Department of Health Strategic Plan 2014/15-2018/19

Objectives

South Africa’s 2014/15 to 2018/19 health strategy seeks to achieve “a long and healthy life for all South Africans” by improving health status through prevention, healthy lifestyles and equitable, efficient, quality and sustainable health-care delivery.[1]It responds to a quadruple burden of HIV and tuberculosis, maternal and child morbidity and mortality, non-communicable diseases, and violence and injuries, alongside concerns about health-system quality, inefficiency and private-sector costs.[2][3][4]

• Increase life expectancy, reduce maternal, neonatal and child mortality, improve tuberculosis prevention and cure, combat HIV and AIDS, reduce non-communicable diseases, and halve injuries, accidents and violence from 2010 levels by 2030.[4]
• Advance universal health coverage through phased National Health Insurance, founded on equity, social solidarity, affordability, efficiency and financial risk protection.[5][4]
• Strengthen prevention and health promotion by addressing social, economic, environmental and behavioural determinants of health, including tobacco use, unhealthy diet, physical inactivity, harmful alcohol use, obesity and unsafe environments.[6][1][3]
• Implement the Strategic Plan for Non-Communicable Diseases 2012-2017 to reduce risk factors and improve management of chronic conditions, including hypertension and diabetes.[7][8]
• Improve primary health care for mental health, rehabilitation, disability, eye care, oral health and older people, while expanding integrated and decentralised mental-health services.[9]
• Strengthen quality, safety, governance, health information, research, human resources, infrastructure and meaningful public-private partnerships across the health system.[10][11]

Implementation

Implementation combines health-system reform, decentralised district delivery, intersectoral action and strengthened regulation. National leadership is provided through the National Health Council, comprising the Minister of Health and provincial Members of the Executive Council for Health, supported technically by the National Department of Health Director-General and provincial heads of department.[4]Provinces, municipalities and health districts deliver services within national policy, norms and standards, while the District Health System serves as the principal vehicle for primary health care.[12][13]

• Phase in National Health Insurance through pilot districts, expansion towards half of the country’s 52 health districts, a functional fund that purchases services from accredited and contracted providers, and health-facility readiness improvements.[14][15]
• Re-engineer primary health care by expanding ward-based outreach teams, district clinical specialist teams, contracted general practitioners and school-health services, while developing Ideal Clinics and community-based outreach structures.[10][7]
• Strengthen district governance through district management offices, district health councils, clinic committees and district hospital boards, with collaboration among government departments, civil society, development partners and private providers.[13][7]
• Integrate chronic-care services through the Integrated Management of Chronic Diseases Model, which supports patient-centred management of HIV and non-communicable diseases.[6]
• Deliver prevention through healthy-lifestyle mobilisation, school health, human papillomavirus vaccination, screening for raised blood pressure and glucose, and coordinated interventions on violence, injuries and child diarrhoea.[9][16][7][17]
• Develop eHealth and information systems, including an integrated patient-based national health information system using interoperability standards, alongside disease surveillance, research coordination and integrated monitoring and evaluation.[18][14]
• Improve medicines access through essential-medicines selection, treatment guidelines, procurement planning, linked stock systems, central buffer stocks, supplier-performance monitoring and chronic-medicine collection points.[18][19]
• Regulate quality and safety through the Office of Health Standards Compliance, which inspects establishments, monitors adherence to norms and standards, manages complaints and supports patient-safety and quality-improvement processes.[6][20]
• Establish the South African Health Products Regulatory Authority to replace the Medicines Control Council and extend regulation to medicines, medical devices, diagnostics, cosmetics, complementary and alternative medicines, and African traditional medicines.[21][22]
• Build workforce, management and infrastructure capacity through staffing norms, nursing and midwifery education, leadership development, conditional grants, infrastructure standards and provincial support.[23][24][25]
• Monitor progress through national norms and standards, user-feedback systems, dashboards, health-management information, research, surveillance and programme indicators.[10][26]Key non-communicable disease targets include reducing obesity from 65% to 55% among women and from 31% to 21% among men, and screening five million people each for high blood pressure and raised blood glucose by 2018/19.[7][17]
• Finance reform through public and private-sector capacity, National Health Insurance pilots, conditional grants and health-economics research.[5][15]National Health Insurance pilot allocations were South African rand 70 million, South African rand 74 million and South African rand 77.9 million over the medium-term period, while the national health conditional grant allocations were South African rand 420 million, South African rand 444 million and South African rand 467.5 million.[15]

Monitoring & Evaluation

The plan combines health-outcome monitoring, service-performance indicators, regulatory compliance, surveillance and audit-based accountability. It links progress towards universal health coverage to outcomes including life expectancy, morbidity, mortality, maternal and child mortality, and disability.[5]National quality oversight is anchored in the Office of Health Standards Compliance, which monitors norms and standards, inspects establishments and operates an ombudsman route for patient complaints.[6][27]

