B991 Health and Social Care : Health issues facing South Africa

1. Health issues facing South Africa

South Africa’s healthcare varies from the fundamental health care which is offered freely by the government in the state hospitals to the very specialized and high technology health services predominantly in the private sector. South Africa, just like any other developing country in the world finds herself submerged into an avalanche of health challenges and crises which day by day threaten the existence of life of the occupants of the country (Babar 2017, p. 188). Approximately 80% of the total population of the country heavily depends on medical services offered by the state. This leaves the public sector overstretched and even at times under-resourced thereby deteriorating the quality of healthcare services.

Despite modernizing her health system in the year 2000, South Africa is still faced with numerous health issues that leave the sustainability of health in the country hanging in the balance. The most affected parts are the rural areas and the situation worsens daily. Among the health issues in South Africa include high infant mortality rates, high HIV/AIDS prevalence rates, and high death rates. Besides the burden of infectious diseases, the health sector also suffers the lack of the required medical equipment and personnel to control the ballooning health crisis (Benatar 2011, p. 108).  

HIV/AIDS Pandemic and Local Response

According to World Health Organization, WHO, South Africa accounts for up to 17% of the HIV infection burden of the whole world. This is despite the population of the country accounting for 0.7% of the total world’s population (Holtz 2012, p. 544). Special attention has been given to the devastating effects of this pandemic to individuals, population groups, families and the society as a whole. HIV/AIDS affects all the demographic groups of the country. Initially, the government denied these facts and ignored the need to attend to these patients, a situation that was later reversed. According to South Africa National AIDS Survey, up to 1000 patients lose their lives per day in South Africa as a result of HIV/AIDS.

The government in collaboration with international agencies considered distributing ART to all IV patients in the year 2003 and the expenditure on the pandemic increased to 48.2% in the year 2005 and still continues to be on the rise. The high death rates of HIV patients have been attributed to the long distances that they have to travel in order to get healthcare services. Some of them have to cover as long as 60 miles. Most of them give up collapse on the way before getting to the medical facility. Another factor for the high deaths is limited actuality of a medical facility in the rural areas. The existing medical facilities are not equipped with the necessary machines that can foster control and management of the disease (Binns 2014, p. 236).

Tuberculosis

Tuberculosis and AIDS in South Africa account for 24% of reported world case problems. It is estimated that 6 out of 10 people in the country are living with HIV/AIDS. 950 people out of 100000 in the year 2012 were recorded to be suffering from tuberculosis. In as much as there has been a notable progress in dealing with the diseases, its effects still remains a gigantic burden (Hallas 2009, p. 654). 1.8% of the reported new cases are resulting from Multi-Drug Resistant. The tremendous effects of the disease are experienced in the rural areas of the country where extensively drug resistant tuberculosis was recorded to be as high as 1545 cases as of 2015. This was the highest prevalence recorded in the world. 10% of the multi-drug resistant cases in South Africa are extensively drug resistant cases.

The prevalence of tuberculosis in the rural areas is high than the urban areas because of the overcrowding in those rural areas. The victims reside in overcrowded areas which facilitate the spread of the disease since it is airborne. The spread of the disease has also been facilitated by late detection, drug resistant form of TB and poor treatment management in the available health facilities.

The government of South Africa launched the National Strategic Plan for HIV/AIDS and TB that came up with a program geared towards addressing the structural drivers of the two pandemics. The program also aimed at protection of human rights and enhancing access to justice for the oppressed, prevention of new infections as well as improving sustainable health and wellness among the citizens (Bridge 2014, p. 211).

Lack of equipment and personnel

The country has inadequate medical facilities to sustain the ever growing demand for health care from her citizens. At the same time, the existing medical facilities are poorly equipped either in terms of machinery or personnel. In addition to incompetent management, one would not be surprised to come to face with the chronic shortage of qualified nurses and doctors in the medical facilities (Dalal-Clayton 2013, p. 451). Most of the South African medical staff are either serving in the private sector or abroad citing poor working environment in the public health centers. Up to 70% of the medical staff in South Africa works in the private sector. This makes the doctor-to-population ratio in the country to be about 0.77 per 1000.

In an attempt to reverse this situation, the country has signed a cooperation agreement with Cuba that enables her to employ Cuban doctors as well as train her medical students in Cuba. Other engagements were done with Iran and Tunisia in a bid to increase the number of doctors. Still, the government has eased registration by foreign doctors to live and work in South Africa. Unfortunately, even with all these initiatives in place, the situation is not any better either as the hospitals still suffers inefficient administration, poor planning as well as poor management. In some of the hospitals, there are not even enough porters leaving patients to lay in beds next t next bodies for a relatively long time (Durojaye 2016, p. 302).  

With the high number of medical staff serving the private sector, a wide disparity in health care is created in which the public health sector is left for the have-nots.  Most of the state hospitals are wallowing in crises with most of the facilities run down and increasingly becoming non-functional mismanagement, neglect and underfunding. On the other hand, 16% of the population of the country has private health insurance that enables them to have access to medical services from the private health facilities. About 25% of the uninsured population can manage to pay for the private healthcare services from their pockets most of the comprising of senior government staff (Hallas 2009, p. 218).

2. Health trends

Maternity and Child Mortality and Life Expectancy at Birth

There has been a remarkable decrease in the infant mortality, mortality among children aged below 5 years and neonatal mortality in spite of the tremendous changes that were conducted in the country before 2005 exacerbated by HIV/AIDS. Up to 2.2 million people lost their lives during this period resulting from the failure to put into practice a timely and feasible Anti-Retroviral Therapy programs (Terrill 2015, p. 155). There have also been widely varying trends in the maternal mortality.

