Achieving universal health coverage in South Africa requires higher public sector spending

This article was published in The Conversation on international Universal Health Coverage Day on 12 December:

Doherty J, McIntyre D. 2015. South Africa needs to spend more on health care to achieve universal cover. The Conversation – Africa. 12 December 2015.

#FeesMustFall and the campaign for universal health coverage

To mark the second international Universal Health Coverage Day on 12 December, my colleague, Di McIntyre, and I have just published an editorial in the South African Medical Journal.

The article argues that both the education and health sectors have been underfunded since the demise of apartheid. This is for several reasons, including fiscal policy choices.

Strengthened public funding is required for both sectors, not only from a human rights perspective, but also because economic growth depends on investment in these sectors.

You can read the article here.

Achieving universal health coverage in Africa: is there a role for formal for-profit providers?

Here is the link for a blog post that has just been published on Oxfam’s Global Health Check – it summarises the recommendations of the paper in my previous post.

Doherty J. 2015. Achieving universal health coverage in Africa: is there a role for formal for-profit providers? Global Health Check. Available at: http://www.globalhealthcheck.org/?p=1841

Progress towards Universal Health Coverage in Fiji, Ghana, Hong Kong, Indonesia and Zambia

Some new country UHC assessments have been added to the website of the Global Network on Health Equity (GNHE).

  • Bangladesh
  • Fiji
  • Ghana
  • Hong Kong
  • Indonesia
  • Peru
  • South Africa
  • Taiwan
  • Tanzania
  • Uganda
  • Zambia

I’ve posted the link here because I am the editor of the series.

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.

GNHE universal health coverage assessments for Bangladesh, Peru, South Africa, Taiwan, Tanzania and Uganda

To celebrate Universal Health Coverage Day, GNHE (the Global Network on Health Equity) is releasing a series of assessments about the progress towards financial risk protection and access to quality health care for all in:

Bangladesh

Peru

South Africa

Taiwan

Tanzania

Uganda

Go to the GNHE website to download the assessments.

Further assessments will be released over coming weeks.

Getting South Africa ready for National Health Insurance: critical next steps

Here are the powerpoint slides for a recent presentation I gave about National Health Insurance to a Symposium by Economic Research Southern Africa (ERSA) on 6 February 2014:   ERSA NHI presentation_Jane Doherty 

The theme of the Symposium was “Critical choices regarding universal health coverage” and it was held at the Stellenbosch Institute for Advanced Study.

My presentation was titled “Getting South Africa ready for NHI: critical next steps.” 

If you look on ERSA’s website you will find more details on the Symposium.

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.

NHI Snippets (6): NHI and staff shortages: how can clinical associates help?

South Africa has begun producing a new type of health professional – a clinical associate.

You can read a bit more about clinical associates here but, in brief, they are people ideally suited to working in hospitals, helping doctors carry out some of their tasks – like dealing with emergencies and doing procedures.

Clinical associates don’t replace doctors or nurses  – they work with them, sharing some of their workload, and allowing them to concentrate on the tasks for which only they are qualified.

There is no doubt that more doctors and nurses need to be trained and recruited into the South African health system. But will this alone solve the country’s staff shortages? Realistically, how many decades will it take to fill all the country’s vacant posts? Can the country afford a system exclusively based on doctors and nurses? Is this even necessary?

It takes less time to train a clinical associate. They can become very good at what they do because they focus on a special set of skills and are supervised by doctors. They are recruited from rural and disadvantaged communities. Health workers a bit like them have made an enormous difference to many health systems around the world, especially in Africa but even in the United States.

So clinical associates could do a lot to address staff shortages in the public sector, especially in district hospitals. They could help bring good quality care closer to communities in a way that is affordable for the country. Along with other initiatives – such as strengthening hospital management – they could help produce public services that live up to the aspirations of the NHI policy.

So why isn’t there more excitement about this new category of health professional? Why don’t we hear about them in the press or from government spokespeople?

Clinical associates are noted as a priority in the latest government human resource strategy but the future of clinical associates and the strategy of NHI need to become much more closely intertwined.