Health Care In South Africa Research Articles

Prehospital care providers' understanding of responsibilities during a behavioural emergency.

BackgroundPrehospital emergency care providers are frequently called to assist with the management of mental healthcare users (MHCUs). The Mental Health Care Act no. 17 of 2002 regulates mental healthcare in South Africa, but the act fails to consider the responsibilities of prehospital emergency care providers in the provision of mental healthcare. Rather South African Police Services were given authority over the well-being of a MHCU in the prehospital setting.AimTo investigate prehospital emergency care providers’ understanding of their responsibilities towards MHCUs and the community during the management of behavioural emergencies.SettingThe research was carried out at prehospital emergency care providers from the three main levels of care, currently operational within the boundaries of Pretoria, South Africa.MethodsA grounded theory qualitative study design was chosen using semi-structured focus groups for each level of prehospital emergency care – basic life support (BLS), intermediate life support (ILS) and advanced life support (ALS). Data from each focus group were collected through audio recordings and transcribed and analysed using a framework approach.ResultsA total of 19 prehospital emergency care providers participated; two focus group interviews were performed for each level of care. The BLS focus groups each consisted of two participants. The ILS focus groups consisted of three participants each, and the ALS focus groups consisted of six and three participants. Four key themes were identified: perceptions of behavioural emergencies, responsibilities, understanding of legislation and barriers experienced.ConclusionParticipants placed high value on their moral and medical responsibilities towards MHCUs, which they described as ensuring the safety of themselves, MHCUs and the community; preventing further harm; and transporting MHCUs to an appropriate healthcare facility. There was a desire for revision of legislation, better education, skill development and awareness of mental healthcare in the prehospital emergency care setting.

Outcomes of newborn hearing screening at an academic secondary level hospital in Johannesburg, South Africa.

BackgroundThe Health Professions Council of South Africa (HPCSA) issued early hearing detection and intervention guidelines, which has universal newborn hearing screening (UNHS) as one of the important goals. Despite established evidence of the importance of UNHS globally, there has been no mandated formalised and standardised implementation as yet in South Africa.ObjectivesThe aim of this study was to describe the outcomes of newborn hearing screening (NHS) in an academic secondary level hospital in Johannesburg, South Africa.MethodsThis was a prospective non-experimental feasibility study over a 3-month period, involving conducting hearing screening of 121 neonates. Audiologists conducted a risk factor assessment, otoscopic examinations and distortion product otoacoustic emissions (DPOAEs) screening on each neonate, with follow-up appointments for re-screening and diagnostic audiological assessments for all neonates with refer findings. Data were analysed using STATA intercooled version 11©, through both descriptive and inferential statistics (Fisher’s exact test), with significance established where p-values less than 0.05 were considered statistically significant.ResultsOf the 121 neonates screened, the majority (75%) were screened in the first 24 h of life. A high refer rate (47%) of the total sample was found on DPOAE screening. No maternal or neonatal risk factors were found to be significantly associated with refer findings.ConclusionFindings contribute towards the existing evidence base that raises implications for successful implementation of NHS programmes in public healthcare in South Africa. Screening protocols need to consider the timing of screening, the measures and procedures adopted in the screening protocols, as well as the follow-up strategies.

Probing the Context of Vulnerability: Zimbabwean Migrant Women's Experiences of Accessing Public Health Care in South Africa

The economic meltdown and worsening levels of poverty in Zimbabwe led to a significant increase in the number of women migrating to South Africa from 2005 to 2010 (Crush et al., 2015: 367). A Southern African Migration Programme (SAMP) survey in 1997 found that 61% of Zimbabwean migrants were male and 39% were female (Crush et al., 2015: 367). This suggested that there was an increase in the number of women migrating to South Africa compared with other countries in Southern Africa. This gives us reason to speculate that the numbers could have increased a decade later because of the economic crisis that resulted in large numbers of people migrating out of Zimbabwe. Most Zimbabwean women are now moving across borders independently of their spouses and partners in search of better and sustainable livelihoods (Dzingirai et al., 2015: 13; Mbiyozo, 2019). Whilst some have valid immigration documents, a large number of these women are undocumented, which heightens their vulnerability to various structures of violence (Bloch, 2010;Rutherford, 2020: 172).

