Does expanding fiscal space lead to improved funding of the health sector?

Together with colleagues, I have just published an article that examines whether improved fiscal space in Kenya, Lagos State (Nigeria), and South Africa led to improved per capita spending on health.

Click here for the answer, together with an explanation of the trends.

Building capacity for priority-setting

Colleagues and I have just published a new article in the journal, Global Health Action.

It is titled Strengthening expertise for health technology assessment and priority-setting in Africa.

As the article explains, “The focus on priority-setting is in response to the urgent need to ensure scarce resources are used effectively in support of Universal Health Coverage, and the scant literature discussing how technical economic evaluations should be integrated into highly political and complex priority-setting processes. Researchers’ roles in developing capacity in these areas are highlighted because few African governments have technology assessment units that can take responsibility for driving formal priority-setting processes.”

Universal health coverage assessment: South Africa

If anyone missed this in an earlier blog, I’ve posted a preliminary assessment of South Africa’s progress towards universal health coverage here.

The purpose of the assessment is to use what data are available to analyse the extent to which South Africans are enjoying financial protection against the costs of using health care services, and accessing the services they need.

Leadership from ‘below’?: clinical staff and public hospitals in South Africa

In earlier posts I’ve referred to two relatively lengthy reports on clinical leadership – one a literature review and the other reporting findings from interviews with clinical leaders in South African district hospitals.

The main findings from these reports are now summarised in a policy note that is applicable to practitioners from other sectors.



Can the private health sector fix the failings of public health systems?

My latest book chapter has just been published:

Doherty J, McIntyre D. 2013.  Addressing the failings of public health systems:  should the private sector be an instrument of choice?  In:  Surender D, Walker R (eds). 2013. Social policy in a developing world.  Cheltenham, UK:  Edward Elgar.

Research on the for-profit health sector in Africa

I would like to get into contact with researchers, policy-makers and legal experts working on appropriate policies and legislation governing the for-profit private health sector in Africa.

Or perhas you do work on other low- or middle-income countries that might be relevant to the African situation?

On the ‘About Jane Doherty’ tab above you will find my e-mail address if you want to let me know about the work you are doing or have research or reports to share.

On the ‘Private health sector’ tab you will find my own work on the private sector (with links to the electronic versions where available). Of particular interest might be:

  • FORTHCOMING: A situation analysis of private sector legislation in East and Southern Africa which is still in an early draft form
  • FORTHCOMING: Doherty J, McIntyre D. (2013)  Addressing the failings of public health systems:  should the private sector be an instrument of choice?  In: Surender R, Walker R.  (2013)  Social policy in a developing world.  Cheltenham, UK:  Edward Elgar
  • Doherty J.  2011. Expansion of the private for-profit health sector in East and Southern Africa. EQUINET with HEU, UCT and TARSC Policy Brief 26. Harare: EQUINET.
  • Doherty J.  2011.  Expansion of the private health sector in East and Southern Africa.  EQUINET Discussion Paper 87.  EQUINET:  Harare.
  • A report summarising research on the for-profit private health sector in South Africa from the 1980s to 2003:  Doherty J, Steinberg M.  2003.  Priority health care information needs for reform:  what role for BHF?  Johannesburg:  Board of Healthcare Funders.

Health financing and expenditure in South Africa

Colleagues and I have just published a new chapter on health financing and expenditure in South Africa:

McIntyre DE, Doherty JE, Ataguba JE.  (2012)  Health care financing and expenditure – post-1994 progress and remaining challenges.  In:  Van Rensburg HCJ (ed).  Health and health care in South Africa (2nd edition).  Pretoria:  van Schaik Publishers. ISBN: 9780627030130

NHI Snippets (6): The high cost of private health care in South Africa

So, I’ve elaborated a little on the poor health of South Africans relative to the country’s level of economic development and wealth.

The second major point I made at the beginning of this blog series was that a huge proportion (43%) of all the money spent on health care in South Africa is paid as premiums by people on medical aid (medical aid is what is know internationally as ‘voluntary private health insurance’).  In fact, the proportion is so huge that South Africa tops the list of countries around the world in this regard, even outdoing the United States.

If you want to see this point displayed graphically, click on this link – Proportion of spending on health insurance – for a slide by Prof. Di McIntyre of the Health Economics Unit at UCT.1   On the extreme right of the graph are South Africa and the United States, each spending a large amount on voluntary private health insurance (the red section of the bars).  The other countries shown in the graph have health systems which are getting close to achieving universal health care coverage (in a later blog I’ll explain this term but in broad terms it means that most citizens are able to access and afford adequate health care).  You’ll see that, for these countries, the red section of the bar is very small.

The last bit of information you need to know to appreciate this graph is that ‘the big red bit’ of South Africa’s bar is spent by only 16 percent of the population.2  So the following picture emerges:

1.  Only a very small proportion of South Africa’s population has access to high quality care (this is assuming that lots of resources translates into good quality, which isn’t wholly true, so I’d like to qualify this statement in a later blog as well as note that good quality care is also available in the under-resourced public sector);

2. Private health care is very expensive and funding this care places a very high financial burden on those who can afford it.

3. Countries achieving universal health care coverage have not relied on private voluntary health insurance to do so (I’ll elaborate this point later and, of course, we need to have the discussion about why universal health care coverage is desirable.)



1. McIntyre D.  2011.  Options for South Africa:  Financing.  Presented at National Department of Health Consultative Conference on “National Health Insurance:  Lessons for South Africa”, Gallagher Estate, Midrand, 7-8 December 2012.  Available at:

2.  McIntyre DE, Doherty JE, Ataguba JE. (forthcoming). Health care financing and expenditure – progress since 1994 and remaining challenges. Health and health care in South Africa (2nd edition). Van Rensburg H. Pretoria: van Schaik Publishers.

NHI Snippets (4): Too many women die in South Africa from causes related to childbirth

In NHI Snippets (2) I made the point that health in South Africa is poor, especially when viewed in light of the country’s relative wealth.

I gave some figures on how many women die from causes related to childbirth.  I know these figures can seem very abstract so, as promised, I’ve found a graph (by Jack Langenbrunner) that helps to show how well South Africa does in preventing these deaths compared to other countries. 

Click “MMR relative to other countries” to see the graph and here to see the full presentation which includes additional graphs on other health indicators (the link takes you to the Health Systems Trust page with all the conference presentaitons – you will find Jack Langenbrunner’s presenation on Day 2).

As you can see, South Africa does badly when one considers both its average per capita income and its average per capita spending on health (in the graph, countries in the top right block manage to ‘buy’ much less health for the money they have at their disposal).  In this sense, South Africa is much less ‘efficient’ than some poorer countries that do much better.

Decentralised financial management capabilities for pilot hospital sites in South Africa

I have finally uploaded scanned copies of the last few annexures from the 1996 Hospital Strategy Project’s analysis of decentralised financial management issues.

Annexure F is very relevant to the current debate on readying public hospitals for National Health Insurance as it presents recommendations for decentralised financial management capabilities in pilot hospitals. 

Look on one of my ealier posts, entitled Decentralised Financial Management of Hospitals, for the uploaded files.