a) Progress on public healthcare sector transformation
The Minister was referring to transformation of health services in South Africa since 1994, which began with the Reconstruction and Development Programme (RDP) that emanated from the Freedom Charter. RDP aimed at redressing the harmful effects of apartheid and complete transformation of the entire health delivery system.
Key milestones in health transformation were: the establishment of a national health system (NHS) made up of various role players; the implementation of an extensive programme of public clinic building & upgrading; provision of free primary health care (PHC) health services and essential drugs in PHC facilities; the orientation of services and emphasis on PHC approach enshrined in the White Paper on the Transformation of the Health System in 1997 and the National Health Act of 2003; as well as the establishment of the district health system (DHS) as a vehicle to deliver & manage PHC services closer to where people live.
Several other initiatives were undertaken to transform health services delivery to ensure better access for all including:
The health system strength was tested during COVID-19, and proved to be resilient enough to curb the pandemic and provide care to all those who needed it. Currently, the country is engaged in National Health Insurance (NHI) as a major health reform in pursuit of Universal Health Coverage.
The latest Auditor-General Report for FY2022/23 Annual Report acknowledged the progress that the Department is making to improve audit outcomes.
b) Public health service transformation is measured by monitoring indicator performance, evaluations of each individual component/intervention, conducting research surveys and analyzing civil registration vital statistics data to monitor outcomes at a population level. The examples are a) the District Health Barometer which gauges district performance on service delivery; b) Early Childhood Development programme evaluation; and c) the South African Demographic & Health Survey (SADHS)
The World Health Organization (WHO) introduced the UHC service coverage index to measure progress in the provision of UHC as required for the Sustainable Development Goals (SDGs). It is a single composite indicator that includes reproductive, maternal, newborn and child health; infectious diseases; non-communicable diseases; as well as service capacity and access among the general and the most disadvantaged population. The WHO Tracking Universal Health Coverage: 2023 Global Monitoring Report shows that SA UHC index improved from medium (43%) in 2000 to high (71%) in 2021.
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