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WATER IS LIFE, SANITATION IS DIGNITY

Water Sector Policy Database (WSPD)

Policy Detail Information
Policy Name: Health Sector Strategic Framework 1999 - 2004

Open Policy Document Open Policy Document
This document has been opened: 1 246 times to date.
Date Of Release: 01 Jan 1999
Date Of Expected Review: 01 Jan 2005
Date Last Updated: 15 Feb 2007
Policy Type: Strategic Framework
Policy Level: National
Department: Department of Health
Contact Name: Switchboard
Phone Number: 012 312 0000
Fax Number: 012 326 9395
Email:
Directorate: Policy & Legislation
Contact Name: Switchboard
Phone Number: (012) 312 0000
Fax Number: (012) 326 9395
Email:
Topics covered:
Other Policies and Strategies Impacting on WS/WR
Policy Precis:

This document sets out the strategic thrust of the health sector for the period 2000-2004. It will form the basis of more detailed and province-specific plans - which will be operationalised through annual business or operational plans.
Key aims:
• consolidate achievements in improving access to care and advancing equity;
• deal decisively with the HIV/AIDS epidemic and its ramifications which threatens to undo our developmental gains;
• stabilise the hospital sector, including the need to promote greater efficiency and consider additional sources of funding for this sector; and
• adopt a multidimensional approach to ensure steady improvement in quality of care.
Key strategies:
• the need to strengthen partnerships with communities, key stakeholders, the private sector, NGOs and CBOs and;
• to build an accountable public health sector geared towards improving the standard of health care delivery to ensure a healthier nation, rallying under the banner of Batho Pele

Section Summary

  Section Number Section Heading Section Description
0 Vision and mission, Preface Vision and mission
Our Vision is a caring and humane society in which all South Africans have access to affordable, good quality health care.

Our Mission is to consolidate and build on the achievements of the past five years in improving access to health care for all and reducing inequity, and to focus on working in partnership with other stakeholders to improve the quality of care of all levels of the health system, especially preventive and promotive health, and to improve the overall efficiency of the health care delivery system.

Preface
This document sets out the strategic thrust of the health sector for the period 2000-2004. It will form the basis of more detailed and province-specific plans - which will be operationalised through annual business or operational plans.

This strategic framework builds on our understanding of our current strengths and weaknesses and relates these to our vision of the future. The document has to be read in conjunction with others, particularly:

The Reconstruction and Development Programme (RDP) - 1995;
The ANC's National Health Plan, 1995;
The White Paper on the Transformation of the Health System - April 1997;
Review of Public Health Service Delivery - June 1999; and
Demographic and Health Survey - June 1999.
We also drew from the lessons of many other discussions, conferences, reports and publications of the past 5 years.

The key message that constitutes the essence of what we have to do in the coming years is the need to:

consolidate achievements in improving access to care and advancing equity;
deal decisively with the HIV/AIDS epidemic and its ramifications which threatens to undo our developmental gains;
stabilise the hospital sector, including the need to promote greater efficiency and consider additional sources of funding for this sector; and
adopt a multidimensional approach to ensure steady improvement in quality of care.
The overarching strategies that are critical for our success include:

the need to strengthen partnerships with communities, key stakeholders, the private sector, NGOs and CBOs and;
to build an accountable public health sector geared towards improving the standard of health care delivery to ensure a healthier nation, rallying under the banner of Batho Pele.
This document represents the shared views of my colleagues the MECs for Health from all the nine provinces. I thank them sincerely for their co-operation. We believe that the implementation of this programme will add further impetus to our project of a 'better life for all". It will also lay a solid foundation for our country as we enter the African Century. I hope that this will provide a rallying point for all of us particularly the health workers as we tackle the challenge of transforming our country.

Dr M.E Tshabalala Msimang
Minister of Health
1 Background and Achievements By solid co-operation between national and provincial health departments, supported by others inside and outside government, a national health system has been created.

1.1 BACKGROUND
Prior to 1994 the South African health system was built on apartheid ideology and characterised by racial and geographic disparities, fragmentation and duplication and hospi-centricism with lip service paid to the primary health care approach. There were 14 Departments of Health each having their own objectives. Access to health care for rural communities and those classified as 'black' was difficult. Besides the lack of facilities, the financial burden of finding and financing transport to health facilities and payment for health services acted as barriers to access to care. Many rural hospitals had very limited access to medical doctors and medicines were not always available at public health facilities and expensive.