Private Healthcare in South Africa: Expensive Doesn’t Always Mean Excellent

Private Healthcare in South Africa: Expensive Doesn’t Always Mean Excellent

Understanding non-communicable diseases: combining health surveillance with local knowledge to improve rural primary health care in South Africa

ABSTRACT Background: NCDs are non-infectious, long-term conditions that account for 40 million deaths per annum. 87% of premature NCD mortality occurs in low- and middle-income countries. Objective: The aims were:develop methods to provide integrated biosocial accounts of NCD mortality; and explore the practical utility of extended mortality data for the primary health care system. Methods: We drew on data from research programmes in the study area. Data were analysed in three steps: [a]analysis of levels, causes and circumstances of NCD mortality [n = 4,166] from routine census updates including Verbal Autopsy and of qualitative data on lived experiences of NCDs in rural villages from participatory research; [b] identifying areas of convergence and divergence between the analyses; and [c]exploration of the practical relevance of the data drawing on engagements with health systems stakeholders. Results: NCDs constituted a significant proportion of mortality in this setting [36%]. VA data revealed multiple barriers to access in end-of-life care. Many deaths were attributed to problems with resources and health systems [21%;19% respectively]. The qualitative research provided rich complementary detail on the processes through which risk originates, accumulates and is expressed in access to end-of-life care, related to chronic poverty and perceptions of poor quality care in clinics. The exploration of practical relevance revealed chronic under-funding for NCD services, and an acute need for robust, timely data on the NCD burden. Conclusions: VA data allowed a significant burden of NCD mortality to be quantified and revealed barriers to access at and around the time of death. Qualitative research contextualised these barriers, providing explanations of how and why they exist and persist. Health systems analysis revealed shortages of resources allocated to NCDs and a need for robust research to provide locally relevant evidence to organise and deliver care. Pragmatic interdisciplinary and mixed method analysis provides relevant renditions of complex problems to inform more effective responses.

KN95 filtering facepiece respirators distributed in South Africa fail safety testing protocols

Background . Given the global shortage of N95 filtering facepiece respirators (FFP2 in Europe) during the COVID-19 pandemic, KN95 masks (Chinese equivalent of the N95 and FFP2) were imported and distributed in South Africa (SA). However, there are hardly any published independent safety data on KN95 masks. Objectives. To evaluate the seal, fit and filtration efficiency of several brands of KN95 masks marketed for widespread use in SA healthcare facilities, using standardised testing protocols. Methods . The verifiability of manufacturer and technical details was first ascertained, followed by evaluation of the number of layers comprising the mask material. The testing protocol involved a directly observed positive and negative pressure user seal check, which if passed was followed by qualitative fit testing (sodium saccharin) in healthy laboratory or healthcare workers. Quantitative fit testing (3M) was used to validate the qualitative fit testing method. The filtration efficacy and integrity of the mask filter material were evaluated using a particle counter-based testing rig utilising aerosolised saline (expressed as filtration efficacy of 0.3 µm particles). Halyard FLUIDSHIELD 3 N95 and 3M 1860 N95 masks were used as controls. Results . Twelve KN95 mask brands (total of 36 masks) were evaluated in 7 participants. The mask type and manufacturing details were printed on only 2/12 brands (17%) as per National Institute of Occupational Safety and Health and European Union regulatory requirements. There was considerable variability in the number of KN95 mask layers (between 3 and 6 layers in the 12 brands evaluated). The seal check pass rate was significantly lower in KN95 compared with N95 masks (1/36 (3%) v. 12/12 (100%); p<0.0001). Modification of the KN95 ear-loop tension using head straps or staples, or improving the facial seal using Micropore 3M tape, enhanced seal test performance in 15/36 KN95 masks evaluated (42%). However, none of these 15 passed downstream qualitative fit testing compared with the control N95 masks (0/15 v. 12/12; p<0.0001). Only 4/8 (50%) of the KN95 brands tested passed the minimum filtration requirements for an N95 mask (suboptimal KN95 filtration efficacy varied from 12% to 78%, compared with 56% for a surgical mask and >99% for the N95 masks at the 0.3 µm particle size). Conclusions . The KN95 masks tested failed the stipulated safety thresholds associated with protection of healthcare workers against airborne pathogens such as SARS-CoV-2. These preliminary data have implications for the regulation of masks and their distribution to healthcare workers and facilities in SA.

KN95 filtering facepiece respirators distributed in South Africa fail safety testing protocols.

