The 20th edition of the South African Health Review was released this month. This edition considers the healthcare developments of the past 20 years, explores the current challenges faced by our healthcare system, and reflects on possible issues for South Africa in the years ahead. SOPH staff and colleagues contributed the following three chapters in the series.
Development of the health system in the Western Cape: experiences since 1994
Lucy Gilson, David Pienaar, Leanne Brady, Anthony Hawkridge, Tracey Naledi, Krish Vallabhjee, Helen Schneider
Provincial governments in South Africa have a critical responsibility in terms of population health, yet few provincial-level analyses of health-system
development have been undertaken. This chapter reports on research being conducted in the Western Cape to understand the province’s particular experience of
health-system transformation since 1994, set against wider national experience. The research is being undertaken collaboratively by the authors of this chapter, a team of Western Cape provincial health managers and researchers.
The chapter is structured to reflect the Western Cape’s 22-year experience. The situation that faced the province in 1994 is outlined briefly, followed by a description
of key features of the three health strategies that have driven provincial health-system development over time. An assessment is then presented of the overall nature and patterns of Western Cape health-system change, and the achievements and limitations of this transformation are considered. The chapter concludes with some early lessons from this experience, and relevant, international experience is considered.
Addressing social determinants of health in South Africa: the journey continues
Vera Scott, Nikki Schaay, Helen Schneider, David Sanders
With the recent change from the Millennium Development Goals to the 17 new Sustainable Development Goals, the focus of the global
development agenda is expanding: there is attention on a broader set of social determinants and, importantly, a specific sensitivity to equity, which could have
a substantial effect on health. Addressing social determinants is a cornerstone in the National Department of Health’s Primary Health Care Re-engineering Strategy, and an approach that is embedded in the country’s National Development Plan. However, the translation of this policy commitment to programmatic action at different levels in the health system and in partnership with other sectors remains elusive.
This chapter draws on evidence collated by the World Health Organization Commission on the Social Determinants of Health, complemented with empirical evidence from South Africa to strengthen the contextual sensitivity of the analysis, in order to identify the social determinants impacting on the major components of the
burden of disease in South Africa. Obesity is used as a case study to illustrate how action to address these determinants is required at different levels in the health system, and in partnership with other sectors.
The evidence is then used to interrogate the National Development Plan and the PHC Re-engineering Strategy as two major policy instruments that have the potential
to address social determinants. The particular limitations of both policy initiatives are identified, and the chapter proposes how the health sector can take on a
stronger advocacy role both within government and beyond to support the broader international health and development agenda.
Advancing the agenda on non-communicable diseases: prevention and management at community level
Thandi Rose Puoane, Lungiswa Primrose Tsolekile, Bonaventure Amandi Egbujie, Marc Lewy, David Sanders
South Africa is experiencing an increase in the prevalence of non-communicable diseases (NCDs), which imposes a heavy burden on healthcare services. The
South African government has made great strides towards management and control of NCDs, including the development of management guidelines, health-
promotion and prevention policies intended to assist healthcare workers, facilities and communities in NCD care. However, it appears that the facility-based component of NCD management and control efforts has received more attention than the community-level components.
The national strategic plan for NCDs highlights the importance of community-level interventions in chronic NCD care. Thus there is a need for community-based
strategies for NCD prevention, control and management to complement facility-based health services.
This chapter explores the advancement of the NCD agenda in South Africa through an emphasis on community-level prevention and management. It describes
interventions that used community actors such as community health workers in NCD care. The chapter discusses some of the challenges of these interventions, and ends with possible suggestions for South Africa.
To access the full edition, click here http://www.hst.org.za/publications/South%20African%20Health%20Reviews/HST%20SAHR%202017%20Web%20Version.pdf