national context in health image
● Government’s health budget increased by 11%, from R168 billion in 2016, to R187 billion in 2017.
● Stats SA’s mid-year population estimates show a decrease in infant mortality, from 34.4 per 1 000 live
births in 2015, to 33.7 per 1 000 live births in 2016.
● The same mid-year population estimates show an increase in the number of people with HIV, from
4.72 million in 2003 to 7.03 million by 2016.
● A South African National Aids Council (SANAC) report titled, Let our actions count – South African
National Strategic Plan on HIV, TB and STIs 2017–2022 indicates that deaths due to HIV dropped by
78%, from 681 434 in 2006, to approximately 150 375 in 2016. Deaths due to tuberculosis (TB)
dropped by 46%, from 69 916 in 2009, to 37 878 in 2015.
● The same SANAC report found TB to be the leading cause of death in South Africa, accounting for
8.4% of all natural deaths in 2015.
● The latest statistics from the World Health Organisation showed that South Africa’s doctor to patient
ratio had hardly changed, from 0.78 per 1 000 patients in 2013, to 0.77 per 1 000 patients in 2015;
lower than in most other BRICS countries (Brazil: 1.9 per 1 000 people, Russia: 3.3 per 1 000 people
and China: 1.5 per 1 000 people).
● According to Moneyweb and the South African Nursing Council, in 2016, there were approximately
five nurses per 1 000 people.
● Based on the General Household Survey, 2016, the number of South Africans covered by medical aid
increased by 30%, from 7.3 million in 2002, to 9.5 million in 2016 (17% of South Africans).
● A report by Khulumani Support Group, titled Structure of the Health System in South Africa, shows that
in 2015, South Africa had 4 200 public health facilities. On average, each clinic catered for 13 718
people, which exceeds the World Health Organisation’s guidelines of 10 000 per clinic.
● As a disease that cuts across many other health concerns and has vast psychological and emotional
implications, HIV/Aids is best addressed through approaches that enlist the cooperation of the
authorities and leverage different skills and experience. Funders are advised to consider initiatives
that actively engage or partner with government health structures, NPO service providers and
businesses that meaningfully address the pandemic.
● Consider supporting community-based HIV/Aids initiatives, such as home-based care and antiretroviral
adherence clubs, which do not necessarily fall within government’s budget allocation.
● More funds should be channelled into research in the health sector, as well as into initiatives that aim
to increase South Africa’s health worker capacity.
Quality in Healthcare for South Africa, 2007
This policy aims to improve the quality of care in the public and private health sectors, by addressing
access to healthcare; increasing patients’ participation and the dignity afforded to them; reducing
underlying causes of illness, injury and disability through preventive activities; expanding research on
evidence of effectiveness; ensuring the appropriate use of healthcare services; and reducing healthcare
errors. These improvements generally reflect the needs of various vulnerable populations.
Integrated School Health Policy, 2012
To deal with past injustices, democratic South Africa has had many school health policies, including
this most recent one which aims to improve existing school health services, as well as to strengthen
collaboration between key roleplayers such as the Departments of Health, Basic Education, and Social
Development. This policy focuses on addressing health issues that cause barriers to learning, morbidity
and mortality among learners during childhood and adulthood. The provision of health services (as
opposed to screening and referral) in schools is prioritised.
National Health Insurance (NHI), 2017
This policy aims to promote equity and efficiency in the health sector, and to ensure that all South Africans
have access to affordable, quality healthcare services regardless of their socioeconomic status. The NHI will
be phased in over 14 years and derives its mandate from South Africa’s Constitution, which states that the
state should ensure healthcare for all. The implementation is underpinned by the National Development
Plan, which envisions that, by 2030, a common fund should enable equitable access to healthcare,
regardless of what people can afford or how frequently they need to use a service.
National Emergency Care Education and Training Policy, 2017
After 1994, the need to increase geographical reach meant that emergency care personnel were required
to operate independently and provide an increased level of clinical care. This necessitated a higher level
of training. This policy therefore aims to facilitate the alignment of emergency care education and training
with current education legislation and national training needs. Similar to other health professions, the
Emergency Care Qualification Framework would have three tiers consisting of an entry-level, mid-level, as
well as a professional qualification allowing access to postgraduate studies.

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