SAHR 2007 - Health Systems Trust

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Health and Related Indicators 15 Table 5: Demographic indicators by ethnic group Demographic African Coloured Indian / Asian White Other All Annual population growth rate 1996 2.8 2.0 1.7 1.1 - 1.9 a 2004 1.1 1.0 0.8 -0.4 - 0.9 b Average household size 1996 4.7 4.7 4.3 2.9 - 4.4 c 2001 3.9 4.3 4.0 2.8 - 3.8 d Crude death rate 2001 low estimate 12.6 9.0 5.6 9.0 - 11.7 e 2003 9.3 6.0 6.4 8.6 - 12.1 f 2004 9.7 6.1 6.3 8.0 - 12.3 f 2005 10.0 6.2 6.4 7.9 - 12.6 f Population 1996 31 127 631 3 600 446 1 045 596 4 434 697 375 204 40 583 573 g 2001 35 416 166 3 994 505 1 115 467 4 293 640 - 44 819 778 d 2005 37 205 700 4 148 800 1 153 900 4 379 800 - 46 888 200 g 2006 37 662 900 4 198 800 1 163 900 4 365 300 - 47 390 900 g 2007 38 079 900 4 245 000 1 173 700 4 352 100 - 47 849 800 g Population % by ethnic group 1996 76.7 8.9 2.6 10.9 0.9 100.0 c 2001 79.0 8.9 2.5 9.6 - 100.0 d 2007 79.6 8.9 2.5 9.1 - 100.0 g Population % composition d 2001 60+ years 6.4 6.4 7.8 15.9 - 7.3 2001
Socio-economic indicators As long as poverty remains a key determinant of health, indicators of socio-economic status will remain important inputs for health policy-making and management. Measures of poverty are thus important, but also highly contested. The Treasury has announced that Government intends to develop an official “poverty line” for South Africa, “to assist in measuring the extent of household poverty and monitoring progress in poverty reduction” [Poverty line]. The proposal is to base this poverty line on minimum food needs for daily energy requirements, plus essential non-food items. In addition to the official poverty line, two additional thresholds have been proposed. One, below the poverty line, will be used to measure extreme poverty. The other, above the poverty line, will measure a broader level of household income adequacy. Starting with a pilot period, Statistics SA expects to publish the new series before the end of 2007, update the poverty line and the lower and upper thresholds annually (based on a basket of goods and the consumer price index), and review the measure every 5 years. Depicting poverty at a district level has been accomplished using various indices, such as the multiple deprivation index cited in the District Health Barometer report [DHB 2005/06]. Alternative indices have been proposed, such as that used in the “Baseline survey of the 21 ISRDP and URP nodes” [ISRDP & URP Baseline] prepared for the Department of Social Development in November 2006. This report was based on 8 387 individual interviews conducted in the 13 Integrated Sustainable Rural Development Programme nodes and the 8 Urban Renewal Programme nodes, at the halfway mark of these 10-year programmes. While the results are not easily incorporated into this chapter, some are highlighted here as indicative of the more nuanced and in-depth data that are becoming available. The rate of unemployment averaged 79.1% in the rural and 62.6% in the urban nodes. Not surprisingly, government grants were described as the “mainstay of many households” in these settings. Across all 21 nodes, 50.4% of households were female-headed. While access to sanitation had improved in every urban node compared to the 2002 baseline, the situation in rural nodes was mixed. While 77% of URP households had a flush toilet inside the house or yard, only 20% of ISRDP households enjoyed the same access. In the rural nodes, 28% of respondents obtained their water from a source other than a “piped” one (e.g. a borehole, river, dam or truck), a source likely to be of poor quality. Although the specific health question used (proportion of household infected by malaria in the past 12 months) was of limited use, except in particular provinces, other questions posed were instructive. Half of all respondents described their health as “poor” (53% in the rural nodes and 43% in the urban nodes). The health problem perceived to be most significant varied, but the four main problems identified were HIV/AIDS, alcohol, TB and drug abuse. Of relevance to the discussion on the extent of use of the private sector, while 72% of all respondents reported using public clinics and 11% reported using public hospitals, 14% reported using private medical practitioners. This last proportion varied considerably, from 31% in urban Mitchell’s Plain to 3% in rural Sekhukhune district. Interestingly, 2% or less reported using private hospitals, pharmacies or traditional healers. The report called for qualitative research into the reasons for patient choices, beyond the predictable factors of cost, location and convenience, in order to understand why patients with access to free PHC services chose to use private medical practitioners or secondary / tertiary hospitals. Another new secondary source of socio-economic data is the Development Indicators Mid-term Review [Development Indicators 2007], issued by the Presidency in 2006, midway through the government’s term of office. Using a poverty line based on an income of R3 000 per capita per annum (expressed in constant 2000 Rands), it showed that fewer people were living in poverty in 2006 (43.2%) than was the case in 1993 (50.1%). However, the report did note that “the rate of improvement of income for the poor has not matched that of the rich” and that “while income poverty is declining, inequality has not been reduced”. This was also shown by the increase in the Gini coefficient, which measures income inequality. The value of this measure rose from 0.672 in 1993 to 0.685 in 2006. The report also contains data on the population in each of 10 Living Standards Measure groups from 2001/02 to 2005/06. The number of people in the poorest category (LSM 1) dropped substantially from 2001/02 (3 456 000) to 2005/06 (1 895 000). There was evidence of a growing “middle class”, as represented by those in LSM 4-10. The Theil index is another measure of inequality. While inequality by this measure has been rising, it has changed in nature. Inequality between races has declined, while inequality within race groups has grown. In 1993, 61 per cent of inequality was between race groups, however, by 2006 inequality between race groups had declined to 40 per cent. Over the same period, inequality within race groups has become much more prominent. 224
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South African Health Review 2007 LI
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Foreword The 12th edition of South
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12 Traditional and Complementary Me
