Prof. Nokuthula Sibiya
Over 40 years ago, at the World Health Organisation’s (WHO) Alma Ata conference, the integration of health programmes was first raised as a way of achieving healthcare for all. In South Africa, the Integration of Services Policy came out in 1996, with the aim of making primary health care services more accessible and available. Integrated care remains a difficult concept to define, but it is generally expected to improve the efficiency of health service delivery.
The Department of Health is in the process of rolling out National Health Insurance (NHI). The NHI is a health financing system that pools funds to provide access to quality health services for all South Africans on the basis of their health needs, irrespective of their socio-economic status. The aim of the NHI is to reduce inequalities and address challenges in both public and private sector health care, increase access to quality health care and better health outcomes across all socio-economic groups through expanded coverage. The imperative for NHI in South Africa is premised on the fact that the majority of our citizens have little or no access to healthcare. Currently, South Africa has an estimated population of 55 million citizens, with an estimated unemployment rate of 27%. For this reason, 80% of the population rely on the public sector for their health care needs.
However, the distribution of health care professionals is not aligned to the needs of the majority of citizens, in the same way that the distribution of gross domestic product is not evenly shared by individuals. For a start, the private sector has a higher percentage of health care professionals than the public sector, and urban areas have more doctors and nurses than rural areas. This is a matter that is not relevant to South Africa alone. To address the challenge of maldistribution of health care professionals, in 2015 the WHO introduced the Global Strategy on Human Resources for Health: Workforce 2030, which aims to achieve four things. The first is to maximise the performance, quality and impact of the health workforce through evidence-informed policies on human resources for health (HRH). The second objective is to ensure that adequate investments is made in HRH so that the current and future needs of the population are covered to address shortages and maldistribution, and improve health outcomes.
The third objective is to ensure that health institutions at sub-national, national, regional and global level have policies to ensure effective leadership and governance, but the target for 2020 is for all countries to have HRH responsible for developing and monitoring policies and regulatory mechanisms to promote patient safety and adequate oversight of the private sector. The last objective is created to strengthen data on HRH for monitoring and accountability of national and regional strategies.
In order to strengthen the healthcare system in South Africa, we need an integrated system, one that will aid in dispelling the disparities that exist in the public healthcare system. These range from a lack of resources to the constant battle against both communicable and non-communicable diseases. An integrated system could see more HRH moving into the public healthcare system, and as well as the introduction of more cost-effective medicine to treat disease. It is also worth noting that developed countries, such as France, Germany and the UK, are also starting to depict a trend of more patients turning to complementary and alternative medicine for preventative and palliative care. Indigenous knowledge systems play a major healthcare role in many countries, including South Africa, in the delivery of primary health care. Therefore, allowing for integrated care in public facilities should not be seen as a foreign step for South Africa. As we prepare for 2030, I believe it is imperative that we begin to ponder on and create a platform for integrated care.
*Prof. Sibiya is the Executive Dean: Faculty of Health Sciences at the Durban University of Technology and the winner of the Department of Science and Technology’s 2018 South African Women in Science Awards in the category of Distinguished Women Scientists in Humanities and Social Sciences.
Integrated care: A solution for South African healthcare (The Science Forum 2019, pg. 47)