This 12th edition of the District Health Barometer (DHB) covers 52 districts and includes a total of 47 financial and health indicators, 11 of which are new. This annual publication provides an overview of the performance of public health services in South Africa and has become an important planning and management resource for health service providers, managers, researchers and policy makers in the country. The DHB plays an important role in providing information for district mangers to benchmark their districts against the others in the country and in strengthening the use of data for priority setting and decision making. The Barometer is used as the basis for workshops with district managers which provides an opportunity to engage with the data and collaborate with technical experts on how best to use this information for planning. This edition paints a mixed picture, showing significant gains in some areas while highlighting areas that need further attention. Mortality rates in South Africa increased between 1997 and 2006 and declined thereafter until 2015, mainly due to the HIV epidemic and the roll-out of ARTs. Despite this, HIV and AIDS and associated conditions still stand out as being a leading cause of morbidity, together with cerebrovascular diseases, ischaemic heart disease, diabetes mellitus, road injuries, interpersonal violence and hypertensive heart disease.
Equity in Health
The deadline for meeting the Millennium Development Goals (MDGs) is quickly approaching. While progress has been made on a number of the goals, it is already clear that many targets will not be reached. Policy makers have been reluctant to start discussions of what comes after the 2015 deadline, fearing that negotiating a new framework would detract from efforts to meet the Millennium Development Goals (MDGs). While there seems to be broad support for a post- 2015 framework, there is not yet agreement on what this could look like. The United Nations and the World Health Organisation have started discussions on the issue, and it appears that sustainable development goals may be the way forward. In a survey of developing countries by the Institute of Development Studies, respondents overwhelmingly agreed that although the MDG framework has shortcomings, it is desirable to have an internationally agreed framework in place. Eighty percent of the respondents agreed that the post- 2015 arrangement should be target based, in part because it allows monitoring of progress.
Many commentators, including the World Health Organisation (WHO), have advocated progress towards universal health coverage on the grounds that it leads to improvements in population health. In this report, the authors reviewed the most robust cross-country empirical evidence on the links between expansions in coverage and population health outcomes, with a focus on the health effects of extended risk pooling and prepayment as key indicators of progress towards universal coverage across health systems. The evidence suggests that broader health coverage generally leads to better access to necessary care and improved population health, particularly for poor people. However, the available evidence base is limited by data and methodological constraints, and further research is needed to understand better the ways in which the effectiveness of extended health coverage can be maximised, including the effects of factors such as the quality of institutions and governance.
The aim of this study was to assess the distribution of health care benefits in the Kenyan health system, compare changes over two time periods and demonstrate the extent to which the distribution meets the principles of universal coverage. Two nationally representative cross-sectional households surveys conducted in 2003 and 2007 were the main sources of data. A comprehensive analysis of the entire health system was conducted including the public sector, private-not-for-profit and private-for-profit sectors. The three sectors recorded similar levels of pro-rich distribution in 2003, but in 2007, the private-not-for-profit sector was pro-poor, public sector benefits showed an equal distribution, while the private-for-profit sector remained pro-rich. Larger pro-rich disparities were recorded for inpatient compared to outpatient benefits at the hospital level, but primary health care services were pro-poor. Benefits were distributed on the basis of ability to pay and not on need for care. In conclusion, the Kenyan health sector is clearly inequitable and benefits are not distributed on the basis of need.
An equitable distribution of healthcare use, distributed according to people’s needs instead of ability to pay, is an important goal featuring on many health policy agendas worldwide. However, relatively little is known about the extent to which this principle is violated across socio-economic groups in Sub-Saharan Africa (SSA). The authors ex-amine cross-country comparative micro-data from 18 SSA countries and find that considerable inequalities in healthcare use exist and vary across countries. For almost all countries studied, healthcare utilization is considerably higher among the rich. When decomposing these inequalities wealth is found to be the single most important driver. In 12 of the 18 countries wealth is responsible for more than half of total inequality in the use of care, and in 8 countries wealth even explains more of the inequality than need, education, employment, marital status and urbanicity together. For the richer countries, notably Mauritius, Namibia, South Africa and Swaziland, the contribution of wealth is typical-ly less important. As the bulk of inequality is not related to need for care and poor people use less care because they do not have the ability to pay, healthcare utilization in these countries is to a large extent unfairly distributed. The weak average relationship between need for and use of health care and the potential reporting heterogeneity in self-reported health across socio-economic groups imply that the findings are likely to even underestimate actual inequities in health care.
Dr Margaret Chan of China will be the next Director-General of the World Health Organization (WHO). After her appointment, she told the World Health Assembly she wanted to be judged by the impact WHO's work has on the people of Africa and on women across the globe. In her acceptance speech, Dr Chan said: "what matters most to me is people. And two specific groups of people in particular. I want us to be judged by the impact we have on the health of the people of Africa, and the health of women. Improvements in the health of the people of Africa and the health of women are key indicators of the performance of WHO."
As the People's Health Movement monitors the election of the organization's new Director General, all candidates have been sent a set of questions on key health issues. Dr Pascoal Manuel Mocumbi answers to the inquiries from the People’s Health Movement to the Candidates for the position of WHO’s Director General.
Dr. Jong Wook Lee, 57, of South Korea, was on Tuesday January 28 chosen by a World Health Organisation executive committee vote of 17-15 to take over the position of WHO director general, BBC News reports. Lee, who will succeed Norway's Dr. Gro Harlem Brundtland, narrowly defeated Peter Piot, a Belgian epidemiologist who heads UNAIDS.
Six companies involved with the UNAIDS- and WHO-sponsored Accelerating Access program have said they would increase the antiretroviral drug supply to Africa, "acknowledg[ing] that current efforts only scratched the surface" of the continent's epidemic, Reuters reports.
As the legal campaign against the South African government’s decision not to provide antiretroviral drugs grows apace, it has emerged that the manufacturer of one of the drugs is about to supply the drug free of charge.