WHITE PAPER SETS STRATEGY FOR
HEALTH TRANSFORMATION IN SA

The Health Minister, Dr Nkosazana Zuma, this week published a ground-breaking White Paper setting out the strategy for the transformation of the health system in South Africa. The White Paper, Towards A National Health System, aims to achieve comprehensive primary health care, to deliver quality health care for all citizens, efficiently and within a caring environment.

Background to the White Paper

Most South Africans have inadequate access to basic services, such as health, clean water and basic sanitation. Up to 55 per cent of the population live in poverty, and three-quarters of these live in rural areas. Mortality rates for infants, under-fives and mothers in childbirth are much higher than expected in a country with South Africa's income level, and there are gross inequalities in health across racial divides. Reform is urgently needed to give all South Africans access to good quality health care.

Key Points

The White Paper highlights a series of key policy initiatives, including:

• decentralising the management of health services, placing the emphasis on the district health system
• increasing access to services by making primary health care available to all citizens
• ensuring the availability of safe, good-quality essential drugs in health facilities
• rationalising health financing through budget reprioritisation
• focusing on sustainable food security for the needy, through the Integrated Nutrition Programme
• strengthening disease prevention and health promotion in areas such as HIV/AIDS, Sexually Transmitted Diseases and maternal, child and women's health
• developing a National Health Information System, to facilitate health planning and management.

Goals and Objectives

Goal: to unify fragmented health services at all levels into a comprehensive and integrated NHS

Action:

• reorganise the Department of Health, so that it can fulfil its designated functions
• integrate the activities of public and private health sectors, including NGOs and traditional leaders, to maximise the effectiveness and efficiency of all available health care resources
• reorganise the health care system based on primary health care services, with effective referral systems at primary, secondary and tertiary care levels.

Goal: to promote equity, accessibility and utilisation of health services

Action:

• increase access to integrated health care services for all citizens, focusing on rural, peri-urban and urban poor and the aged, with an emphasis on vulnerable groups
• establish health care financing policies to promote greater equity between people living in rural and urban areas, and between people served by the public and private health sectors
• distribute health personnel throughout the country in an equitable manner.

Goal: to extend the availability and ensure the appropriateness of health services

Action:

• establish a district health system in which all communities are covered by a basic health unit, which offers an essential package of care
• ensure a functioning referral system at the primary, secondary and tertiary levels
• improve access to comprehensive health services
• ensure the availability of high-quality, low-cost essential drugs
• ensure that every South African develops his or her potential fully, with the support of community-based nutrition promotion activities.
  
  Goal: to develop health promotion activities

Action:

• promote a healthy environment
• improve the psychological well-being of people and communities
• ensure access to health-related information community support and health services for adolescents
• reduce alcohol and other drug abuse, with particular emphasis on tobacco, glue, cocaine, Mandrax, heroin and marijuana
• promote healthy behaviour to prevent sexually-transmitted diseases and HIV
• prevent the transmission of communicable diseases such as tuberculosis, and the development of hypertension and diabetes
• help the disabled to become independent and reach their potential for achieving a socially and economically productive life
• reduce the incidence of intentional and unintentional injuries.
  
  Goal: to develop human resources available to the health sector

Action:

• promote the optimal use of the skills, experience and expertise of all health personnel
• develop education and training programmes aimed at recruiting and developing personnel who are competent to respond appropriately to the health needs of the people they serve
• ensure that the composition of human resources in the health sector reflects the demographic patten of the general population
• promote a new culture of demographic management in the health sector
• ensure a caring and compassionate health sector.

Goal: to foster community participation across the health sector

Action:

• involve communities in various aspects of the planning and provision of services
• establish mechanisms to improve public accountability and promote dialogue and feedback between public and private health providers
• encourage communities to take greater responsibility for their own health promotion and care.

Goal: to improve health sector planning and monitoring of health status and services

Action:

• develop a National Health Information System to facilitate the measurement and monitoring of the health status of the population, enable the evaluation of health service delivery and support effective management at all levels of the health service
• ensure that those responsible for the health status of the population are kept up to date with the information generated
• monitor the health impact of the implementation of the RDP, including the development of a nutritional surveillance mechanism
• build capacity at the provincial, district, local and community levels to develop plans based on priorities, and ensure appropriate ANC cost-effective interventions.

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