HEALTH SECTOR STRATEGIC FRAMEWORK 1999 - 2004
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.
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 Africans can be proud of.
The following summary reflects the key achievements since 1994: