Great improvements in access to healthcare services

Tuesday, March 11, 2014

Pretoria – The advances made by the country in the treatment of HIV and Aids and TB have resulted in a dramatic improvement in health outcomes, among those, increased life expectancy and reduced infant and child mortality rates.

These are just some of government’s achievements highlighted in the 20 Year Review: South Africa 1994 to 2014 document, released on Tuesday by President Jacob Zuma.

The Review noted that over the past 20 years, access to healthcare services, including free basic healthcare, has steadily increased for South Africans across the board, with more than 1 500 healthcare facilities built and hundreds more being revamped.

“One of the major challenges that confronted the democratic government was the rapid rise in the HIV epidemic. South Africa’s HIV and Aids response has now received international acclaim.

“There has also been a significant reduction in malaria cases and deaths due to malaria. Severe malnutrition has also significantly declined,” President Zuma said.

Strides made in healthcare since 1994

Prior to 1994, public health services were only available to a small portion of the population, while the majority of South Africans had inadequate or no access to healthcare. The disproportionate allocation of resources was mirrored in the life expectancy figures of the different race groups. 

According to the Development Indicators 2012 -- as quoted in the 20 Year Review -- in 1990, life expectancy amongst white South Africans was 69 years for males and 76 years for females. By contrast, life expectancy amongst Africans was 60 years for males and 67 years for females. At birth, the probability was that the life of an African female would be nine years shorter than that of a white female.

The indicators also show that in 1995, the infant mortality rate amongst Africans (at 48.3 per 1 000 live births) was six times higher than that of whites (at 7.4 per 1 000 live births).

Policies and programmes initiated by government

Immediately following the election of the Government of National Unity in 1994, a range of pro-equity policies and programmes was initiated, many of which were elements of the Reconstruction and Development Programme (RDP).

Through RDP, primary healthcare (PHC) was revitalised and free maternal and child healthcare was introduced, which has proven successful in addressing mortality figures.

Over the past 20 years, major transformation has taken place in South Africa in health legislation, policy and the delivery of services to all South Africa.

Access to good quality healthcare

Government’s initiatives to ensure that all South Africans have access to good quality healthcare, irrespective of their financial status, include the implementation of the National Health Insurance (NHI), which will take 14 years to implement. NHI will address the country’s health burden and ensure that South Africans become a healthy, productive nation.

The NHI is a financing system that will provide all South Africans with essential healthcare, regardless of their employment status. As part of the first phase, in 2012, 11 pilot districts were identified to test the feasibility of the NHI green paper.

Although government has improved the health status of South Africans, more work remains in order to meet the 2030 health objectives, as set out in the National Development Plan (NDP).

The NDP’s goals include raising the life expectancy of South Africans to at least 70 years, progressively improve TB prevention and cure, reduce maternal, infant and child mortality and significantly reduce prevalence of non-communicable chronic diseases.

The goals also include universal healthcare coverage; establishing primary healthcare teams to provide care to families and communities, and filling vacancies in the healthcare sector with skilled, committed and competent individuals.

According to the 20 Year Review, the life expectancy in the country has increased from 52.7 years in 2002 to 59.6 years in 2013. The infant mortality rate has decreased from 63.5 deaths per 1 000 live births in 2002, to 41.7 deaths per live births in 2013.

The under-five mortality rate has also decreased from 92.9 deaths per 1 000 live births in 2002, to 56.6 deaths per 1 000 live births in 2013.

The Review also notes that severe malnutrition among children has decreased from 88 971 in 2001 to 23 521 in 2011.

Cervical cancer, family planning

Government is to implement the Human Pappilloma Virus (HPV) vaccination in schools. From March 2014, Grade 4 schoolgirls aged 9 and 10, will receive vaccinations against HPV. 

The introduction of the HPV vaccine is part of the Integrated School Health Programme. It is a significant public health milestone and is expected to reduce cervical cancer and reduce associated mortality within the next two to three decades.

In February this year, government launched a new contraception implant, which will increase the choice of contraceptives already available to women.

The device is 4cm long and the size of the lead of a pencil in diameter. It is implanted under the skin on the upper inner arm. The method offers prevention for three years, after which it needs to be replaced.

The device costs approximately R1 700 through private healthcare. However, public health facilities will offer it for free to all women, regardless of their socio–economic status. It became available in all public hospitals from 27 February 2014 and will reach all public clinics by June 2014.

Medical students

Government in 2002 requested medical schools to enrol an additional 220 medical students in 2012 to increase the number of doctors. This figure increased to 425 in 2013.

Currently, South Africa has 2 074 students from rural areas and disadvantaged backgrounds studying medicine in Cuba.

Zuma noted that despite this progress, government must still improve the quality of care in the public health sector and also attend to the increasing private healthcare costs.

In a bid to produce 1 000 PhD graduates over the next 10 years, a National Health Scholarship Programme was established by government, where 13 PhD scholars were funded during the 2012/13 financial year. –

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