Given the global shortage of N95 filtering facepiece respirators (FFP2 in Europe) during the COVID-19 pandemic, KN95 masks (Chinese equivalent of the N95 and FFP2) were imported and distributed in South Africa (SA). However, there are hardly any published independent safety data on KN95 masks. To evaluate the seal, fit and filtration efficiency of several brands of KN95 masks marketed for widespread use in SA healthcare facilities, using standardised testing protocols. The verifiability of manufacturer and technical details was first ascertained, followed by evaluation of the number of layers comprising the mask material. The testing protocol involved a directly observed positive and negative pressure user seal check, which if passed was followed by qualitative fit testing (sodium saccharin) in healthy laboratory or healthcare workers. Quantitative fit testing (3M) was used to validate the qualitative fit testing method. The filtration efficacy and integrity of the mask filter material were evaluated using a particle counter-based testing rig utilising aerosolised saline (expressed as filtration efficacy of 0.3 µm particles). Halyard FLUIDSHIELD 3 N95 and 3M 1860 N95 masks were used as controls. Twelve KN95 mask brands (total of 36 masks) were evaluated in 7 participants. The mask type and manufacturing details were printed on only 2/12 brands (17%) as per National Institute of Occupational Safety and Health and European Union regulatory requirements. There was considerable variability in the number of KN95 mask layers (between 3 and 6 layers in the 12 brands evaluated). The seal check pass rate was significantly lower in KN95 compared with N95 masks (1/36 (3%) v. 12/12 (100%); p<0.0001). Modification of the KN95 ear-loop tension using head straps or staples, or improving the facial seal using Micropore 3M tape, enhanced seal test performance in 15/36 KN95 masks evaluated (42%). However, none of these 15 passed downstream qualitative fit testing compared with the control N95 masks (0/15 v. 12/12; p<0.0001). Only 4/8 (50%) of the KN95 brands tested passed the minimum filtration requirements for an N95 mask (suboptimal KN95 filtration efficacy varied from 12% to 78%, compared with 56% for a surgical mask and >99% for the N95 masks at the 0.3 µm particle size). The KN95 masks tested failed the stipulated safety thresholds associated with protection of healthcare workers against airborne pathogens such as SARS-CoV-2. These preliminary data have implications for the regulation of masks and their distribution to healthcare workers and facilities in SA.

Tiered healthcare in South Africa exposes deficiencies in management and more patients with infectious etiology of primary adrenal insufficiency.

ObjectiveWe wished to determine the prevalence, etiology, presentation, and available management strategies for primary adrenal insufficiency (PAI) in South Africa (SA), hypothesizing a prevalence greater than the described 3.1 per million. There is great inequity in healthcare allocation, as two parallel healthcare systems exist, potentially modifying PAI patients’ clinical profiles, private being better resourced than public healthcare.MethodsAn online survey of physicians’ experience relating to PAI.ResultsThe physicians were managing 811 patients, equal to a prevalence of 14.2 per million. Likely causes of PAI in public/ academic vs private settings included: AIDS-related [304 (44.8%) vs 5 (3.8%); p<0.001], tuberculosis [288 (42.5%) vs 8 (6.0%); p<0.001], autoimmune disease [50 (7.4%) vs 88 (66.2%); p<0.001], malignancy [27 (4.0%) vs 7 (5.3%); p = 0.500], genetic including adrenoleukodystrophy (ALD) [5 (0.7%) vs 16 (12.0%); p<0.001], respectively. Overall, more patients presented with nausea [101 (74.3%) and vomiting 89 (65.9%), than diarrhoea 76 (58.9%); p = 0.008 and 126 (15.5%) in adrenal crisis. Features suggestive of a crisis were hypoglycaemia [40 (78.4%) vs 42 (48.8%); p = 0.001], shock [36 (67.9%) vs 31(36.9%); p<0.001], and loss of consciousness [25 (52.1%) vs 27 (32.9%); p = 0.031]. Greater unavailability of antibody testing in the public vs. the private sector [32 (66.7%) vs 30 (32.1%); p = 0.001], [serum-ACTH 25 (52.1%) vs 16 (19.5%); p<0.001] and glucocorticoids were [26 (54.2%) vs 33 (40.2%); p = 0.015]. Many patients, 389(66.7%) were not using identification, indicating that they need steroids in an emergency.ConclusionA survey of South African physicians suggests a higher prevalence than previously reported. Patients presented with typical symptoms, and 15.5% presented in adrenal crisis. Significant disparities in the availability of physicians’ expertise, diagnostic resources, and management options were noted in the public versus private settings. Greater awareness among health practitioners to timeously diagnose PAI is required to prevent a life-threatening outcome.

