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

Objectives

The 2014/15 to 2018/19 National Department of Health Strategic Plan seeks to achieve a long and healthy life for all South Africans by preventing illness and disease, promoting healthy lifestyles, and continuously improving access, equity, efficiency, quality and sustainability of health-care delivery.[1]It is grounded in constitutional health rights and the National Health Act 61 of 2003, which establishes a uniform health system founded on equity, efficiency, quality care, sound governance and shared responsibility across public and private providers.[2]

The strategy responds to a quadruple burden of disease: HIV and AIDS associated with tuberculosis, maternal and child morbidity and mortality, rising non-communicable diseases, and violence, injuries and trauma.[3]It frames universal access to affordable, good-quality health care as a matter of social solidarity, equity and fairness, principally through phased National Health Insurance.[4]

• Strengthen an efficient and responsive health system that provides financial risk protection and supports the National Development Plan 2030.[5]
• Increase life expectancy to at least 70 years by 2030, reduce non-communicable disease prevalence, achieve universal health coverage, deploy primary health-care teams and fill posts with skilled and committed personnel.[5]
• Address social determinants of health; strengthen health information, management and accountability; improve care quality; develop human resources; and build meaningful public-private partnerships.[6]
• Prevent non-communicable diseases by reducing tobacco use, physical inactivity, unhealthy diets and harmful alcohol use, which are identified as major shared risk factors.[7]
• Implement the Strategic Plan for Non-Communicable Diseases 2012-2017 to reduce risk factors and improve detection and management, alongside health promotion and a mass mobilisation strategy promoting healthy choices.[8][9]
• Improve integrated services for mental health, disability, rehabilitation, eye care, oral health, care of older people, emergency medical services and environmental health.[8][10]
• Reduce maternal, neonatal and child mortality; expand sexual and reproductive health services; prevent mother-to-child HIV transmission; and strengthen immunisation, nutrition and early childhood development.[11][12]
• Strengthen regulation of medicines, medical devices, diagnostics, food safety, clinical trials and health establishments to assure safety, efficacy, quality and patient-centred care.[13][14]

Implementation

Implementation combines national policy, regulation, financing and standard-setting with decentralised provincial, municipal and district delivery.[2]The National Health Council, comprising the Minister of Health and provincial Members of the Executive Council for Health, and its Technical Advisory Committee provide strategic and technical implementation forums for Outcome 2 priorities.[5]Provincial Departments of Health deliver most frontline services, supported by district management structures, health and community workers, public and private providers, civil society, research bodies, development partners and other government departments.[11][15]

• Implement National Health Insurance through phased pilots, a proposed National Health Insurance Fund purchasing services from accredited and contracted providers, health-financing research and provincial conditional grants.[16][17]
• Re-engineer primary health care through ward-based outreach teams, contracted general practitioners, district specialist teams, expanded school health services, Ideal Clinics and strengthened district governance.[6][18][9]
• Improve facility readiness through infrastructure, equipment, supply-chain and financial management, laboratory services, patient-based health information systems, workforce development and compliance with national quality standards.[19][6]
• Use integrated and patient-centred chronic disease management, including the Integrated Management of Chronic Diseases Model, particularly in communities facing combined HIV and non-communicable disease burdens.[4]
• Expand screening and counselling for raised blood pressure and blood glucose, with a target of five million people screened for each condition, and reduce obesity among women from 65% to 55% and among men from 31% to 21%.[20]
• Deliver multidisciplinary rehabilitation and community-based care through primary health-care clinics and district hospitals, while decentralising integrated mental health services.[8]
• Coordinate intersectoral action on social, economic, environmental and behavioural determinants of health, involving schools, communities, food producers and retailers, media, parents and child-care providers.[21][1]
• Strengthen quality assurance through the Office of Health Standards Compliance, including inspections, enforcement of norms and standards, patient complaints mechanisms, annual Quality Improvement Plans and user feedback.[4][14][22]
• Regulate medicines and related products through the South African Health Products Regulatory Authority, intended to replace the Medicines Control Council, supported by product evaluation, licensing, post-marketing surveillance and remedial action.[13]
• Maintain national health information, research, surveillance, monitoring and evaluation functions, including coordinated disease-surveillance systems and a proposed National Health Research Observatory.[23][16]
• Monitor progress through indicators for life expectancy, mortality, service coverage, facility standards, patient safety, obesity, hypertension and diabetes screening, alongside programme-specific targets for HIV, tuberculosis, maternal and child health.[24][12][9][20]
• Resource implementation through conditional grants, including National Health Insurance pilot allocations of 70 million, 74 million and 77.9 million South African rand over the medium-term period, although the supplied material does not provide a consolidated strategic-plan budget or funding gap.[17]

