Question NW3257 to the Minister of Health

Reply:

a) Progress on public healthcare sector transformation

The Minister was referring to transformation of health services in South Africa since 1994, which began with the Reconstruction and Development Programme (RDP) that emanated from the Freedom Charter. RDP aimed at redressing the harmful effects of apartheid and complete transformation of the entire health delivery system.

Key milestones in health transformation were: the establishment of a national health system (NHS) made up of various role players; the implementation of an extensive programme of public clinic building & upgrading; provision of free primary health care (PHC) health services and essential drugs in PHC facilities; the orientation of services and emphasis on PHC approach enshrined in the White Paper on the Transformation of the Health System in 1997 and the National Health Act of 2003; as well as the establishment of the district health system (DHS) as a vehicle to deliver & manage PHC services closer to where people live.

Several other initiatives were undertaken to transform health services delivery to ensure better access for all including:

• The Bilateral Health Cooperation Agreement signed between the Governments of the Republic of South Africa and Cuba in 1996 provided an opportunity for recruitment of young South African students to undergo medical training in Cuba through the Nelson Mandela Fidel Castro Medical Training Programme (NMFC). To date, 3071 doctors have been produced through the NMFC.

• The pricing legislation introduced Single Exit Prices (SEPs) in 2006 for registered and unregistered medicines, determining appropriate logistics fees for wholesalers and distributors of pharmaceuticals, as well as formulating the dispensing fees for pharmacists and licensed persons. This pricing legislation reduced medicines prices by 45%, which reduced financial barrier and increased access to much needed medicines for ordinary people.
• The shift from curative care to preventive care was strengthened by “PHC Reengineering” strategy adopted in 2010. PHC reengineering involved the deployment of community health workers, school health services and the district clinical specialist model which focussed on disease prevention and addressing key drivers of maternal and infant mortality.

• The Office of Health Standards and Compliance established in 2013 has been instrumental in safeguarding the quality of healthcare services in health facilities and ensuring compliance to norms and standards.

The health system strength was tested during COVID-19, and proved to be resilient enough to curb the pandemic and provide care to all those who needed it. Currently, the country is engaged in National Health Insurance (NHI) as a major health reform in pursuit of Universal Health Coverage.

The latest Auditor-General Report for FY2022/23 Annual Report acknowledged the progress that the Department is making to improve audit outcomes.

b) Public health service transformation is measured by monitoring indicator performance, evaluations of each individual component/intervention, conducting research surveys and analyzing civil registration vital statistics data to monitor outcomes at a population level. The examples are a) the District Health Barometer which gauges district performance on service delivery; b) Early Childhood Development programme evaluation; and c) the South African Demographic & Health Survey (SADHS)

The World Health Organization (WHO) introduced the UHC service coverage index to measure progress in the provision of UHC as required for the Sustainable Development Goals (SDGs). It is a single composite indicator that includes reproductive, maternal, newborn and child health; infectious diseases; non-communicable diseases; as well as service capacity and access among the general and the most disadvantaged population. The WHO Tracking Universal Health Coverage: 2023 Global Monitoring Report shows that SA UHC index improved from medium (43%) in 2000 to high (71%) in 2021.

END.