SAHR 2007 - Health Systems Trust

Authors:
Candy Day i
Andy Gray ii
15
Health and Related
Indicators
Introduction
The 1997 White Paper on the Transformation of the Health
System in South Africa [White paper 1997] envisaged a
“National Health System”, which would “integrate the activities
of the public and private health sectors, including NGOs
and traditional healers, in a way which maximises the effectiveness
and efficiency of all available health care resources”.
This principle was reiterated in the section dealing with the
planned District Health System. The plan was to establish
a “district health system that facilitates health promotion,
provides universal access to essential health care and allows
for the rational planning and appropriate use of resources,
including the optimal utilisation of the private health sector
resources”. This year, the Review has focused on the private
healthcare sector. Accordingly, this chapter has sought to
gather the best available data on that sector, but also to
highlight the extent to which available national health information
systems include or exclude the contribution of the
private sector. In most cases, systems for gathering healthrelated
information from the private and public sectors are
not integrated or even coordinated, making comparison
across the sectors difficult.
Having concrete international targets, in the form of the
Millennium Development Goals (MDGs), has focused attention
on the need to have robust estimates of disease burdens.
In a series in the Lancet in 2007, members of the World
Health Organization’s Health Metrics Network outlined the
challenges in this arena. Boerma and Stansfield [Lancet
369(779-86)] highlighted four problems:
1. how “the emphasis on monitoring and evaluation is
leading to proliferation of indicators and excessive
reporting requirements”;
2. that “the risk of inadequate or poorly targeted investments
can be kept to a minimum by understanding the
causes of poor availability of health statistics, including
lack of accurate measurement instruments, application
of suboptimum methods of data collection, and
inadequate use of methods and analyses to produce
comparable estimates”;
3. how “the preoccupation with MDGs does not take into
account the rapid health transition, which implies that
health statistics should systematically include a much
wider array of health issues from acute infectious
diseases to chronic non-communicable diseases and
injuries, disaggregated by socioeconomic position”;
and
4. how “the growing number of national household
surveys, which are the main source of most population
health statistics, need to be streamlined into
cohesive and comprehensive country health survey
programmes”.
They also provided a very useful table of data sources, their
strengths and limitations, as well as global trends. This table,
reproduced below, shows clearly how the private sector
is commonly excluded from certain key data collection
methods (emphasis added).
i
Health Systems Trust
ii Department of Therapeutics and Medicines Management, University of KwaZulu-Natal
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