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Other Funders for the Health System
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This response raises a number of qu
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ucts are currently sold without reg
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The authors conclude that mandatory
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servicing and inappropriate hospita
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systems is also critical; worrying
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Authors: Laetitia Rispel i Geoffrey
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Stewardship: Protecting the Public
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Introduction The importance of the
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diseases such as tuberculosis and t
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17 of 2002). This Act entirely repl
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(d) and any other matter relating t
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Year Act No. Title Objects 1997 90
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References 1 Department of Health.
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Purchasing of Health Care 33Pooling
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Introduction This chapter presents
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Medical schemes are the largest fin
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per person dependent on the public
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An increase in hospital expenditure
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private pharmacy do so for self-tre
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References 1 McIntyre D, Thiede M,
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Policy and legislative framework In
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Medical schemes and revenue collect
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There is evidence that when faced w
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are thus contributing factors to th
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Figure 2: Historic membership of me
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Solvency of the risk pools has beco
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Figure 4: 100 Proportion of risk be
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will retain that benefit for their
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There is a general sense (but often
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From a benefit design perspective t
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and towards competition based on ef
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37 Du Preez L. Registrar wants cura
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Introduction There has long been co
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an element of cream-skimming which
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Table 1: Distribution of health car
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isk equalisation mechanism were imp
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once the cost spiral in medical sch
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Revenue collection: Collecting orga
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Current debates A key area of ongoi
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References 1 Gluckman H. The Provis
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Authors: Patrick Matshidze i Lyn Ha
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Health Information Systems in the P
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Authors: Shahieda Adams i Reno Mora
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Health and Health Care in the Workp
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Author: Bettina Taylor i 8 Rationin
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Rationing of Medicines and Health C
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Health Care Delivery 139
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Authors: Haroon Wadee i Farzana Kha
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Human Resources for Health 9 Table
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Human Resources for Health 9 Table
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Human Resources for Health 9 source
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Human Resources for Health 9 Refere
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Authors: Shadrack Shuping i Sipho K
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Public-Private Partnerships 10 Alth
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Public-Private Partnerships 10 Tabl
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Public-Private Partnerships 10 Conc
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Authors: Thulani Matsebula i Michae
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Private Hospitals 11 Table 1: Priva
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Private Hospitals 11 Table 3: Distr
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Private Hospitals 11 Human resource
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Private Hospitals 11 Figure 3: 16 T
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Private Hospitals 11 Figure 4: 2 50
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Private Hospitals 11 Monitoring qua
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Page 196 and 197: Traditional and Complementary Medic
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Page 210 and 211: Economics of the Traditional Medici
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Page 222 and 223: HIV and AIDS, STI and TB in the Pri
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Health and Related Indicators 15 MD
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Glossary AFA AIDS ALP AMA ANC ART A
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Glossary KZN LFS LIMS LP LPP MAR MC
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Glossary SAPC SARS SASIM SASSA SEP
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Index A Acts (Legislation and Bills
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Index N and O National Health Refer
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SAHR 2007 - Health Systems Trust

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