

A accountability definition 322 health system performance 150, 320, 321, 234, 251, 278, 298, 321, 366, 368 in health standards compliance 129 information and indicators for 322–325 longstanding failures 291 private sector 415 accountability dimensions information and indicators’ requirements 324 accruals 370, 382 acountability relationships in health system 323
AfCFTA African Continental Free Trade Area 400
African Continental Free Trade Area (AfCFTA) 400 AIDS prevalence 21, 22, 88
Alma-Ata Declaration 46, 58, 60, 320, 346 annual health planning maturing process 309–310 anti-microbial resistance scaling up needed 410
Astana Declaration 60, 61, 320
B
Beaufort West Clinic green building 240 bed capacity provincial spread 224, 225 Bioko Island Malaria Elimination Project 400
C
capacity constraints effect on public confidence 391 financial and human resource 230 of data on workforce 348 capitation system of reimbursement inability to develop 365
CCMDD Centralised Chronic Medicines Dispensing and Distribution programme 66, 114,163, 327–328 Centralised Chronic Medicines Dispensing and Distribution programme (CCMDD) patient-centred care 66, 114,163, 327–328 child health district clinical specialist teams 64–65 child health improving 299 need for improved 25, 41, 42, 407 climate change implications for health planning 293 clinical associates importance of 343 clinics antenatal 270 dependence on 227 extent of reliance on 18, 227–228 Ideal Realisation and Maintenance 232–233 infrastructure ratings 228 patients’ proximity to 226 Stock Visibility System (SVS) 326–327 collaboration intersectoral 306 collaborative governance definition 293 community health workers effectiveness of programmes 346 community service compulsory 345 cost pressures public sector 382 role in maintenance neglect 229 COVID-19 financing 388–389 global response shortcomings 397 impact on economic growth 389–390 impact on mental health of workforce 347 South Africa’s role in global responses 398 COVID-19 infrastructure lessons impact of technology 238 importance of flexibility 238 improving ventilation 238
COVID-19 Tools Accelerator (ACT-A) initiative South Africa’s role in 398
COVID-19 vaccines
Manufacturing Task Force on 398
D
data collection value of rapid 331 data innovations driven by COVID-19 150, 325–326 data shortages effect on health care 262, 329, 332 data sources for human resource planning 340–341 need for improved 348, 408 DDM
District Development Model 62, 76 declarations of Alma-Ata improving health outcomes 46, 58, 60, 320, 346 development assistance international 401–402
Diagnostic-Related Group (DRG) inability to develop a 365 district clinical specialist teams 64 District Development Model (DDM) 62, 76 district health interventions 295, 296, 302, 305, 321
Draft 10-Year Health Infrastructure Plan 237
Draft Maintenance Strategy 238 DRG
“Diagnostic-Related Group” 365
E
emergency obstetric care (EmOC)
Gauteng Province 297 EmOC emergency obstetric care 297 expenditure declining 62 health care 36-37, improving efficiency 132 mental health 193–195 primary health care 70 total district 124 workforce 63
G gender and human rights 97
gender equity in medical workforce 351 gender issues in budgeting 388 global and regional health South Africa’s role in 417 global health initiatives South Africa’s contributions 398–399 Global Strategy on Human Resources for Health: Workforce 2030 equitable access to health workers highlighted 338
goods and services spending per capita 385 governance at provincial level 63, 69 challenges 250, 291, 297, 348 challenges in hospitals 125–126, 129 community participation in 251, 312 implementation of improved 250 importance of good leadership and management for 311 improving 251, 263, 270, 283, 414 policy and planning 249 positive experiences 298 relational view of 293 relationships and interfaces 292, 294, 295, 296, 298, 303, 305 SA Lancet Commission’s findings on 249 weaknesses 77, 130, 283, 312, 409, 414 governance practice dominant relationships in 294 governance relationship district-province 305 provincial-national 306
H
health accounts data national 368 health budget trends 370–372 provincial 370 health care expenditure inequitable 375 health care facilities access to 266 infrastructure planning shortcomings 230–231 waiting times 226 health care needs for the future 241
health channels need for greater efficacy 321 health data
improved access and use of 415 health expenditure per capita variations 376
health financing legislation need 416 reforms 416
health financing reform building consensus around 367 lessons from COVID-19 367 health governance critical roles in 310
health governance charter need for 414
health indicators core 324
health infrastructure capacity constraints 230 challenges 229–230 improving 412 priorities and efficiencies 413 ranked against other African countries 228–229
health infrastructure planning impact of climate change 239
health infrastructure provision asset management shortcomings 232 compliance issues 231 funding and spending inadequacies 231 inadequate capacity and skills 231 overreliance on consultants 232 recommendations 232
Health Market Inquiry (HMI) findings 110, 249, 278, 349, 379–380 health ombud 250, 255, 329, 413
