SAHR 2007 - Health Systems Trust

Authors:
Laetitia Rispel i
Geoffrey Setswe i
1
Stewardship: Protecting
the Public’s Health
Abstract
South Africa has a large private health sector, dominated by medical schemes, which cover
about 14% of the population. Transformation efforts in the health sector have spanned
more than a decade, but the problems of inequity remain acute between the public and
private sectors. This chapter provides an assessment of how well the Ministry of Health is
doing on stewardship of the private health sector in South Africa. The 2000 World Health
Organization concept of stewardship emphasises four elements which are used in this
chapter to analyse health sector developments in South Africa through a ‘stewardship
lens’. These elements include: careful and responsible management of the well-being of
the population; establishing the best and fairest health system possible; concern about the
trust and legitimacy with which activities are viewed by the citizenry; and maintaining and
improving national resources for the benefit of the population. The chapter concludes that
stewardship is sub-optimal and that there is scope for improvement, given the huge levels
of health inequity and disparities between the public and private sectors.
i
Human Sciences Research Council