Monitoring & Evaluation

The framework combines health-system performance monitoring with programme-specific indicators, quality regulation, surveillance and audit-based accountability. It links measurement to National Development Plan 2030 goals, including life expectancy of at least 70 years, lower non-communicable disease prevalence, universal health coverage and a skilled health workforce.[5]

• Monitor quality and compliance through national norms and standards, user-feedback systems, patient safety measures, clinical governance, facility inspections and complaints handling by the Office of Health Standards Compliance.[19][6][25]
• Use health information systems, disease surveillance, research coordination and an integrated monitoring and evaluation plan to support decision-making and track strategic health outcomes.[26][23][16]
• Track maternal and child health against explicit 2018/19 targets, including 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, 98% immunisation coverage, and infant HIV polymerase chain reaction positivity below 1% at around six weeks.[12]
• Measure HIV and tuberculosis performance through prevalence, case detection, treatment initiation and outcomes, treatment coverage, mortality, antiretroviral therapy retention, and periodic independent programme reviews.[27][28][11]
• Track non-communicable disease prevention through obesity reduction targets, screening of 5 million people each for raised blood pressure and blood glucose, tobacco exposure, physical fitness and mortality indicators.[7][9][20]
• Assess regulatory performance through post-marketing pharmaceutical surveillance, governance reports twice yearly, audit opinions, product-registration timelines, Quality Improvement Plans and patient-satisfaction measures.[29][13][14][22]
• Strengthen local accountability through the National Health Council, its Technical Advisory Committee, district health councils, district management offices, clinic committees and hospital boards.[5][15][9]

Several extracts provide targets and operational indicators, but do not specify one consolidated indicator framework, common reporting timetable, formal evaluation methodology or accountability cycle covering all strategic areas.[24][23][8]

Costing & Financing

Financing is centred on phased National Health Insurance, conditional grants, public-entity transfers and targeted investments in quality improvement, medicines, HIV and tuberculosis services, and health information. The extracts identify resource pressures and financing mechanisms, but do not provide a complete costed strategy, consolidated funding gap or macroeconomic assumptions.[23][17][30]

• Fund National Health Insurance pilots through a conditional grant to provinces, with medium-term allocations of 70 million, 74 million and 77.9 million South African rand; the wider national health conditional grant, including a National Health Insurance component, receives 420 million, 444 million and 467.5 million South African rand over the medium-term expenditure framework period.[17]
• Allocate 30 million South African rand in 2014/15 for the South African demographic health survey, while prioritising health economics research on healthcare rollout and alternative financing mechanisms.[17]
• Support HIV and AIDS treatment through the comprehensive conditional grant, projected to grow by an annual average of 14.2%, while medical-supply expenditure, mainly condoms, is projected to rise by an annual average of 15.9%.[31]
• Provide additional transfers to the South African National AIDS Council of 15 million South African rand in 2015/16 and 15.8 million South African rand in 2016/17, alongside additional human papillomavirus vaccination allocations of 200 million South African rand in both 2014/15 and 2015/16.[31][15]
• Channel most programme funding for public entities to the Medical Research Council and National Health Laboratory Service, while listed 2014/15 entity budgets also cover the Council for Medical Schemes and occupational disease compensation.[32][33][34]
• Align organisational implementation with available budgets, noting that separating organisational-structure development from the budget process has impeded delivery of key outputs.[18]
• Manage affordability through pricing regulation, health-financing research, pharmaceutical economic evaluation, procurement planning, supplier-performance monitoring and resource mobilisation through international cooperation.[23][16][17]

Additional resource information includes audit costs rising from 14.7 million South African rand in 2010/11 to 25.6 million South African rand in 2013/14, and a once-off 24.8 million South African rand payment for the health facilities audit in 2011/12.[26][35]Several programme extracts do not specify budgets, allocations, financing sources or funding gaps for their respective activities.[11][8][13]