Briefing paper had to be presented to national government on Poverty and access to health care. Poverty is the state where person lack in availing personal resources and this impact upon their health condition
- Apply the theoretical concept which inform about health care and their transformation into policy and practise
- Evaluate the key elements in health care and their application in practice and constraints of implementing changes.
- Discuss on the political, social and economic context of different disease
- Presentation on informed cases of health care intervention.
Access to health care is all about the timely use of personal health services so that outcome towards a better living can be attained (Khamisa and et.al., 2015). The present briefing paper has been prepared on access to quality healthcare services within South Africa. This study is very important for the reader as getting access to quality health care services is a basic right of all people but this situation is not present in South Africa. It will further assist the local government to assess the issues that are present in health care system so that proper steps can be taken by them.
It is beyond doubt that a huge relation exists between poverty and better access to health care facilities. For 100s of years it has been found that people who belong to lowest socio-economic levels in any nation have got higher death as well as illness rates (Mayosi and Benatar, 2014). This correlation has been observed throughout the world regardless of whether death occurred on account of infectious or non-infectious diseases and how the socio-economic position of the person was measured. The impact of this relation is particular apparent in South Africa because there is a presence of widespread poverty in the nation.
The history of denial to proper health care in South Africa goes back to early 1960s when the nation was grappled with apartheid policies and had become quite isolated from the rest of the world (Marten and et.al., 2014). It was the time when black people in the nation were considered inferior in all contexts and were not given a chance to come out of poverty issue. This forced them to live within disorganized homes, made children homeless which then led to increased poverty cases thereby leading to less access to health care facilities (Churchyard and et.al., 2014). A notable feature of the African healthcare system is its fragmentation in public as well as private health. During the time of 1880s health care facilities were segregated on a racial basis. But then the health act launched in 1919 gave responsibility of curative health care to 4 provinces while preventative care to local bodies (Poku, 2017). Then came the Gluckman Commission during 1942 to 1944 which had made an attempt to redirect the health care system.
The vision was to start a chain of community health centers but then as soon as Nationalist Party came into power during 1948 there was a rejection of Gluckman recommendations entirely. Then came the collapse of the Rand currency of South Africa in the year 1989 and a repeal against apartheid law started in all parts of the nations followed by conduction of free election in 1994 (Khamisa and et.al., 2015). This brought a change in the situation when first democratic elections were held and apartheid system was brought to an end by African National Congress under the leadership of Dr Nelson Mandela. The party established five main programs which focused on meeting the basic needs; developing human resources; building economy; democratization of state and society as well as implementing the RDP. All the five programs were there to bring an improvement in the overall level of poverty followed by health status of the country. Most importantly, the Reconstruction and Development Programme started by Mr Mandela emphasized on the need to provide affordable healthcare through introduction of primary health facilities so that overall health of South African population can be maintained and improved.
There was also a creation of a fragmented health care system that had presence of separate public and private firms followed by 4 former provinces as well as 10 former homelands (Rogerson, 2018). Free health care services were also provided to vulnerable population that included children, pregnant females as well as old age population. Resources were redistributed in rural areas that were in high need of heath care facilities. This also meant that health care staff were required to be retrained and encouraged to work for rural people by serving the poorest in poor communities. There was further a development of policy by Department of health which ensured to pay allowance to healthcare workers who wanted to relocate (Churchyard and et.al., 2014). However, the above mentioned changes had a set of their own challenges. One such was that although the public sector health services were united into one but health facilities for black as well as homelands have been lacking with respect to funding. Issues further arose as reconstruction of healthcare as well as provision of free services led to immense burden on workers.
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The current times showcase that after the end of apartheid era, South Africa has a presence of around 40 million citizens and the government spending on the health care services in terms of GDP has also increased but still it is poorer in terms of meeting the health care needs in comparison to other nations (Mayosi and Benatar, 2014). The high level of illiteracy on account of poverty has also led to lack of knowledge about health, less vaccinations in children, presence of malnutrition, under nutrition as well as smoking and drinking habits (Wiley and Allen, 2016). The poverty situation has also been found to have close relation with creation of asthma, cancer, heart diseases, depression, teenage pregnancy among others (Poku, 2017).
A range of legislative reforms have been introduced within Africa in order to provide services to the poor such as free care for pregnancy females and children; programs to build clinics on a widespread basis; free primary healthcare services, program to build clinics as well as National Health Act. The policies undertaken in this direction have been quite revolutionary and have benefitted the poor people in South Africa to a great extent (Harrison and et.al., 2015). However these have not been enough to bring a turnaround in the overall health care system of South Africa. This is as the government spends around 8.5 percent of its GDP on health care while half is spent on private sector that caters to needs of elite. The remaining 84 percent of population that carries the greatest burden of diseases has been under resourced (Okoror and et.al., 2014). It has further been found that South Africa despite having middle income status has got a presence of poor health outcomes in comparison to other middle income nations.
As of now, the public health service units are quite overcrowded with the clients on account of free service. Health care practices also have a presence of heavy burden on them as they have to attend a long queue of patients on a daily basis (Khamisa and et.al., 2015). They further have a presence of limited resources to perform their activities which also makes them overworked and underpaid. They are thus left with no option but to look for jobs in developed nations such as UK, Australia and USA. There is also a marked differences in rates of diseases as well as mortality between the different races. For example, the prevalence of HIV in the nation showcase that white men and women have a very low diseases prevalence being 0.6 percent and 1.9 percent respectively whereas the highest relevance of the disease has been found in blacks being 13.3 percent (Stoops, Williamson and Braa, 2018).
