality of public health care
• An ineffective and inefficient health system
• Ineffective operational management at the coalface
• Spiralling private health care costs
Quality health care has mostly been accessible to those who can afford and access it, and not those who need it. Until recently, South Africa’s performance against key health indicators has compared poorly with other countries with similar or less levels of investment and expenditure.
Health care – Action required
In countries that have succeeded in reforming their health systems, committed leadership in all layers of the health system has been key.
The government health system is responsible for maternal health, safe childbirth, vaccination and primary care of children, treatment of widespread infections such as HIV and Aids and tuberculosis, and acute care.
Longer-term health outcomes are shaped by factors largely outside the health system: lifestyle, diet and nutritional levels, education, sexual behaviour, exercise, road accidents and the level of violence.
The National Development Plan makes recommendations in all of these areas.
Priorities include maternal and infant health, disease management, sex education, nutrition, exercise, and combating smoking and alcohol abuse.
These are social responsibilities that must be taken seriously by every citizen, and promoted by families and institutions.
Specific action includes:
• Improved management, especially at institutional level
• More and better-trained health professionals
• Greater discretion over clinical and administrative matters at facility level, combined with effective accountability
• Better patient information systems supporting more decentralised and home-based care models
• A focus on maternal and infant health care
Improving health care management
Institutional health care management must change. Complementary reforms should include greater delegation of authority over staffing, shift structures and routine procurement.
A district-based approach to primary health care is part of the pilot phase of national health insurance.
The health system needs more personnel (including professionals and paramedics), new forms of management authority, and strengthened statutory structures for community representation.
HIV and Aids
Despite policy mismanagement in the early 2000s, the HIV and Aids epidemic has demonstrated South Africa’s ability to effectively implement a wide-ranging and complex disease-management programme. The health system’s remarkable success in managing the epidemic over recent years is commendable.
But we must not be complacent. There is a continuing need for education, prevention, testing and treatment. Lowering the rate of new infections will reduce the demand on the public health system.
Even if there are no new infections, there will still be a sizeable number of HIV-positive people requiring treatment, posing continuing challenges for the tuberculosis infection rate and the risk of drug-resistant HIV strains developing. The epidemic and its implications for public policy are likely to remain for at least another generation – possibly two.
National health insurance
Building a national health insurance system is an important objective. There are four prerequisites to its success: improving the quality of public health care, lowering the relative cost of private care, recruiting more professionals in both the public and private sectors, and developing a health information system that spans public and private health providers. These reforms will take time, require cooperation between the public and private sectors.
Health care – Key medium-term goals for 2019
The Medium Term Strategic Framework (2014 to 2019) identifies the following sub-outcomes to achieve a long and healthy life for all South Africans.
• Progressively achieve universal health coverage by means of national health insurance
• Improve quality of health care
• Re-engineer primary health care for better outcomes
• Reduce health care costs
• Improve human resources for health
• Improve health management and leadership
• Improve health facility planning and infrastructure delivery
• Manage and prevent HIV & Aids and tuberculosis
• Reduce maternal, infant and child mortality
• Develop and implement an efficient health management information system for improved decision making
Health care – Key medium-term targets for 2019
The Medium Term Strategic Framework (2014 to 2019) identifies the following targets to achieve a long and healthy life for all South Africans.
GRAPHIC: MARY ALEXANDER
Researched, edited and compiled by Mary Alexander
Updated December 2015