5 June 2012
Progress on establishing South Africa’s National Health Insurance scheme to improve the effectiveness of the country’s health system is well under way, according to a government mid-term review report released in Pretoria last week.
The report, released by Minister in the Presidency for Performance Monitoring and Evaluation Collins Chabane in Pretoria on Friday, reviews the progress made by the current administration at the November 2011 mid-point of its 2009-14 electoral term.
“The Department of Health conducted an audit of service quality in over 75% of health facilities and improvement plans are now being developed,” Chabane said, adding that a green paper had been produced and released for public input on the matter.
He said the department had also developed a human resource strategy that linked intake of health professionals to projected demand. An audit of 122 nursing colleges was also in progress.
However, the report acknowledged that despite radical interventions since 1994, the country’s health sector remained poor compared to other countries with a similar profile as South Africa.
South Africa has high levels of maternal and child mortality, with life expectancy declining significantly from 1994 to 2009; officials said this was an indication of a “reversal” of earlier gains made towards meeting the UN Millennium Development Goals.
The Department of Health has committed to a strategy to change the situation. The plan will include:
- Fast-tracking the implementation of a far-reaching health care reform plan that includes a National Health Insurance scheme which will eventually cover all South Africans.
- Strengthening the fight against HIV and tuberculosis (TB), non-communicable diseases and injury and violence.
- Beefing up human resource management at state hospitals and strengthening coordination between the public and private health sector.
- Deploying municipal ward-based health teams and school health teams to communities and schools respectively.
- Regulating costs to make health care affordable to all.
- Increasing life expectancy from 56.5 years in 2009 to 58.5 years in 2014.
Also contained in the report was detailed progress on reducing new HIV infections, cutting the mother-to-child transmission rate from 3.5% in 2010 to less than 2%, increasing the total number of patients on antiretroviral therapy (ART) from 1.1-million in 2009 to 2.5-million, and improving the TB cure rate to 85%.
Chabane said the government had seen the reduction of mother-to-child transmission from 8% in 2008 to 3.5% in 2011, protecting more than 30 000 babies from infection per year.
In addition, 19.9-million people had undergone voluntary testing for HIV by 2011. “The number of people receiving treatment increased from 1.1-million in 2009 to 1.7-million in 2011,” he said.
There has also been a stabilisation of HIV prevalence – the number of people living with HIV – after rising since the 1990s, which was indicated by antenatal surveys.
The rate of new infections has decreased from 1.4% to 0.8% in the 15-24 age groups, with the trend looking set to continue in the coming years.
Acceleration of campaigns
Authorities say the turnaround could be attributed to an acceleration and expansion of HIV awareness and prevention campaigns, counselling and testing, treatment, care and support.
“Since the presidential launch of the HIV Counselling and Testing (HCT) Campaign in April 2010, the number of people tested has increased substantially, confirming improvements in health-seeking behaviour among South Africans,” Chabane said.
“As at mid-2011, 15.1-million people had been tested and an additional 4.8-million people have since been tested.”
The number of public facilities initiating patients on ARV drugs also increased from 490 in 2010 to 2 948 in 2011 and the number of nurses trained to provide treatment increased from 290 in 2010 to 10 000 in 2011.
In future, the initiation of antiretroviral (ARV) treatment at a CD4 count of less than 350 should result in increased numbers of people on treatment and reduced deaths.
Through improving procurement processes, the Health Department managed to achieve a 50% decrease in the prices of ARV drugs, which will enable the health sector to treat more patients with the same amount of resources.
Improvements were also made in TB control and management, with more than eight million people screened during the HCT Campaign. Of these, one million were referred for further diagnosis and management at relevant health facilities.
The number of people who default on their TB treatment declined from 7.9% in 2009 to 6.5% in 2010 and, for the first time, the national TB cure rate reached the 70% mark in 2010.
Despite these significant strides, the report noted that much work is required to achieve the 85% cure rate recommended by the World Health Organisation (WHO).
The department has improved the early diagnosis and detection of resistance to TB treatment, which should reduce the risk of spreading TB.