- Child health
- Communicable disease control
- HIV, AIDS and TB
- Re-engineering primary healthcare (PHC)
- Improving health infrastructure
- National Health Insurance
- Health teams
- National Health Laboratory Service (NHLS)
- Medical schemes
The Department of Health has an overall responsibility for
healthcare in the country, with a specific responsibility for
Healthcare in South Africa's is undergoing far-reaching reforms to revitalise and restructure the system and to ensure access to healthcare for all. The department's service delivery agreement includes the following goals:
- life expectancy must increase from 54,9 years for males and 59,1 years for females (Statistics South Africa 2011) to 58 years for males and 60 years for females by 2014
- South Africa's Maternal Mortality Ratio (MMR) must decrease to 100 or less per 100 000 live births by 2014 (the MDG Country Report estimates South Africa's MMR at 625 per 100 000)
- the child mortality rate must decrease to 20 or less deaths per 1 000 live births by 2014
- the tuberculosis (TB) cure rate must improve from 64% in 2007 to 85% by 2014
- 80% of eligible people living with HIV and AIDS must access antiretroviral (ARV) treatment
- new HIV infections must be reduced by 50% by 2014.
As part of improving the healthcare system and ensuring that all South Africans have equitable access to essential healthcare services, government is introducing the National Health Insurance (NHI) system.
Consolidated spending on health and social protection
is R268 billion in 2013/14. Health infrastructure remains
a priority. In 2012, 1 967 health facilities and 49 nursing
colleges were in different stages of planning, construction and
Total expenditure on the comprehensive HIV and AIDS Conditional Grant was expected to amount to R26,9 billion over the 2011 to 2014 period, based on the number of people on treatment increasing from 1,2 million in 2011 to 2,6 million by 2013/14. At national level, an additional amount of R692 million for 2012/13 was allocated. This was be used to improve quality; strengthen public healthcare teams; upgrade and maintain nursing colleges, improve maternal and child health; and for universal coverage of HIV and AIDS.
The Integrated School Health Programme (ISHP) [PDF] was launched in October 2012. It aims to ensure that all learners have access to primary healthcare services.
The strengthening of school health services through the
ISHP is a key component of the primary healthcare restructuring
process in the Department of Health and the Care and
Support for Teaching and Learning Programme within the
Department of Basic Education.
The Department of Social Development will be responsible for assisting learners to access services, particularly where financial barriers impede accessing services.
The ISHP aims to individually assess every learner once
during each of the four educational phases. Assessments
during the foundation phase will focus primarily on identifying
health barriers to learning, and identifying children who have
or are at risk for long-term health, psychological or other
The key health workers involved in the programme will be nurses and health promotion practitioners.
The four-month Catch-Up Immunisation Campaign ran from February to May 2012. It aimed to provide children under five years old with an additional dose of Pneumococcal Conjugate Vaccine aimed at protecting them and their communities against pneumococcal diseases. The campaign targeted all children between 18 and 36 months, and children with underlying medical conditions such as HIV infection, cardiac conditions and those who were on cytotoxics.
To get maximum benefit of the introduction of the pneumococcal vaccine, it is common practice to conduct a catch up campaign that targets children below five years. Due to the high price of the vaccine and other compelling needs, it was not possible to conduct such a campaign up until 2012.
HIV prevalence in South Africa appears to be stabilising after peaking in the 1990s and early 2000s. South Africa has the largest ARV therapy programme in the world. By September 2012, more than 20 million people had undergone voluntary testing for HIV and AIDS. People receiving treatment increased from 1,1 million in 2009 to 1,7 million in 2011. This number was expected to increase following the launch in the same month of a campaign to encourage HIV and AIDS testing and counselling among South Africa's 1,3 million public servants.
The Department of Health launched a campaign to counsel
and test 15 million South Africans for HIV. This target was
achieved and exceeded, with 20,2 million South Africans
knowing their status by June 2012. Through this programme,
1,6 million people were counselled and placed on ARV
By June 2012, the number of people living with HIV and AIDS in the country stabilised, with the rate of new infections decreasing from 1,4% to 0,8% in the 15 to 24 age group.
The rate at which TB was being cured rose slowly but steadily to 73%, still short of the 85% target. The number of people who tested for TB increased to eight million. Of these, one million were referred for further diagnosis and management at relevant health facilities.
The re-engineered PHC model comprises three streams:
- creation and deployment of municipal ward-based PHC outreach teams in defined geographic areas (wards)
- deployment of district clinical specialist teams in all districts across the country
- strengthening of school health services.
The Department of Health conducted an audit of service
quality in over 75% of health facilities and improvement plans
are being developed. An audit of all 122 nursing colleges was
completed in June 2012, with 45 of the target 105 colleges
To improve capacity to implement the NHI, the department has increased the number of matriculants sent to Cuba to
1 000 matriculants in 2012. The department also encouraged
the country's eight medical schools to increase their intake
of students – the University of the Witwatersrand accepting
40 extra students, which the department covered with an
additional R8 million.
Other universities followed suit, increasing their intake by an overall 160 students in 2012, for which the department gave R48 million. The department also planned to set up a new medical school in Limpopo and build a tertiary hospital in Mpumalanga, in anticipation of the new university planned for the region in 2014.
The NHI will offer all South Africans and legal residents access
to a defined package of comprehensive health services. Government
is committed to offering as wide a range of services
as possible. Although the NHI service package will not include everything,
it will offer care at all levels, from primary healthcare
(PHC) to specialised secondary care, and highly specialised
tertiary and quaternary levels of care.
National Treasury also approved an NHI conditional grant of R1 billion over the Medium Term Expenditure Framework period 2012/13 – 2014/15. NHI will be implemented over a period of 14 years.
By the end of 2012, there were more than 159 569 medical
practitioners registered with the Health Professions Council of
South Africa (HPCSA). These include doctors working for the
State, those in private practice and specialists. The majority
of doctors practise in the private sector.
By November 2012, there were 5 387 dentists, 2 293 dental assistants, 984 oral hygienists and 496 dental therapists registered with the HPCSA. Dentists are subject to the CPD and community-service systems. Oral health workers render services in the private and public sectors.
The NHLS trains pathologists, medical scientists, occupational health practitioners, technologists and technicians in pathology disciplines, including: anatomical pathology, haematology, microbiology, infectious diseases, immunology, human genetics, chemical pathology, epidemiology, occupational and environmental health, occupational medicine, tropical diseases, molecular biology, medical entomology and human nutrition.
In November 2012, there were about 97 medical schemes in South Africa with around 8 469 784 beneficiaries. These schemes have an annual contribution flow of about R84,9 billion.