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South African Health Review 1997 South African Health Review 1997 SOUTH AFRICAN NORTHERN HEALTH REVIEWPROVINCE GAUTENG MPUMALANGA NORTH WEST SWAZI- 1997 LAND FREE STATE KWAZULU-NATAL LESOTHO NORTHERN CAPE EASTERN CAPE WESTERN CAPE Published by the Health Systems Trust 1997 Information presented in this Review is based on best available data derived from numerous sources. Discrepancies between different sources, even for important indicators such as the infant mortality rate, reflect the current quality of data. All data should thus be interpreted carefully, and with recognition of potential inaccuracy. Published by the Health Systems Trust and supported with a grant from the Department for International Development (UK) and the Henry J. Kaiser Family Foundation (USA) Health Systems Trust Email: [email protected] 504 General Building Tel: (031) 307-2954 Cnr Smith and Field Streets Fax: (031) 304-0775 Durban 4001 South Africa ISSN: 1025-1715 ISBN: 1-919743-17-0 First edition November 1997 Cover photo by Jane Edwards-Miller Designed and printed by Kwik Kopy Printing, Durban FOREWORD The South African Health Review is the most comprehensive analysis of health and health care in South Africa today. Previous Reviews focused on the development of new health policies as part of the restructuring process in the health sector. 1997 has been characterised by pressure on decision-makers to translate these policies into tangible improvements in the quality of life of South Africans. This edition of the South African Health Review attempts to evaluate the impact of these policies, reflects on progress, and points to areas where changes in health policy have not translated into significant action. Further, the Review seeks to measure the attainment of equity in health care, a major priority of the new government. The Review includes a national clinic survey that offers a snapshot of the status of health care provision at the primary level of health care. We hope to improve and further develop the survey and retain it as an annual measure of the move toward equity in health care. With this addition, the Review will continue to provide an independent perspective on the degree to which health policy reform translates into real improvements in health care. The South African Health Review is a culmination of hard work by many individuals, a task that has significantly grown in complexity over the years. The Board of Trustees of the Health Systems Trust is grateful to them and acknowledges that without their efforts, the quality of the publication would not be of the high standard that it is today. More than 40 authors wrote the 27 chapters of the Review; reviewers helped enhance the quality of the information; staff members of the Health Systems Trust took responsibility for management of the publication process including co-ordination and editing; health service managers and health workers made inputs which constitute the foundation of this publication. We trust that the Review will continue to be a valuable reference document to Departments of Health, educational institutions, libraries, the donor community and health workers. JAIRAM REDDY CHAIRPERSON BOARD OF TRUSTEES HEALTH SYSTEMS TRUST i TABLE OF CONTENTS Acknowledgements iv Preface v Measuring the Move Towards Equity from the Site of Service Delivery vii The Year in Review xvii Peter Barron, Health Systems Trust Kathy Strachan, Business Day Carel Ijsselmuiden, Department of Community Health, University of Pretoria Chapter 1 The Broad Picture: Health Status and Determinants 1 Debbie Bradshaw, CERSA, Medical Research Council Chapter 2 Health and Development 17 Dingie Van Rensburg, Centre for Health Systems Research and Development, University of the Orange Free State Ega Kruger, Centre for Health Systems Research and Development, University of the Orange Free State Peter Barron, Health Systems Trust Chapter 3 Legislation 29 Jane Stuurman-Moleleki, National Progressive Primary Health Care Network Lynette Sait, National Assembly Portfolio Committee on Health Peter Long, National Progressive Primary Health Care Network Chapter 4 Private Sector 37 Gustaaf Wolvardt, Medical Association of South Africa Natasha Palmer, Health Systems Trust Chapter 5 Provincial Restructuring 45 David Robb, formerly Department of Health and Developmental Welfare, North West Province Marie Annandale de Villiers, Department of Health and Welfare, Northern Province Krish Vallabjee, Department of Health, Western Cape Chapter 6 Local Government Restructuring 53 Shan Naidoo, Southern Metropolitan Substructure, Johannesburg Chapter 7 Hospital Restructuring 59 Brian Ruff, Gauteng Department of Health Chapter 8 Financing and Expenditure 81 Alex van den Heever, Centre for Health Policy, University of the Witwatersrand Vishal