Over the past few years, our country has been through an exciting process of transformation. During this time we have benefited from the lessons of others and believe that we have also contributed to humanity's common foundation of wisdom.

We have firmly placed before our country a perspective of health that recognises good health as both a prerequisite for social and economic development as well as an outcome of that process. Health must be considered as an investment rather than simply as expenditure. It is also a perspective that sees good health as a product of many determinants - many of which lie outside the formal health sector. For our country to succeed and our citizens to be healthy - government and all associated institutions cannot and should not function in isolation. Our inability to form strong partnerships has been one of our key weaknesses as a government over the past 5 years, a weakness that must be urgently corrected.

It is common knowledge that lack of water and sanitation is a common cause of cholera, diarrhoeal and other illnesses that afflict so many in our country and that there is a relationship between various communicable diseases, including TB, and conditions of squalor. Yet we often have not structured our institutions and service delivery systems in ways that can easily respond to these realities. The adoption by this government of the Primary Health Care Approach forces us to challenge this model. We share the vision captured in the President's "State of the Nation" address - a vision of integrated planning and delivery. This is the only way to optimise use of resources and derive the full utility of our investments.

In spite of these shortcomings, we believe we have made significant gains in the past five years. By solid co-operation between national and provincial health departments, supported by others inside and outside government, a national health system has been created. The policy of Primary Health Care was clearly enunciated and now commands national support. The public health system has been transformed from a fragmented, racially divided, hospital-centred service favouring the urban population into an integrated, comprehensive national service driven by the need to redress historical inequities and to give priority to the provision of essential health care to disadvantaged people, especially those residing in the rural areas.

The public health system can be proud of the structural transformation it has effected. Practical progress has also been made in filling in the details of this transformation. Hundreds of new clinics have been built or rehabilitated, and health care has been made free at the point of delivery for pregnant women, young children and all who use the public primary health care system. New posts have been created at the public primary level of care. The access of poor people to essential health care has thereby been greatly improved. The policy of the delivery of primary health care through the district health system has been clearly formulated and implementation has commenced.

Inevitably, a multitude of challenges remain: planning and management skills are still weak at all levels, but especially in hospitals; management systems need to be upgraded; essential management information is lacking at all levels of the health system; more primary health care nurses need to be trained; the quality of care that is provided in public health facilities must be improved; many clinics are short of equipment; drug procurement, distribution and management must be improved; and the consolidation of the district health system is bedevilled by the continuing territorial divide between provincial and local governments.

We need to focus more attention on the building of a culture of quality and efficiency throughout the health care system. We need to explore possible areas of co-operation between the private and public sectors. Despite these challenges we are certain that we are well on the road to building a health service that all South African
2 Socio-economic context and Health Status The disease profile depicted below does not reflect a healthy nation nor a middle income country, nor a country that spends 8,5% of GDP on health services. South Africans will continue to depend on the public health system, and the high levels of unemployment and poverty suggest that this majority will not be able to make any significant contribution towards the cost of their health care. All arms of government need to work in unison to reverse these trends.

2.1 SOCIO-ECONOMIC CONTEXT
South Africa is classified as a middle income country by the World Bank. This, classification, however, tends to mask the reality of two worlds in one - one rich and predominantly white and, the other, poor and predominantly black. There are high levels of unemployment (37.8% according to STATSA) and high levels of poverty (70,9% in rural areas, 28,5% in urban areas, 49,9% overall according to the Poverty and Inequality Report, 1998). The majority of the poor live in rural areas. Economic growth has not matched the level of population growth, let alone the levels needed to address the enormous backlogs, which are a legacy of our past. Furthermore, government has adopted a tight macroeconomic policy framework (GEAR) which emphasises, inter alia, deficit reduction and a progressive reduction in the tax burden. This scenario impacts significantly on the health sector and our planning has to be rooted in this reality.

It is clear that the majority of South Africans will continue to depend on the public health system for the foreseeable future. Also, the high levels of unemployment and poverty suggest that this majority will not be able to make any significant contribution towards the cost of their health care. To this burden on the public health sector the growing burden of the HIV/AIDS epidemic must be added.

The fiscus currently provides between 40 and 45% of health care expenditure - yet the public health sector provides services to about 80% of the population. Clearly any sustainable strategy for effective health care delivery must include mechanisms for tapping into the large pool of private resources in ways that also benefits those currently dependent on the public health system.