health partnerships public-private 76, 201, 218, 348, 400 Health Patient Registration System (HPRS) 67, 365 health personnel trends 383–385 health practitioners staffing ratios 344–345
Health Products Regulatory Authority (SAHPRA) need for scaled up efforts 104–118, 410 health providers 262, 264, 281, 304, 320, 321, 322, 344, health reforms political economy 366
health service managers further development of 351 health services inequitity 381 standardising 381 health spending provincial 369, 376 reforms 369 compared with international benchmarks 228, 372–375 public 291, 369 trends in 368–370 health standards compliance accountability for 129 health system culture impact on the health system 350 health system governance dominant relationships 294–295 re-sets needed 312–314 health system governance actors 293 health workforce migration 343 need for strategic leadership capability 350 HEEG
United Nations High-Level Commission on Health Employment and Economic Growth (HEEG) report 338–339 high-quality health system conceptual framework 247 definition 247 HIV Advocacy and Health Delivery 399 co-infection 83, 164, 191 lessons from 165, 172 Masoyise Health Programme 214 prevalence 21-22, 58, 62, 82, 88–92, 99, 270 rights-based access to 97 targets set by the United Nations 372 treated as a chronic disease 409 Treatment Action Campaign (TAC) 270 HIV/AIDS burden on health system 82 co-morbidities 159 expansion of care 70 impact on health system development 58 unequal response 88 HMI
Health Market Inquiry 110, 249, 278, 349, 379–380
hospital boards
minimal impact on community needs 321 hospital services
decentralised management 410 hospitals
accountability 128 community engagement 128 definition of ideal 129 financial management reforms 387 funding 131–132 human resources 132–133
Ideal Hospital Realisation and Maintenance Framework (IHRM-F) 129–130 infrastructure 133, 228–230 leaders and management 126–127 mental health services in 185 of the future 239
Office of Health Standards Compliance (OHSC) 129 persistent challenges 125–126 private for mental health services 186 psychiatric 186 ratings 228 role of specialised 124 strengthening governance 129 waiting times 226 workforce 132–133
household surveys provide data from a citizen perspective 325 HPRS
Health Patient Registration System 67, 365
Human Resource Information System (HRIS) aims 353
human resource planning data sources 340 strategic intervention 339 human resources performance studies 341 human resources for health digitisation 353 research 350 skills mix 343 task shifting 343 human resources for health management practices shortcomings 350
Human Resources for Health Plan for 2020/21–2024/25 250
Human Resources for Health Strategy 2030 immediate commitments 354–355 strategic goals 354 vision, goals and actions 354
human resources health strategy implementation 250, 415 prioritiesed recommendations 415 human resources management information systems 348 human resources studies undertaken in South Africa 341–342
IIdeal Clinic Realisation and Maintenance (ICRM) implementation challenges 232–233, 256, 307–308 successes 249 inequalities and inequities need for improved monitoring 407 infrastructure provincial spread 224 infrastructure planning health care facilities 230 Infrastructure Unit Support Systems (IUSS) project achievements 235 challenges 237 Integrated Human Resource, Personnel and Salary System (PERSAL) 348
Joint Health Action Plan 387
Lancet Global Health Commission on High-Quality Health Systems holding systems accountable 320, 321 leadership in Eastern Cape hospitals 300 development 311 leadership and governance WHO definition 292 leadership development need for 414 leadership practices autocratic 311 enabling 300 legislative development health 414
MMasoyise Health Programme 214
maternal mortality 17–18
maternal-child health
3-feet Model 75 programme structures 64
maternal, neonatal and child health (MNCH) experiencing improvement 299 medical workforce
gender equity 351 medico-legal litigation challenges and reforms 386–387 meetings new approaches 304
mental health services
increased investment needed in 412
MomConnect 50, 259 mothers living with HIV 270 mothers of infants
MomConnect 259
NNational Digital Health Strategy moving towards anticipated gains 331
National Health Insurance limited progress 363–365, 381, 391
National Health Insurance Bill data requirements for implementation planning 348 potential for alienation 366 resources for health planning 347–348
National Indicator Data Set (NIDS) summary of Core Health Indicators 324
National Policy on Management of Hospitals see hospitals 123
National Quality Improvement Plan (NQIP) 249, 256
National Quality Strategic Framework proposed structure 248 mandate 247
National Strategic Direction for Nursing Education and Practice: A Road Map for Strengthening Nursing and Midwifery in South Africa (2020/21–2025/26) objectives 355 NDP 2030 implementation of 249
Nelson Mandela-Fidel Castro Medical Collaboration Programme impact on medical student training 347 Non-Communicable Disease National Strategic Plan rapid implementation needed 411 non-communicable diseases (NCDs) data needs for 165–166, 407 nursing strategy recruitment and succession planning 355