Brijlal, Centre for Health Policy, University of the Witwatersrand Chapter 9 Human Resources 91 Robert Van Niekerk, Centre for Health Human Resources, University of the Western Cape David Sanders, Centre for Health Human Resources, University of the Western Cape Chapter 10 Drug Policy 99 Andy Gray, Department of Pharmacy, University of Durban-Westville Peter Eagles, Department of Pharmacy, University of the Western Cape ii Chapter 11 Health Information Systems 105 Kobus Herbst, Department of Health and Welfare, Northern Province and MEDUNSA Caesar Vundule, Department of Health and Developmental Welfare, North West Province Chapter 12 Research 113 Jane Edwards-Miller, Health Systems Trust Chapter 13 Upgrading Health Facilities 119 Geoff Abbott, Division of Building Technology, CSIR Chapter 14 Community Involvement in Health 129 Elise Levendal, National Progressive Primary Health Care Network Sheila Lapinsky, Health Department, Western Cape David Mametja, Health Systems Trust Chapter 15 Health and the Media 137 Kathy Strachan, Business Day Chapter 16 Maternal, Child and Women’s Health 139 Marian Jacobs, Child Health Unit, University of Cape Town Alyssa Wigton, Child Health Unit, University of Cape Town Nonhlanhla Makhanya, Health Systems Trust Beatrice Ngcobo, Gender Commission Chapter 17 Mental Health 153 Tennyson Lee, Centre for Health Policy, University of the Witwatersrand Ruth Zwi, Gauteng Department of Health Chapter 18 Oral Health 165 Usaf Chikte, Department of Community Dentistry, University of Stellenbosch Chapter 19 Occupational Health 171 David Rees, National Centre for Occupational Health Tony Davies, National Centre for Occupational Health Chapter 20 Disability 179 Pam McLaren, Disability Action Research Team Sue Philpott, Disability Action Research Team Chapter 21 HIV/AIDS 187 Liz Floyd, Gauteng Department of Health Chapter 22 Tuberculosis 197 Karin Weyer, Tuberculosis Research Programme, Medical Research Council Chapter 23 Sexually Transmitted Diseases 203 Mark Colvin, CERSA, Medical Research Council Chapter 24 Nutrition 207 David McCoy, Child Health Unit, University of Cape Town Mmipe Saasa-Modise, Goldfields Nutrition Centre, MEDUNSA Chapter 25 Injury and Trauma 213 Alex Butchart, Health Psychology Unit, UNISA Margaret Peden, National Trauma Research Programme, Medical Research Council References 223 Tables of health and related indicators 238 Index 248 iii ACKNOWLEDGEMENTS EDITOR Peter Barron, Health Systems Trust PROJECT CO-ORDINATORS Gcinile Buthelezi, Health Systems Trust Thokozile Nkabinde, Health Systems Trust ASSISTANT EDITOR Lucinda Franklin, Health Systems Trust ACKNOWLEDGEMENTS External Reviewers National Department of Health Joce Kane-Berman, Western Cape Department of Health David Power, Red Cross War Memorial Children’s Hospital Michael Sinclair, Henry J Kaiser Family Foundation, USA Julian Lambert, Department for International Development, UK Internal Reviewers Peter Barron Leslie Bamford Andrew Boulle Gcinile Buthelezi Candy Day Jane Edwards David Harrison Nonhlanhla Makhanya David Mametja Thokozile Nkabinde Natasha Palmer Other Support We wish to thank the large number of individuals as well as all the staff at the Health Systems Trust, who contributed to the production of this document. Julia Elliot, Rachael James, Jurie Thaver, and Irene Kaiser who helped type editorial changes. Alyssa Wigton, Heather Jacklin and David McCoy made useful suggestions. Lynda Campbell and her team at Kwik Kopy Printing for the excellent presentation and layout of the publication. The individual authors who gave generously of their time in writing their chapters for no monetary award. The researchers, too numerous to mention, who assisted with data collection for the clinic survey, and David Harrison who proof read the final version and compiled the index. We thank you all for your help and support. iv PREFACE The preface of the 1996 South African Health Review posed a number of crucial questions. One of these questions was “What has changed for the poor, rural woman or child who presents to the clinic?” With the publication of the 1997 South African Health Review, we are able to answer the question by saying that we are not yet sure what has changed; however we do have a far better picture of the activities in the clinics. A survey was undertaken by the Health Systems Trust which looked at the basic infrastructure of clinics and the types of services provided. Some of the results of this survey are presented at the beginning of this review and sketch an outline of what is happening in the clinics. Ultimately, we would like to be able to answer the question posed above, and to paint a far clearer picture than we have at present. To do that we require information. If there is one thread running through this review,
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