• Monitor health-system quality against six basic hospital standards: cleanliness, infection control, staff attitude, safety and security, waiting times, and medicine stock availability.[27]
• Use national norms and standards, user feedback, health-care safety and clinical governance to improve quality, alongside an efficient health-management information system for decision making.[10][11]
• Track population health through reported life-expectancy, adult-mortality, demographic and social-determinant indicators drawn from Statistics South Africa, the Medical Research Council and Millennium Development Goals reporting.[28][29][30]Life expectancy at birth rose from 56.5 years in 2009 to 60.0 years in 2011, while adult mortality declined from 46% to 40%.[29]
• Assess communicable-disease programmes through the 2013 Joint Review of HIV, tuberculosis and prevention of mother-to-child transmission programmes, alongside indicators for case detection, treatment, cure, retention, treatment success and antiretroviral therapy coverage.[31][32][33]
• Apply explicit 2018/19 targets for maternal, neonatal, child, HIV, tuberculosis, immunisation, school-health and sexual and reproductive health outcomes. These include maternal mortality below 100 per 100,000 live births, neonatal mortality below 6 per 1,000 live births, under-five mortality of 23 per 1,000 live births, and 98% immunisation coverage among children under one year.[34]
• Use district dashboards to identify indicators below target and districts or provinces performing below average, with District Health Authorities, district health councils and management offices supporting local accountability.[26][13]
• Monitor non-communicable disease action through obesity reduction and screening targets: reduce obesity from 65% to 55% among women and from 31% to 21% among men, and screen five million people each for raised blood pressure and raised blood glucose.[7][17]
• Strengthen surveillance through national health-information systems, disease-surveillance programmes, coordinated surveillance for Notifiable Medical Conditions, and the proposed National Public Health Institute of South Africa.[35][14][36]
• Use administrative accountability measures including Auditor-General audit opinions, audit-committee oversight, fraud-prevention measures, disciplinary referrals, governance reports twice yearly, and board or council oversight of public entities and statutory councils.[37][35][21][20]

The source specifies numerous programme indicators and targets, but does not provide one consolidated reporting calendar, a single evaluation methodology, fully defined indicator specifications, or a unified accountability matrix for the entire strategy.[18][14][9][38]

Costing & Financing

Financing is centred on phased National Health Insurance, conditional grants, provincial transfers, public-entity funding, health-financing research and measures to improve affordability and control costs. National Health Insurance is intended to use integrated public- and private-sector capacity, while its viability is linked to public-sector quality improvement and lower private-sector costs.[5][6]

• Finance National Health Insurance pilots and health-economics research on national rollout and alternative financing mechanisms. Pilot allocations are South African rand 70 million, South African rand 74 million and South African rand 77.9 million over the medium-term period; the national health conditional grant receives South African rand 420 million, South African rand 444 million and South African rand 467.5 million.[15]
• Allocate a once-off South African rand 30 million in 2014/15 for the South African demographic health survey.[15]
• Transfer 91.8% of the relevant programme allocation to provinces over the Medium Term Expenditure Framework period, principally through provincial and national conditional grants.[25]
• Allocate South African rand 16.3 billion to the health facility revitalisation grant and South African rand 3.1 billion to the indirect national health grant infrastructure component over the Medium Term Expenditure Framework period.[25]
• Provide South African rand 200 million annually for human papillomavirus vaccination in both 2014/15 and 2015/16, before transfer through the provincial equitable share from 2016/17.[13]
• Support HIV and tuberculosis implementation through a National Treasury conditional grant and donor resources, including the United States President’s Emergency Plan for AIDS Relief and the Global Fund.[39]Additional transfers to the South African National AIDS Council are recorded for 2015/16 and 2016/17.[26]
• Use procurement planning, market intelligence, supplier-performance monitoring, essential-medicines selection, tendering and medicine-pricing regulation to support affordability and supply security.[18][19]
• Recognise financing risks from inadequate funding for service-delivery improvements and fluctuating health-sector costs, with stakeholder negotiations and a National Pricing Commission proposed as responses.[15]
• Fund administrative and regulatory functions through spending on accommodation, audit services, public entities, pharmaceutical regulation, workforce compensation and health-facility audits. Audit expenditure rose from South African rand 14.7 million in 2010/11 to South African rand 25.6 million in 2013/14.[37][35][8][36]

Several programmes identify resource pressures, including regulatory backlogs, infrastructure needs, workforce requirements, complex drug-resistant tuberculosis treatment and quality-improvement investment.[23][32][21]However, the source does not provide an overall strategy budget, a comprehensive funding-gap estimate, a unified costing methodology, or detailed macroeconomic assumptions.[4][15][8]