The public health budget accounts for between 10 and 11% of the overall budget of government. This reflects an upward trend since 1995/96. Since fiscal decentralisation there is however great variation between provinces on the actual budget allocations for health. There continues to be significant inter-provincial inequities even though the variation in per capita spending between provinces has reduced from 3 to 2 fold. However there are indications that this movement towards inter-provincial equity in health spending has slowed down and may even have reversed (Review of the Public Health Service 1999).

Within each province there is also large intra-provincial inequity, with the rural areas continuing to bear the brunt of poverty and inadequate resource allocation. In the Eastern Cape, for example, some districts are 166% above the equity target whilst others are below by 77%.

Our vision of a caring and humane society and the constitutional assertion of our equality and humanity obliges us to make decisive interventions to reverse these trends. All arms of government need to work in unison on this. It is particularly in this context that the Presidential call for an integrated rural development strategy strikes a responsive chord amongst us. The health sector commits to being an active partner in this initiative.

2.2 HEALTH STATUS
The recently conducted South African Demographic and Health Survey (SADHS) found that South Africans are not very healthy, even though we are classified as an upper middle income country and despite the fact that we spend a considerable amount of our GDP - more than many other countries - about 8.5%, on health services.

About 45 babies of every 1000 born live die in infancy. This figure is projected to increase to 60/1000 by 2004 as a result of the HIV/AIDS epidemic. Close to 60 (59) children per 1000 die before their fifth birthday. Many mothers die delivering babies - estimated to be 150 per 100000 women. It is projected that our current life expectancy of 60 years will reduce to 40 years by 2008 as a consequence of the impact of AIDS. All this means that we have to turn back the spread and impact of HIV/AIDS if we are to maintain our current mortality rates.

The impact of the HIV epidemic is growing and we do not seem to be able to halt its growth. Data from the annual national antenatal clinic surveys has shown an increase of 33,8% in the prevalence of HIV infection between 1997 and 1998. More disturbing is the high rate of increase in teenager's aged 15 to 19 years (65.4%). These findings highlight the need for carefully targeted health promotion strategies to this age group. The SADHS showed that whilst over 95% of teenage respondents had some knowledge of HIV/AIDS, this information was
3 Strategic Health Priorities A TEN POINT PLAN TO STRENGTHEN IMPLEMENTATION OF EFFICIENT, EFFECTIVE AND HIGH QUALITY HEALTH SERVICES
REORGANISATION OF SUPPORT SERVICES
Health information system
Transformation of laboratory services
Transfer of mortuaries services to Department of Health
Transformation of the blood transfusion services
Reorganisation of the Office of the Registrar for Medical Schemes
LEGISLATIVE REFORM
IMPROVING QUALITY OF CARE
REVITALISATION OF PUBLIC HOSPITALS
National Planning Framework
Rehabilitation of hospital stock
Decentralising hospital management for improved efficiency and quality of care
PRIMARY HEALTH CARE AND THE DISTRICT HEALTH SYSTEM
Comprehensive Primary Health Care Package
The District Health System: towards efficient delivery of high quality care
STRATEGIC INTERVENTIONS TO DECREASE MORBIDITY AND MORTALITY
Promote integration of government interventions
Child, Youth and Adolescent Health
Decreasing the incidence of HIV/AIDS, STDs and TB
Malaria control
Improve women's health and reduce maternal mortality
Mental Health and Substance Abuse
Chronic Diseases
Promote poverty alleviation and food security strategies
Tackle violence against women and children
Emergency medical services
RESOURCE MOBILISATION, ALLOCATION AND MANAGEMENT
Strengthening planning and budgeting and monitoring of inter and intra-provincial equity
Certificate of Need and Licensing
Secure PHC funding and implement effective referral systems
Medical Schemes and Social Health Insurance
Revenue generation and retention
Public-Private Partnerships
Conditional Grants
Donor Funds
Health technology
Financial management: systems and skills
HUMAN RESOURCE DEVELOPMENT AND MANAGEMENT
Human resource development
Human resource management
COMMUNICATION AND EMPOWERMENT OF HEALTH SERVICE USERS
Communication within the National Health System
Communication between the Department of Health and stakeholders
INTERNATIONAL CO-OPERATION
ASSUMPTIONS
Annex Objectives, Indicators and Targets DRAFT OBJECTIVES, INDICATORS AND TARGETS FOR THE HEALTH SECTOR STRATEGIC FRAMEWORK, 1999-2004

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