Around 81% of South Africans use public healthcare, but 18% take out private health insurance schemes, which range from basic emergency service cover to full medical plans. The South African government offers co-payments towards healthcare up to a maximum of 40% of the total cost, with the amount you’re entitled to depending on your income.
With regard to public healthcare in 2017, Chief Director of Social Statistics, Dr Isabelle Schmidt said that less than 17% of the population had medical aid cover.
In an attempt to narrow the gap between the two sectors, the South African government is trying to phase in a new National Health Insurance system across the country, which promises greater funding for various forms of healthcare.
The first steps in implementing the new system took place in 2017, with the government hoping that over the next decade it could make better healthcare more readily available to those who can’t afford it.
Cabinet approved the National Health Insurance (NHI) Bill. The NHI Bill is meant to realis universal health coverage in South Africa as the Bill provides for the creation of the NHI Fund, which will report to the Health Minister. Government will roll out NHI in phases.
The skills and funding gap in the South African healthcare system places a burden on the public system, with under staffing and long waiting times a consistent problem.
More than 1,2 million births were recorded, and survival rates among infants and children under 5, and post-HIV interventions have increased. The infant mortality rate (IMR) has declined from an estimated 53,2 infant deaths per 1 000 live births in 2002 to 36,4 infant deaths per 1 000 live births in 2018. On average, a woman will give birth to 2,4 children in her lifetime, which is 0,1 lower than the global average of 2,5.
The doctor-to-population ratio is estimated to be 0.77 per 1 000. But because the majority of GPs – over 70% – work in the private sector, some suggestions are that there is in actual fact just one practicing doctor for every 4200 people. A recent study by consulting firm Econex, for the Hospital Association of SA, notes that up to 17% of newly qualified doctors might be emigrating, while up to 80% of doctors prefer not to work for the state because of poor working conditions.
Eastern Cape – of the various hospitals in the Eastern Cape, Amathole and Alfred Nzo face a high HIV burden, Nelson Mandela Metro and Sarah Baartman face a high TB burden and OR Tambo, Chris Hani, and Buffalo City all face a high dual burden of both HIV and TB. In terms of HIV, in mid-2016, HIV prevalence across all ages in the province was at 11.8% (768 000 people). Between 15 – 49 year olds this increased to 19.2%. Between mid-2015 and 2016, the rate of new HIV infections remained stubbornly high at 35 000. HIV related deaths mid-2015 to mid-2016 were at 11 100. According to the Thembisa Model, ART (antiretroviral treatment) coverage in the province was at 52.3%.
Based on these figures, more than 360 000 people in the Eastern Cape who could benefit from treatment were not on treatment. Of those on treatment, only 73.4% were virally suppressed.
The total ART coverage in 2017 was at 53.81%. This is still significantly far from the 81% that the government is aiming for by 2020, as outlined in the National Strategic Plan on HIV, TB, and STIs 2017 – 2022.
The Free State is South Africa’s second-smallest province by population after the Northern Cape, with a 2014 midyear population estimate of almost 2.8‑million – just over 5% of South Africa’s total population.
According to the Free State health department’s annual report for 2013-2014, 86.8% of babies aged one or younger were immunized. This was down from 95.1% and 91.7% in the previous two years. The department admitted in its last annual report that it had not achieved its target of 95%, citing vaccines being out of stock, new data policies and poor data management as reasons.
This makes healthcare the fourth largest item of government expenditure, superseded by education (19 cents), social protection (13 cents), and executive and legislative organs (13 cents). The Free State province has made important gains in responding to the epidemics of HIV and TB and to STIs, but the response still needs to be accelerated to completely eliminate these three public health threats by 2030. For HIV, three districts have increased epidemics of HIV (micro epidemics), namely: Lejweleputswa (12.4 rate per 100, 000 population); Thabo Mofutsanyane (10.6 rate per 100, 000 population); and Mangaung (10.7 rate per 100, 000 population).
For TB, three districts have increased incidences of TB (TB high burden districts), namely: Xhariep (3.4 rate per 100, 000 population); Lejweleputswa (1.9 rate per 100, 000 population); and Mangaung (1.9 rate per 100, 000 population).
For HIV and AIDS, the province has about 368 000 people living with HIV. Of the 368 000 people living with HIV (PLWHIV), a total of 205 634 people (72.9% of the PLWHIV) are enrolled and receiving ART treatment from the ART facilities of the province. Out of those on ART programmes, 56.3% were confirmed to still be on treatment at their respective ART clinics; of the 56.3% that are confirmed to be on ART treatment, 49.1% (representing 87.2%) were confirmed to have achieved viral suppressions.
The province has about 68 868 people living with HIV that are also confirmed to be suffering from tuberculosis. The province has high incidences of TB, especially in the high TB prevalent districts of Lejweleputswa (Prevalence: 3.4 rate per 100, 000 population); Thabo Mofutsanyane and Mangaung Metro (Prevalence: 1.99 rate per 100, 000 population, for the each of these two districts). TB is more prevalent in the local areas of these districts.
Shortage of human resources is a major issue in Limpopo. Ensuring access to quality healthcare services and ensuring everyone living with HIV and TB get access to treatment and care depends largely on having enough qualified and committed staff. Instead of filling vacant posts and ensuring that there are enough people to properly deliver healthcare, posts are being frozen in many areas.
Human resource shortages cause long waiting times, patients being turned away from facilities, longer hospital stays, higher risk of deaths, and increased pressure on the few staff in place. The overburdening of staff is a major contributor to the worsening of staff attitudes. One of the major causes of medicine stock outs and shortages are a result of staff being too busy to place orders in time. The result of all of this is that patients do not access quality healthcare services as required by the Constitution.
The unavailability of ambulances either in emergencies or for planned patient transport means that many people are forced to make substantial out-of-pocket payments to access health services at facilities.
The Northern Cape recently received a new batch of emergency medical service vehicles to curb deaths and civilians spending their own money to get to the hospital. According to the statistics report in 2016, the John Taole Gaetsewe district comprised of the highest proportion of deaths occurring during infancy.
Upington and De aar’s new state of the art hospitals are running on skeleton staff due to vacancy rates for professionals estimated to be at 70-75% in the province. Doctors and nurses are reluctant to move to the small town of the Northern Cape.
Acting posts are filled for three to four years without being made permanent and overworked staff are great contributors to the long queues at the public health institutions in the province.
Due to shortage of staff, Robert Mangaliso hospital, is a referral facility that is unable to cope with the demands for specialist services and has to make transfers for operations and chronic cases to Bloemfontein.
After HIV and Aids, TB is the second biggest killer in the province and the two infectious diseases have close ties. The Northern Cape health department has admitted that they have known about the 4000 untraceable TB patients, since research was commissioned on the infectious disease two years ago. To date, the patients have not been found. The department doesn’t know how many of these TB carriers are multi and extreme drug resistant cases. Furthermore, the department admits that TB tracer teams hired to ensure that patients across the province continue their medicinal regiments have been disbanded because they are unbudgeted for.
While many continue to complain about the horrendous services they receive at public institutions, South African statistics beg to differ as 71.2% households make use of public clinics or public institutions as their first point of access when ill. Essentially, this eludes to the fact that majority of the country’s population is poor and therefore, simply have no other choice.