Oobstetric deaths causes 18
Occupation Specific Dispensation (OSD) remuneration scales 345 occupational health and safety challenges 218 occupational health services funding 412 Office for Health Standards Compliance (OHSC) inspection reports made public 328–329 value chain 254 OHSC see The Office of Health Standards Compliance (OHSC) ombud health 255
Operation Sukuma Sakhe KwaZulu-Natal province 302–303 oversight actors separate from policy makers 295
Ppackage of essential services importance of 409 pandemic preparedness need to update responses 411 payables 382 performance studies in human resources 341 pharmaceutical analytics units independent called for 331 pharmaceutical utilisation data Mediscor provides public access to 325 pharmacists deployment efficiencies needed 410
PHDC
Western Cape Provincial Health Data Centre 329
policy accountability relationships within the district office 295
political interference governance challenge 305 polycentric process 293 practitioners community service 345 environmental health 147 failures of accountability 278 shortage of 379
Presidential Health Summit human resources for health challenges 348–349
primary health care challenges confronting 60 shortcomings to be addressed 408–409 people’s rights 320
primary health care facilities benchmarks 226 measure of access 266
private financing medical aids 377–378
private health care regulatory and systemic issues 349
private health data fragmented 325 provincial and district health councils extended mandates 414
provincial equitable share (PES) funding formula 375
Provincial Equitable Share formula improving equity 391
public accountability relationships nature of at district office level 296
public health spending 343–344
public health system inverted pyramid of power 297 public health system governance view of 295
measurement of 262
private sector 260-261
quality health system interventions community participation in governance 251
Council for Medical Schemes (CMS) report 251
fighting corruption 250 Human Resources for Health (HRH) Plan 250
National Quality Improvement Plan (NQIP) 251
Office of Health Standards Compliance (OHSC) 250
quality health system interventions statutory health professional councils implementation of mandates 251 Quality Improvement Plan (QI) projects 257–259 quality of care recommendations 413 revolutionising 253 quality of services
national commitment to 410
Rrelational view of governance prominence of 293 relationships policy and oversight 310
Ritshidze Community-led Monitoring 76
S
SAHPRA
Health Products Regulatory Authority 104–118, 410 SECTION27 interviews recommendations 368 views on current and ideal health system 367 service provision relationships of the district office 296 Social, Economic, Commercial and Environmental Determinants of Health (SECEDH) recommendations 408 South African Human Resources for Health (HRH)
Strategy for the Health Sector
South African Lancet National Commission 2019 governance findings 249 high-quality health system definition 247 accreditation 248 certification 248 quality control 248 quality improvement 248 Council for Medical Schemes (CMS) response to 252
SSP
Stop Stockouts Project 327 staffing needs
workload indicators 342 Stock Visibility System (SVS) aim of the system 326 in clinics 326–327 preventing stockouts 327 Stop Stockouts Project (SSP) non-profit organisations involved in 327 Stop TB initiative
South Africa’s role in 398 strengthening governance through relationship building 303 Sustainable Development Goals (SDGs) health and wellness aspirations 397 system-wide governance collective action 307 systems leadership description 294
TTAC
Treatment Action Campaign 270 TB leading natural cause of death 13, 19–20, 25, 33
South African National TB Prevalence Survey
19 policies and programmes 58, 235, 257, COVID-19 impact on 72, 81, 82, 98, 152, 409
national health programmes and support 83–87, 143, 160, 164 co-morbidities 159, 170, 191 occupational disease 201, 205, 206, 214, 218 data 324, 330, 331 stock-outs for medicines 327 community health workers 346 Stop TB initiative 398, 409 technological advances implications 353 telehealth
reshaping the health sector 353 training pipelines planning challenges 339 Treatment Action Campaign (TAC) 270 Triple Billion programme 397 tuberculosis
See TB
UUnited Nations Convention on the Rights of Persons with Disabilities
South Africa’s response 401 United Nations High-Level Commission on Health Employment and Economic Growth (HEEG) report recommendations 338–339 universal health coverage addressing needs 9, 224, 339, 366 financing reforms needed 361 HIV 99 mental health 193 provided by National Health Insurance 281
Wwaiting times for access to health care facilities 226–227
Western Cape Provincial Health Data Centre (PHDC) 329 WHO State of World Nursing 2020 355 WHO frameworks early, criticised 294 whole-of-government (WoGA) key approach 293 whole-of-society (WoSA) key approach 293 achievements 301–302 Western Cape province 301 WISN 255, 342–343
Workload Indicators of Staffing Needs (WISN) Workload Indicators of Staffing Needs 255, 342–343