Audit of Substance Abuse Treatment Facilities in ... - SA HealthInfo

Despite the apparent availability of substance abuse treatment services in each province,for the uninsured the availability of affordable substance abuse treatment has decreased inrecent years, with the number of beds allocated for substance abuse in state hospitalsdecreasing. For the remaining state-subsidised treatment facilities, state funding hasdecreased in real terms, limiting their capacity to expand services to historicallyunderserved areas (Myers & Parry, 2003; Myers & Parry, 2005). This has been partly dueto the diversion of funds from tertiary level substance abuse treatment services to primaryhealth (National Department of Health, 1997) and community-based social services(National Department of Social Development, 1997). While the policy of integratingsubstance abuse services into existing primary health care (PHC) networks has been anattempt to improve the accessibility (and equitable distribution) of health and socialservices for historically underserved communities, in reality implementation has beenslow with few substance abuse treatment services being offered at a community level(Myers & Parry, 2005). Poor infrastructure, limited capacity, and multiple demandsplaced on PHC nurses and community-based social workers have been some of thereasons given for the slow pace of service delivery (Goosen et al., 2003; Sanders &Chopra, 2006). Whatever the reasons, an unintended consequence of these policy changeshas been that access to substance abuse treatment has become even more restricted forpoor South Africans.• Availability of private servicesThe shortage of publicly funded substance abuse treatment centres, together with theincreased demand for substance abuse treatment, has given rise to a growing privatetreatment sector. Compared to the state treatment system, the private for-profittreatment sector has relatively more resources, shorter waiting lists, more evidence-basedtreatment programmes, more experienced staff, and provides relatively better treatmentenvironments (Myers & Parry, 2003; Myers, 2004). Although these facilities fill animportant gap in the market, they have been criticised for serving mostly Whitecommunities (given that they are largely unaffordable to the uninsured and that Whitesmay have wealthier social networks that can be drawn upon to co-fund treatment), havinglimited skills for dealing with the socio-cultural and language context of historically15