Health Sector conditions

South African public health expenditure has increased to R183 billion over the past 20 years, with a large chunk of provincial health budgets spent on salaries. This is according to the 2017 South African Health Review by Health Systems Trust (HST). The review revealed that despite this expenditure, poor-quality primary healthcare services and the growing incidence of non-communicable diseases crippled the system. The report reveals that rising personnel costs have also hit the budget because economic growth has slowed and fiscal pressure has intensified as based on data supplied by the National Treasury.

Non-communicable diseases (NCDs) are also threatening to overwhelm a health system already under strain from HIV and tuberculosis. The review notes that South Africa is experiencing a surge in the prevalence of NCDs “which imposes a heavy burden on healthcare services”. Prevention and early detection measures are therefore crucial for the control and management of NCDs, and failure to implement such interventions can be costly.

A new approach is clearly needed. Experts point out that policy initiatives, including the proposed tax on sugary beverages, will help, but more needs to be done to adequately manage patients, especially those with multiple chronic conditions for which they will likely need treatment for life. The costs of treating this disease burden in future will be significant as will be the costs of early deaths to the economy.

The Minister of Health recently presented the findings and recommendations of a ministerial task team in Parliament that had been mandated to carry out investigations into service delivery at selected hospitals. The major talking points of the report were the wider systemic problems affecting the operations of the Department of Health and hospitals. It has become clear that the decentralisation of funding of hospitals to the provinces has created problems for the Department, as it has little control over four main areas of its operations: (a) procurement/supply chain management, (b) human resources training and recruitment, (c) financial management and (d) maintenance of infrastructure and equipment. The Portfolio Committee on Health resolved to look at the possibility of making changes to the constitution, with a view to addressing the challenges in the areas mentioned. The constitution empowers Members of Executive Committees (MECs) to have authority over medical budgets in their provinces, rendering the Departments weak in ensuring that health facilities have sufficient funds to effect good service delivery. Many health facilities are under-funded, because the provincial executives are the ones who have the power to allocate funding, and they are often not meeting the budgetary requirements of the hospitals. In some cases, even where funds are available, the health facilities are not being allowed to use the money. Consequently, there is a shortage of medical staff, medicines, equipment and other medical necessities.

There has been a drive to increase the capacity of central hospitals in decision-making and accountability. Organisational structures for the hospitals have been designed and approved. Health workforce staffing norms have been developed and a number of hospitals have been benchmarked against staffing normative guides. A staff capacity building drive is ongoing, and the target is to train 80 hospital managers and 800 facility managers by the end of the year. The targets are already being exceeded in this area. There are also plans to develop business plans approved by the National Tertiary Service Grant for hospitals, and 17 tertiary hospitals have already had their plans approved. Regulations for emergency care services has been drafted and published for comments. Also, a monitoring system had been developed to measure compliance with pathology services scope of practice.

The Department has set a target of establishing 1 000 Primary Healthcare (PHC) facilities as ideal clinics in 52 districts, and has managed to go even beyond the target, with 1 037 facilities qualifying as at the start of September. Improvement of the accessibility of primary health services for people with disabilities is a priority, and it was recently revealed that 35% of PHC facilities are accessible to people with physical disabilities. On the need to improve access to quality mental health services, district mental health teams have been established in eight districts across the country.

There are plans to establish the National Public Health Institute of South Africa (NAPHISA), and a Bill has been tabled before the Portfolio Committee on Health for consideration.

MPs expressed concern that NGOs who work with the poorest of the poor are not being funded timeously. They also expressed worry that the National Treasury has recommended that there should not be any more recruitment of health staff in an environment where staff shortages are hampering service delivery.