While some reports indicate that 650 out of 100000 pregnant women lost their lives in 2007 from 150 in 1998 other reports have also indicated that there have been improvements in line with the achievements of the Millennium Development Goals. A majority of the maternal deaths reported in South Africa have been linked to HIV infection. As a result of the introduction of the ART programs, the death resulting from HIV/AIDS have significantly declined among the women of reproductive age.

There have been notable improvements in the life expectancy at birth from 54 years in the year 2005 to 60 years in 2012 (Kelly 2010, p. 88). The increase has been attributed a sustained mortality among children and young adults majorly because of the ART program that was rolled out. It has also been attributed to the enhanced mother-to-child HIV transmission prevention. The normal life expectancy in South Africa the same as those living with HIV/AIDS as long as the patients adapt ART early enough before the CD4 count gets to less than 200 cells per cubic millimeter (Britnell 2015, p. 158).

Changing Disease Patterns

There are three main changing burdens of disease in South Africa as reported by the Global Burden of Disease Study. One of these changes is a deviation in the causes of premature death. HIV/AIDS has been found to be the number one cause of premature deaths in which most people lose their lives before reaching the estimated life expectancy. Other causes of the premature death include injuries, noncommunicable diseases domestic and international violence as well as diabetes. Most of the lives shortening factors include alcohol usage, high blood pressure and a high index of body-mass not forgetting unsafe sex as an independent risk factor (Burger 2009, p. 395).  

Another major cause of changing disease patterns is the emergence of non-communicable diseases both from the rural and urban areas. This is prominent among the poor people dwelling in the urban set ups. this in addition to the continuously changing demographic factors result in an increase in the fraction of people older than 70 years thereby resulting in both short term and long term pressure on the available health care services in these areas (Shahi 2008, p. 615). The burden of these non-communicable diseases is expected to be on the rise with time and even supersede mortality rates from HIV/AIDS since ART has been used in managing the mortality rates resulting from AIDS. Thirdly, South Africa is continuously stacking up poorly in relation to other middle-income countries as far as deaths resulting from adjusted ages are concerned. Premature deaths, life expectancy at birth and years one lives with disabilities pose a great challenge and contribute to the constantly changing disease patterns in the country (Organization 2012, p. 350).

3 South Africa’s position in the world and healthcare future

Going by the latest ranking by Lancet Healthcare Access and Quality Index conducted in 2007, South Africa is placed 119 of the 195 countries of the world as far as quality healthcare is concerned. According to this group, quality in healthcare is defined by the estimated mortality rates resulting from causes that should not be dangerous in case proper medical care is available. This ranking took into consideration the spread of healthcare across the country’s population, the mortality rates, and health interventions across the universal categories. Considered, still, was the population of medical staff and their spread across the population (Karim 2015, p. 588).

South Africa’s healthcare has greatly improved over the last 25 years on the global scale. With a performance index of 52, South Africa ranks 119 along with other countries like Philippines, Gabon, and Namibia just below it. The commendable index was derived from features that covered cancer, tetanus, diphtheria and upper respiratory infections. However, the country still performs poorly and needs great improvements in such areas as non-melanoma skin cancer, tuberculosis, and lower respiratory infections. The HAQ of the country has also been recorded to have improved by 6.4 points from 45.6 in 1990 (Rensburg 2008, p. 175).

Concerning the future of the healthcare of the country, South Africa was placed eighth of 13 as per Future Health Index report. The report is based on the ability to access healthcare and the state of adoption and integration of healthcare technology as these are perceived to be an integral component in the delivery of better patient value and health (Naidoo 2012, p. 263). This report indicated that South Africa performed dismally in access with both the patients and the healthcare providers giving a lot of weight to access as one of the things the government should address urgently in the state hospitals to improve public health.

Due to the limitations in staff and resources the country is not able to meet the access expectations in the healthcare sector. The country is found to be lacking an integrated health system with most of the patients having to give the same information about themselves repeatedly to various doctors. Integrated systems are important in such cases as diagnosis and treatment of diseases. The country may thus find herself unable to meet the healthcare demands of her citizens as a result of failure to comply with the changing phases of technology.

Away from the integration of the health system, the government of South Africa has introduced the National Health Insurance which is a medical cover for her citizens that will enable them to meet their medical bills at less stretched circumstances. The cover provides an access to medical services in the state hospitals thereby aimed at improving health sustainability. In this light, the population that would be able to access healthcare services would tremendously increase. However, the targeted population is quite poorly resourced and the state already overstretched, the insurance is likely to have minimal impact (Rensburg 2008, p. 471). The state hospitals are poorly funded hence not able to offer some critical medical services. This would again compel the medical staff in these hospitals to turn away patients and refer them to the private medical facilities which are not affordable to most of them.

In conclusion, a good healthcare system should be founded on a  medical approach to the health of the people it intends to serve. Efforts concerted towards achieving realistic improvements in the health sector on limited resources calls for an improvement in the management of healthcare as well as governance that would instill the spirit of doing better with less. Going forward, South Africa should aim at improving effective and sustainable healthcare access.

Among the measures that can be deployed include improvement of resource-allocation policies as well as proper training for healthcare professionals. Better working conditions for the medical staff is very vital in keeping checks on the doctor-to-population ratio since these conditions would ensure satisfaction of their needs thereby keeping them within the public sector. Proper management is key in ensuring access to quality medical services and this goes along with streamlining any form of incompetence in the health care system.  

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