A qualitative analysis of perceptions of various stakeholders on nutrition-sensitive agricultural interventions, including the taxation on sugar-sweetened beverages (SSBs), to improve overall health and nutrition in South Africa

BackgroundAs a low-middle income country, South Africa has seen an upsurge in the double burden of malnutrition (DBM). Owing to the rising costs of obesity on healthcare in South Africa, the National Treasury implemented a fiscal policy for the taxation of SSBs, known as the Health Promotion Levy, in line with the WHO recommendation. Potential negative impacts of the policy on the sugar cane industry and economic and rural development have been voiced by different sectors. By including a subsection in the SSBs fiscal policy and aligning the goals with existing policies, government could have made provisions for sugar cane farms to substitute crops with alternatives, including nutritional alternatives where possible, while supporting existing small-scale farms to produce nutrient-dense, local and culturally acceptable crops. Thus, the purpose of the study is to understand the perceptions of the various stakeholders on combining nutrition-sensitive agricultural interventions with the taxation on sugar-sweetened beverages (SSBs) to improve overall health and nutrition in South Africa.MethodsSemi-structured, in-depth interviews were conducted with each participant. The interviews were audio-recorded, transcribed intelligent verbatim, and cross-checked against the audio-recordings by the principal researcher. ATLAS.ti 8 software was used to navigate the data and assist with thematic analysis.ResultsPerceptions of combining SSB taxation with agricultural policies to improve food and nutrition security were positive. The participants found it to be an innovative idea in theory but questioned the feasibility of combining policies. Participants highlighted education as an essential element for successfully changing behaviour to ensure a positive impact of the combined policy approach. Participants believed that before government could scale up nutrition-sensitive agricultural interventions, basic services and government functions would first need to run optimally.ConclusionOverall, perceptions with regard to combining the taxation on SSBs with nutrition-sensitive agricultural policies to improve overall health and nutrition in South Africa were positive. Although participants questioned the feasibility of combining these policies, it was viewed as a way to combat alleged collateral damage linked to the tax, with a specific focus on developing small-scale farmers. More research into these combined policy approaches in a South African context is required.

Discovery Digital Health strategy: COVID-19 accelerates online health care in South Africa

Learning outcomes The broad teaching objective is underpinned by the themes of purpose and partnerships. This is taught through application of business model innovation for sustainability where the value proposition is broadened to social and environmental, and multi-stakeholder partnerships in a time of crisis. Students will be expected to analyse the above concepts through a meso (sustainable value), micro (business models) and macro (ecosystems) lens. Upon completion of the case study discussion, successful students will be able to better understand the three features that support sustainable value, explore how a global pandemic can create new business models and partnerships to create social value and analyse how business ecosystems operate against the 6 C framework. Case overview / synopsis Discovery Holdings Limited is a leading financial service organisation in South Africa, and its Digital Health division is responsible for the platform which delivers telemedicine offerings to doctors and patients. The case highlights the development of the telemedicine offering and the period that is covered spans from the launch of the Discovery DrConnect platform in 2017 to April 2020. Adrian Moss is the protagonist in the case. He is a manager in the Special Projects, Digital Health team of Discovery Health, responsible for the DrConnect project. His challenge is how to raise more awareness of the DrConnect offering and how to enhance uptake from doctors and patients. COVID-19 and the lockdown in South Africa in March and April of 2020 presented an opportunity for both doctors and patients to use telemedicine as a new way of engagement and treatment. Complexity academic level This case is appropriate for masters, MBA and executive education students focusing on the fields of study of environment of business, strategy, business model innovation and social entrepreneurship. Supplementary materials Teaching Notes are available for educators only. Subject code CSS: 11 Strategy.

Compliance with South Africa’s Antimicrobial Resistance National Strategy Framework: are we there yet?

