Transcript Thulani Matsebula TRANSFORMATION IN HEALTH CARE: ARE WE THERE YET? The Transformation Challenge • The distribution of financial and human resources between the.

Thulani Matsebula
TRANSFORMATION IN HEALTH CARE:
ARE WE THERE YET?
The Transformation Challenge
• The distribution of financial and human resources between the public and
private health sectors – remains grossly inequitable;
 Wide disparities in spending between public and private sectors;
 The private sector takes the lion’s share of health care professionals;
 There’s uneven access and poor quality of care across different spheres.
• The private sector is accessible to 15 - 17% of the population, but consumes
more than 60% of financial resources, employs more than 70% of
healthcare specialists;
• Private sector remuneration incentivises healthcare workers to leave the
public sector, with a negative impact on quality of care;
• As a result, South Africa’s health system performs poorly in context of
resources it consumes.
Public Sector Transformation Achievements
• Access to health care is an entrenched right in the Constitution (Sections 27
& 28);
• The use of primary health care services has increased;
• Some health status indicators have improved;
Indicator
Baseline
Progress
2009
2010
2011
2012
2013
Life expectancy at birth: Total
57.1
58.5
60.5
61.3
62.2
Life expectancy at birth: Male
54.6
56.0
57.8
58.5
59.4
Life expectancy at birth: Female
59.7
61.2
63.2
64.0
65.1
• Disaggregation of health status indicators may reveal a different picture.
The Rationale for Transformation
• Post – 1994, a purposeful commitment was made to transform the health
system to ensure equity in resource allocation, restructure the health
system according to the district health system, and to deliver health care
according to primary health care principles;
• The problem as described in the White Paper for the Transformation of the
Health System in South Africa (1997);
 “…South Africa spent approximately 8,5% of GDP on health services, both public and private. This

represents a very high level of spending for a country at South Africa’s level of development. However,
the distribution of resources is highly inequitable and wasteful. A small proportion of the population
benefits disproportionately from services rendered by the private sector, which are comparable to
those offered in more affluent countries. At the same time, the majority of the South African
population has very limited access to any form of services.
Goes on to say….”Moreover, there are considerable in equities and inefficiencies in the distribution of
public health resources, spending being weighed heavily in favour of certain provinces, urban areas
and curative, hospital-based care”.
The Steps Towards Transformation
• Five distinct transformation agendas;
 1994 – 1999: increasing access to healthcare, structural reorganisation of the
health system with focus on public health sector (e.g. policy of free health
care at point of delivery for pregnant mothers, young children and persons
with disabilities);
 1999 – 2004: intervening in the private health sector and focusing on quality
of care issues in the public sector (the Medical Schemes Act amended);
 2004 – 2009: health system consolidation, focusing on human resource issues
and overall capacity building;
 2009 – 2014: deepening access and introducing a focus on universal health
coverage (NHI).
Desirable Elements of a Transformed Health
System
• In measuring progress towards transformation, important to know what
we want to see of a transformed healthcare system;
• Aims previously stated White Paper on Transformation;
•
•
•
•
To unify the fragmented health services at all levels into a comprehensive and
integrated NHS;
To reduce disparities and inequities in health service delivery and increase access to
improved and integrated services, based on primary health care principles;
To give priority to maternal, child and women’s health; and,
To mobilise all partners, including the private sector, NGOs and communities in
support of an integrated NHS.
Assessing Progress Towards Transformation
• Progress toward transformation will be measured against a healthcare
system providing coverage that;
 Provides essential healthcare services
 Does not impose catastrophic expenditure on individuals and households
 Covers everyone
• Discussions on what constitutes essential healthcare services cannot be
separated from a discussion about financing of those services;
• Financing is a crucial dimension of access to healthcare services.
Achieving Universal Health Coverage Through
Transformation
Source: WHO
Transformation: an Interim Assessment
• A statement from the National Development Plan (2011);

“The overall performance of the health system since 1994 has been poor, despite the development of
good policy and relatively high spending as a proportion of GDP. Services are fragmented between
public and private sectors which serve 83% (41.7 million) and 17% (8.3 million) of the population
respectively. Imbalances in spending between the public and private sectors have skewed the
distribution of services, which has been detrimental to both sectors and has led to cost escalation.
Evidence suggests multiple system failure across a range of programmes, including maternal and child
health, HIV/AIDS, tuberculosis and others, with a devastating combined impact. At the heart of this
failure is the inability to get primary health care and the district health system to function effectively.”
• A statement by the Council for Medical Schemes (2012);
– “South Africa’s health system performs poorly in relation to the amount of
money it consumes, and performs below par in respect of most health
indicators. This is in spite of good healthcare policy”.
The Transformation Challenge in Private Health
Care
• In 2013, medical schemes collected ±R130 billion in contributions covering
8.7 million beneficiaries;
• In 2014/15, the public health sector spent ±R140 billion providing
healthcare to a population of 42 million;
• Per capita health spend on a private health sector patient five times that
of a public sector patient;
• Should more money be allocated to the public sector?
• Probably yes, but South Africa is spending 8.7% of GDP on health, higher
than the proportion of expenditure on health by even higher income
countries.
Transformation: Outstanding Matters
• Entrenched interests in private health care, determined to maintain the
status quo, often through costly litigation;
• Failure to transform in private health care – not separate from overall
problem of inequalities that still prevail in society as a whole ( e.g.
reluctance by corporate South Africa to comply with Employment Equity);
• In spite of progress, mainly in passing of policy and legislative reforms, the
health system remains fragmented and inequitable;
• The private healthcare sector is generally a preserve for medical scheme
beneficiaries, who also enjoy access to the public sector when benefits get
exhausted.
THANK YOU