South African health care system suffers from three basic faultiness that are as follows. First fault is in the lack of leadership by Health Minister of the nation being Aaron Motsoaledi. There is also an issue with respect to commitment to be received from competent healthcare managers and doctors that has led to a major failure of the healthcare system. The overall performance of health departments was found to be compromised by the presence of fragment health care planning; lack of proper coordination between national as well as provincial departments; and absence of a single as well as strong health care system (Churchyard and et.al., 2014). Other than this, corruption has also played a key role in aggreviaating the issue as the provincial health funds of 24 billion given between 2009 and 2013 were regarded as irregular spending (Tomlinson and et.al., 2014). It is however not known as to how much money was involved in corruption but showcases the incompetence of public servants and presence of an inefficient management. The second fault is with respect to compromised primary health care as the nation still does not have a presence of district health system that is fully functional. If this is worked upon in the right manner and at right time then proper quality and equitable health care facilities can be ensured to people of South Africa including the poor (Poku, 2017). The third fault is with respect to health workforce crisis in terms of maldistribution of healthcare workers amongst urban and rural areas and also between public and private health sectors. Then there is further an issue of Moonlighting and agency nursing that is prevalent among nurses. A cross sectional survey was also carried out on the prevalence of agency nursing as well as moonlighting and overtime in South Africa on around 3784 nurses of 80 hospitals (Poku, 2017). The nurses have been found to work in critical care units, emergency firms, operation theatre etc. and they were asked to fill up a questionnaire. The study found that more than 70 percent of the nurses were involved either in moonlighting, overtime or agency service while one third of them did all the three (Rispel, 2015).
As per latest report by AnalytixBI’s on Healthcare Landscape of South Africa in 2016 it has been found that there exists a large number of chronic diseases within the nation the highest among them are HIV; high BP; diabetes; cancer etc. The nation has the fastest growing diabetes epidemic in the world. There is a huge prevalence of cancer within the nation as well. For example, a report by world bank has depicted that in the year 2012 there were 645000 new cases of cancer and 456000 deaths on account of the disease within South Africa (Khamisa and et.al., 2015). This is more prevalent in poor on account of less knowledge and awareness about the disease which makes the patient reach at health care in advanced stages of the disease. The poverty has grappled them so much that that they have to travel long distances, make financial sacrifices so as to get a cure. Cancer in people with low socioeconomic status is more as the white population has access to private health care which has good presence of diagnostic and screening facilities. This is not much in case of public healthcare facilities. Asthma cases in South Africa are more than any other continent in the world and approximately 20 percent of school going children suffer firm it (Okoror and et.al., 2014). Out of them only 2 percent are able to receive proper treatment and that too at the right time.
Poverty has given a rise to large number of diseases within South Africa. A study by AVERT has revealed that South Africa is a home to around 790000 HIV cases which accounts to 43 percent of total world cases (Mayosi and Benatar, 2014). A low income is found to be associated with increased exposure to risky sex; increase in transmission of sexual diseases; delayed diagnoses and treatment. People in South Africa pay less focus on their health and future on account of the harsh situation that is faced by them. The cases are majorly found in poor people that specifically include transgender people; sex works; prisoners and those who inject drugs (HIV AND AIDS IN EAST AND SOUTHERN AFRICA REGIONAL OVERVIEW, 2018). Children are also at risk on account of being sexually molested by the males and a prevalence of myth among them that having sex with virgin leads to curing of HIV.
An article by All Africa has further revealed that there is also a high prevalence of Tuberculosis is the nation on account of poor nutrition; weakened immune system; as well as HIV that all happen because of poverty. The reasons for TB in poor African people are on account of crowded living conditions; poor ventilation. There has however been a big progress in bringing an improvement in treatment of TB but still it a huge burden (Churchyard and et.al., 2014). It has further been found that Multidrug-resistant (MDR) tuberculosis is responsible for 1.8 percent of total cases of TB (Global TB report, 2013). It is also true that South Africa has most XDR tuberculosis cases all over the world which account to 10 percent.
Health care changes for the good of people are constantly taking place in South Africa but history is constantly trying to show on surface through present situations. For example, apartheid is marked so heavily in the minds of African population that discrimination in health care figures for white and blacks can still be observed. In this regard, in order to reduce poverty as well as promote health in South African nation there is a need for economy to take a growth path. It is important for the policy makers within South Africa to focus on human capital and try to attain sustainable socioeconomic development. Economic growth that leads to poverty alleviation and improved health of people can only be fuelled through creative and physical capabilities of people.
It is a huge requirement that the attention is diverted on crucial factors that influence of the overall health status of South African population. This is because overall health of the population has already been compromised on the grounds of colonial past, apartheid, economic disparities, corruption, incompetence as well as a delay in applying bwbwigrs of medical advances to all the people.
In this regard, there is a need to work on dysfunctional public health sector by increasing the overall efficiency as well as effectiveness of managerial practices. Priorities are further required to be set for the usage and supply of resources for public health care sector in South Africa which should be utilized in an efficient manner. There is also a need to train and motivate health care workers from time to time so that there number and efficiency increases to meet the needs of widespread population in the nation.
Conclusion and recommendation
From the above report it can be concluded that the South African continent since a long time was grappled with poverty and issue of apartheid that led to decrease in health care facilities provided to the masses. The blacks were forced to live in disorganized homes, had lack of sanitation facilities followed by absence of any proper health care facilities for them. Situation however improved after the end of apartheid in 1994 when several legal policies and programs were brought in place to provide health care facilities to the masses.