Antimicrobial resistance (AMR) is a growing problem worldwide. South Africa has recently released its Antimicrobial Resistance National Strategy Framework (referred to as the Framework) to instigate antimicrobial stewardship programmes (ASPs). Consequently, there is a need to assess compliance with the Framework. Methods: Descriptive study design, collecting quantitative data, among pre-selected public healthcare facilities. One healthcare professional from each participating facility, involved in ASPs, was invited to participate. Results: Overall 26 facilities from 8 provinces participated. Average compliance to the Framework was 59.5% for the 26 facilities, with 38.0% for community health centres, 66.9% for referral hospitals and 73.5% for national central hospitals. For 7 facilities compliance was <50% while 5 facilities were >80% compliant. Conclusion: Although some facilities complied well with the Framework, overall compliance was sub-optimal. With the introduction of universal healthcare in South Africa, coupled with growing AMR rates, ongoing initiatives to actively implement the Framework should be targeted at non-compliant facilities.

The Influence of Racial Differences in the Demand for Healthcare in South Africa: A Case of Public Healthcare.

The study sought to analyse the influence of racial differences in the demand for public healthcare in South Africa, using the 2018 General Household Survey (GHS) data. This was completed to understand if race still plays a role in access to healthcare in post-apartheid South Africa. Logistic regression analysis revealed that race significantly explained the variance in demand for public healthcare, with White populations having the lowest probability of demand for public healthcare compared to other races. Consequently, the study noted that racial differences still play a critical role in affording one access to healthcare after assessing the situation obtaining in public healthcare. Therefore, the study recommends that the government of South Africa should create policies that encourage equal access to basic services in addressing racial inequality in the country.

Reasons for non-compliance with quality standards at primary healthcare clinics in Ekurhuleni, South Africa

BackgroundThe South African Minister of Health stated that compliance with quality standards in health services is non-negotiable as it is fundamental in improving South Africa’s current poor health outcomes, restoring patient and staff confidence in the public healthcare system, achieving widespread sustainable development and providing basic quality healthcare in South Africa. Non-compliance with quality standards, as evidenced by increased quality-related queries from the community, prompted the researcher to explore and describe the reasons for such at primary healthcare clinics in Ekurhuleni.AimThis study sought to explore and describe the reasons for non-compliance with quality standards at the primary healthcare in Ekurhuleni in order to propose recommendations to facilitate compliance with quality standards.SettingThe study was conducted at primary healthcare clinics in Ekurhuleni, one of the metropolitan districts, situated in an area east of the Gauteng province.MethodsA qualitative, exploratory, descriptive and contextual research design was used for this study. Participants were purposefully selected from the population and consisted of individuals who willingly consented to participate. Twelve semi-structured individual interviews were conducted.ResultsThe study findings revealed challenges with management practices, for example, non-involvement in decision-making, lack of support and poor internal communication practices. In addition, challenges with human, material and financial resources were stated as reasons for non-compliance with quality standards.ConclusionRecommendations to facilitate compliance with quality standards were described, which included implementation of effective management practices and allocation of adequate healthcare resources required to facilitate such compliance.

Critical care triaging in the shadow of COVID-19: Ethics considerations

Since the World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern, COVID-19 infection and the associated mortality have increased exponentially, globally. South Africa (SA) is no exception. Concerns abound over whether SA's healthcare system can withstand a demand for care that is disproportionate to current resources, both in the state and private health sectors. While healthcare professionals in SA have become resilient and adept at making difficult decisions in the face of resource limitations, a surge in COVID-19 cases could place a severe strain on the country's critical care services and necessitate unprecedented rationing decisions. This could occur at two critical points: access to ventilation, and withdrawal of intensive care in non- responsive or deteriorating cases. The ethical dimensions of decision-making at both junctures merit urgent consideration.

Chemicals, noise and occupational hearing health in South Africa: A mapping study.

