Overview of Health Sector Reforms in South Africa

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This paper provides an overview of key reforms and organisational development initiatives currently underway within the South African public health sector at the national level.

South Africa has made significant progress establishing certain aspects. For example: progressive public health legislation and policies, a unified national health system, increased infrastructure at primary care level, removed user fees for maternal and child health services, a system of social support grants, steady increase of immunisation coverage, and supporting the world’s largest HIV/AIDS treatment programme.

However, sufficient progress towards MDGs 4, 5 and 6 have not been made. The South African Government has initiated a number of reforms to address this including: Re-engineering Primary Health Care, National Health Insurance (NHI), renewed focus on quality assurance and improvement, governance reforms, a new public entity to manage health products, and performance management reform initiatives.

The paper discusses the appropriateness, potential synergies and sequencing of these reforms, as well as potential gaps and risks. Overall, the health reforms analysed are appropriate to most of the identified priorities. There are potential risks or gaps, particularly in relation to the sequencing of interventions. Some Key issues are identified.

General recommendations include the need to focus the various health sector reforms on empowering the front line health care workers, and the need to establish mechanisms and processes through which the reforms can be both synthesised and translated into concrete and manageable plans, that can be realistically operationalised. Identifying competent health system managers and experts from a range of institutions can help assist with the process of translating policy into practice.

The report highlights the need for strengthening engagement with stakeholders, commentators and civil society on the NHI reform process, and for better articulation of the distinction and linkages between the ‘Primary Health Care Re-engineering’ initiative and the NHI initiative.


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