Government says substantial steps have been taken towards the establishment of the National Health Insurance System as a means of improving the effectiveness of the country's health system.
Officially releasing the Mid Term Review Report, which provides progress on the commitments that government has made, Minister in the Presidency Responsible for Performance Monitoring and Evaluation, Collins Chabane, said on Friday, that a Green Paper had been produced and released publicly for input in this regard.
"The Department of Health had conducted an audit of service quality in over 75% of health facilities and improvement plans are now being developed," said Chabane.
He said the department had also developed a human resource strategy which links intake of health professionals to projected demand. In addition, an audit of 122 nursing colleges was underway.
However, the Mid Term Review report acknowledges that despite radical interventions since 1994, the country's health sector remained poor as compared with other countries with a similar profile as South Africa.
South Africa has high levels of maternal and child mortality with life expectancy declining significantly from 1994 to 2009 with officials saying this was an indication of a "reversal" of earlier gains made towards meeting the Millennium Development Goals.
The Department of Health has committed to a strategy to change the situation. The plan will include:
- Fast-tracking the implementations of the far-reaching health care reform plan that includes the National Health Insurance scheme which will eventually cover all South Africans
- Strengthening the fight against HIV and TB, non-communicable diseases and injury and violence
- Beefing up human resource management at state hospitals and strengthen coordination between the public and private health sector
- Deploying municipal ward-based health teams and school health teams to communities and schools respectively
- Regulating costs to make health care affordable to all
- Increasing life expectancy from 56.5 years in 2009 to 58.5 years in 2014
Also contained in the report is detailed progress in reducing new HIV infections, the mother-to-child transmission rate from 3.5% in 2010 to less than 2%, increasing the total number of patients on antiretroviral therapy (ART) from 1.1 million in 2009 to 2.5 million, and improving the TB cure rate to 85%.
On Friday, Chabane said government had seen the reduction of mother-to-child transmission from 8% in 2008 to 3.5% in 2011, protecting more than 30 000 babies per annum from infection.
He said by 2011, 19.9 million people had undergone voluntary testing for HIV. "The number of people receiving treatment increased from 1.1 million in 2009 to 1.7 million in 2011."
The report further says there has been a stabilisation of HIV prevalence (the number of people living with HIV), after rising since the 1990s, as indicated by antenatal surveys.
The rate of new infections has decreased from 1.4% to 0.8% in the 15 - 24 age groups with the trend looking set to continue in the coming years.
Authorities say the turnaround could be attributed to an acceleration and expansion of HIV awareness and prevention campaigns, counselling and testing, treatment, care and support.
"For example, since the presidential launch of the HIV Counselling and Testing (HCT) Campaign in April 2010, the number of people tested has increased substantially, confirming improvements in health-seeking behaviour among South Africans. As at mid-2011, 15.1 million people had been tested and an additional 4.8 million people have since been tested."
In future, the initiation of antiretroviral (ARV) treatment at a CD4 count of less than 350 should result in increased numbers of people on treatment and reduced deaths. The number of public facilities initiating patients on ARV drugs also increased from 490 in 2010 to 2 948 in 2011 and the number of nurses trained to provide treatment increased from 290 in 2010 to 10 000 in 2011.
The Department of Health said through improving procurement processes it managed to achieve a 50% decrease in the prices of ARV drugs, which will enable the health sector to treat more patients within the same amount of resources.
"Keeping track of the number of people on treatment should be a priority over the remainder of the term. In this regard, the department has begun to implement a comprehensive information management system," reads the report.
As far as TB control and management is concerned, improvements had been made, with more than eight million people screened during the HCT Campaign. Of these, one million were referred for further diagnosis and management at relevant health facilities. The number of people who default on their TB treatment declined from 7.9% in 2009 to 6.5% in 2010 and, for the first time, the national TB cure rate reached the 70% mark in 2010.
The report does say despite these significant strides, much work is required to achieve the 85% cure rate recommended by the World Health Organisation (WHO).
The department has improved the early diagnosis and detection of resistance to TB treatment, which should reduce the risk of spreading TB.