BackgroundChemical exposure leading to ototoxicity is a fresh challenge for occupational healthcare in South Africa.ObjectivesThe critical question is: ‘what is known about occupational ototoxic chemicals with or without noise exposure in South Africa?’MethodThis qualitative, mapping study was completed with published (peer-reviewed) and grey literature from 1979-2019. Data was analysed using the Preferred Reporting Items for Systematic reviews and Meta-Analyses: extension for Scoping Reviews and the Nursing and Allied Health Resources Section subcommittee on Mapping the Literature of Nursing and Allied Health (adapted). Numerical analysis of article type was completed, but the primary focus was on capturing patterns/trends using thematic analysis and ideology critique.ResultsThe African Journal of Disability, African Journal of Primary Health Care and Family Medicine, South African Medical Journal, The South African Journal of Communication Disorders [SAJCD] and Health SA Gesondheid) were included with the SAJCD containing one relevant item and seventeen other items were analysed. Research focusses on the mining sector (gold) in Gauteng, and ototoxic medication (tuberculosis and/or human immunodeficiency virus) take precedence. In KwaZulu-Natal, the focus is on commerce and industry across formal and informal sectors. There are no governmental policies that refer to chemical ototoxicity. Occupational hearing loss is configured exclusively on the meme that noise exposure is the only toxin.ConclusionChemical exposures are only just beginning to be recognised as ototoxic in South Africa. Hearing conservation programmes should always serve the workers’ interests and never bow down to the econometric interests of employers.

Health care in South Africa

Every person who is at least somewhat familiar with the history of medicine knows the name of Christiaan Barnard, cardiac surgeon who performed the first successful heart transplant. This happened on December 3, 1967 at a hospital in Cape Town, South Africa. A man suffering from an incurable heart disease had a healthy organ transplant from a 25-yearold girl who died in a car accident. The patient lived for two weeks and died from complicated bilateral pneumonia, however, this case marked the beginning of a new era in transplantology giving hope of saving hundreds of patients. What do we know about health care of the Republic of South Africa, one of the most developed countries on the African continent? How much does the present situation allow the government to be classified as a world leader in healthcare? Unfortunately, according to the World Health Organization newsletter, South Africa at the present stage tops the sad ranking of countries by the number of HIV-infected and AIDS patients — about 7 million out of the 58 million people are infected with a dangerous virus. Unlike developed countries, where the main cause of death is pathology of the cardiovascular system, strokes and malignant neoplasms, three quarters of patients in the Republic of South Africa die due to infectious processes. Speaking about the heterogeneity of medicine, we were almost for the first time confronted with the fact that health services can be divided not only into health care for the «rich and poor», but also for the «white and black».

Bacterial diversity and functional profile of microbial populations on surfaces in public hospital environments in South Africa: A high throughput metagenomic analysis

With the introduction of the One Health approach to global health advocated by the World Health Organization, the role of the environment as a reservoir and transmission route for diverse microorganisms is increasingly being recognised globally. This study investigated the diversity and functional profiles of bacterial communities using high-throughput metagenomics of the 16S rRNA gene in samples collected from environmental surfaces in different levels of healthcare in South Africa. A total of 150 samples were collected in three public hospitals [District (A), Regional (C) and Central (B)] from intensive care and paediatric wards. Military hospitals were excluded. Swabs were taken from mattresses, drip stands, ward telephones, patient files and sinks. A total of 7,996,346 reads were found, of which 7,319,569 were quality-filtered reads. Unique (and shared) microbial community structures were identified within the different hospital levels, locations and sample source. A total of 11 phyla, 29 classes, 50 orders, 105 families, 190 genera and 288 known species were identified. The primary phyla identified were Proteobacteria, Firmicutes and Actinobacteria. The dominant class identified was Gamma-proteobacteria, followed by Bacilli and Actinobacteria. Acinetobacter (16.08%), Citrobacter (13.64%), Staphylococcus (9.65%) and Corynebacterium (6.15%) were predominant genera. Although the functional profile analysis identified citrate cycle (TCA), signal transduction mechanisms, bisphenol degradation, tyrosine metabolism and transcription-factors as the dominant pathways, human disease functional classes, including involvement in antibiotic resistance, were significantly identified. The drip stands, patient files and ward telephones in all the wards of Hospitals A and C contained a higher number of human diseases functional classes. These findings highlight the potential of different hospital environments to serve as reservoirs and possible sources of bacterial pathogens; thus, the need for better monitoring and hygienic practices within the hospital environment.

Structuring Sustainable Universal Health Care in South Africa.

Intervening in debates around universal health care in South Africa, this article draws on class-based analytical tools from social medicine, political economy, and historical sociology. It is argued there are 3 keys to achieving sustainable universal health care in South Africa: addressing the socioeconomic roots of ill health; establishing a fully public, nonprofit health care system; and adequate investment in undervalued female workers who are the backbone of public health care. Each key is discussed with accompanying recommendations, using evidence from South Africa and other countries. Principal constraints are also identified through an analysis demonstrating the links between inequality, health care financing, and the monopoly structure of the South African health care industry.

