Embedding quality at the core of universal health coverage in South Africa

Abstract

Embedding quality at the core of universal health coverage in South Africa South Africa's White Paper on National Health Insurance 1 represents the government's statement of intent on achieving universal health coverage (UHC)ie, to provide all people with access to a common set of comprehensive health services of sufficient quality, while also ensuring that the use of these services does not expose the user to financial hardship. The White Paper recognises that the health and development of South Africans is largely dependent on the social determinants of health, and that the best way to obtain improved health outcomes is through a multisectoral, multistakeholder primary health-care (PHC) approach that puts the individual at the centre of health and development programmes. The White Paper recognises that service coverage and affordability are crucially important, but not sufficient, to ensure achievement of UHC. As such, a strong emphasis is placed on improving the quality of care at the entry point into the health care system (ie, the PHC system). In South Africa, although PHC facilities are the communities' first point of contact with the health system, inadequate service provision, overburdened clinics with long queues, and poor quality of services has resulted in many people bypassing PHC facilities and going straight to hospital outpatient departments where services are perceived to be better. The National Department of Health thus started preparation for UHC through National Health Insurance by improving the quality of PHC services. The Department's rationale was that improved PHC services would increase communities' confidence in these services, and decrease the occurrence of PHC services being bypassed. The Ideal Clinic Realisation and Maintenance (ICRM) programme was designed in response to the deficiencies in the quality of PHC services, and to lay a strong foundation for the implementation of National Health Insurance. An ideal clinic is defined as a clinic with good infrastructure (ie, physical condition and spaces, essential equipment, and information and communication tools), adequate staff numbers, adequate medicines and supplies, good administrative processes, and adequate bulk supplies; such a clinic uses applicable clinical policies, protocols, and guidelines,

The development and reform of public health in China from 1949 to 2019

“…Better integration will boost the efficiency of the system. South Africa made impressive progress in primary care largely because of its attention to integrated care [66]. Ngazi also appealed that UHC requires a more integrated health system including public health [67].…”

Collaborative postgraduate training in family medicine and primary care: Reflections on my visit to South Africa

“…3,4 To achieve this, appropriate education of family physicians (FP) as well as basic doctors and clinical associate training is required. Integral to this is strengthening family medicine as an academic discipline, with the ability to conduct relevant primary care research to inform both clinical practice and teaching.…”

Providers' Definitions of Quality and Barriers to Providing Care: a Qualitative Study in Rural Mpumalanga Province, South Africa

“…(8,9) While the South African government aims to provide universal health coverage, it must also ensure high quality of care across the public health system to reap its bene ts. (10,11) High quality health care is important for retaining patients and optimizing outcomes for those in need of continuous clinical services. High-quality health systems consistently provide care that improves or maintains health, are valued and trusted by all people, and respond to changing population needs.…”

“…The national government has introduced numerous policy reforms and initiatives (13,14) including the Ideal Clinic Realization and Maintenance (ICRM) program (15) to improve quality of PHC services. (11) ICRM works to support facility-level quality improvement through provision of manuals and training as well as a district support team. However, poor communication between national government, international funders and policy developers, and poor oversight of actual PHC service delivery, continues to create de cits in the performance of district health systems.…”

“…However, poor communication between national government, international funders and policy developers, and poor oversight of actual PHC service delivery, continues to create de cits in the performance of district health systems. (8,11) In 2016, a modeling study suggested that of the estimated 97,000 preventable deaths in South Africa, 51,000 (53%) were attributable to poor quality of care, through incorrect management or inability to retain the patient in care, among those utilizing the health system. (16) Research assessing overall health system quality and patient experience has identi ed numerous implementation challenges and de ciencies within the PHC system, including unequal distribution of resources, management and leadership (2,9,17); service delivery issues such as long wait times (2,8,18); and poor hygiene and infection control.…”