Technical efficiency of provincial public healthcare in South Africa

BackgroundForty-nine million people or 83 per cent of the entire population of 59 million rely on the public healthcare system in South Africa. Coupled with a shortage of medical professionals, high migration, inequality and unemployment; healthcare provision is under extreme pressure. Due to negligence by the health professionals, provincial health departments had medical-legal claims estimated at R80 billion in 2017/18. In the same period, provincial health spending accounted for 33 per cent of total provincial expenditure of R570.3 billion or 6 per cent of South Africa’s Gross Domestic Product. Despite this, healthcare outcomes are poor and provinces are inefficient in the use of the allocated funds. This warrants a scientific investigation into the technical efficiency of the public health system.MethodsThe study uses data envelopment analysis (DEA) to assess the technical efficiency of the nine South African provinces in the provision of healthcare. This is achieved by determining, assessing and comparing ways that individual provinces can benchmark their performance against peers to improve efficiency scores. DEA compares firms operating in homogenous conditions in the usage of multiple inputs to produce multiple outputs. Therefore, DEA is ideal for measuring the technical efficiency of provinces in the provision of public healthcare. In DEA methodology, the firms with scores of 100 per cent are technically efficient and those with scores lower than 100 per cent are technically inefficient. This study considers six DEA models using the 2017/18 total health spending and health staff as inputs and the infant mortality rate as an output. The first three models assume the constant returns to scale (CRS) while the last three use the variable return to scale (VRS) both with an input-minimisation objective.ResultsThe study found the mean technical efficiency scores ranging from 35.7 to 87.2 per cent between the health models 1 and 6. Therefore, inefficient provinces could improve the use of inputs within a range of 64.3 and 20.8 per cent. The Gauteng province defines the technical efficiency frontiers in all the six models. The second-best performing province is the North West province. Other provinces like KwaZulu-Natal, Limpopo and the Eastern Cape only perform well under the VRS. The other three provinces are inefficient.ConclusionsBased on the VRS models 4 to 6, the study presents three policy options. Policy option 1 (model 4): the efficiency gains from addressing health expenditure wastage in four inefficient provinces amounts to R17 billion. Policy option 2 (model 5): the potential savings from the same provinces could be obtained from reducing 17,000 health personnel, advisably, in non-core areas. In terms of Policy option 3 (model 6), three inefficient provinces should reduce 6940 health workers while the same provinces, inclusive of KwaZulu-Natal could realise health expenditure savings of R61 million. The potential resource savings from improving the efficiency of the inefficient provinces could be used to refurbish and build more hospitals to alleviate pressure on the public health system. This could also reduce the per capita numbers per public hospital and perhaps their performance as overcrowding is reportedly negatively affecting their performance and health outcomes. The potential savings could also be used to appoint and train medical practitioners, specialists and researchers to reduce the alarming numbers of medical legal claims. Given the existing challenges, South Africa is not ready to implement the National Health Insurance (NHI) Scheme, as it requires additional financial and human resources. Instead, huge improvements in public healthcare provision could be achieved by re-allocating the resources ‘saved’ through efficiency measures by increasing the quality of public healthcare and extending healthcare to more recipients.

Transforming South African Public Hospitals Through Intrapreneurship Practice: Views of Unit Nurse Managers Regarding Their Potential Contribution

The insurmountable challenges confronting public hospitals globally jeopardize envisaged quality. South Africa health care system faces a number of challenges calling for strategic business approaches embodied through intrapreneurship practice. As a foreign concept in nursing, intrapreneurship is least understood. Views of unit nurse managers concerning their potential contribution towards improving services at public hospitals are least understood. A qualitative, descriptive and explorative study done through focus groups shed light. Data analysed through Tesch approach culminated in rich verbatim. The participants&amp;rsquo; shared the following views concerning their intrapreneurial contribution; ability to take&amp;ndash;risk in bureaucratic public hospitals; they associate the initiative with creativity and novelty through leading transformative projects in teams, the business leaders are knowledgeable, and share ideas internally or outside. The remarkable paradigm shift in nursing adopting business strategies has a significant impact on outcome of nursing care. The proposed recommendations adding significant value, transform health care policy, practice, education. On-going capacity development for the nurses in clinical practice is a necessary quality improvement initiative.