Country Profile
Southern New Hampshire University
Introduction
The remoteness in South Africa lies miles away from major African cities, including Cairo and Lagos where major trading is situated- something that helped reinforce the official system of the apartheid regime, which policies mostly focused on health and economic advances. The economy of South Africa is the largest in Africa and among the top thirty globally, which is the main reason why the country is considered as one of the most economically developed states in Africa (Coovadia et al. 2009). The profile of this country, as well as the fact that it has developed economically, particularly in Africa, makes it is an exciting reference regarding the general healthcare system in the country.
The healthcare in South Africa’s healthcare standard has been identified as the best on the continent of Africa, specifically in the coastal and urban areas. The state has multiple public and private hospital institutions, clinics, and nursing homes. Both hospitals and doctors expect their payment with immediacy after treatment services, but it is recommendable to have public health insurance for a consistent level of health services (Kautzky and Tollamn, 2008). All citizens have been guaranteed universal access to subsidized public health care services, which is based on a sliding scale depending on the income. Besides, private health services are prominent in the country and dramatically continues to grow due to the private medical insurance, personal choices as well as the ease to access higher quality healthcare- a growth that has resulted in high annual inflation in private medical expenses.
The country’s government is independent as it succeeds to manage all its healthcare financial necessities through domestic revenue. However, global organizations and other philanthropic foundations significantly contribute to funding specific health programs they choose to, especially involving HIV treatment and prevention programs. Due to the significant funding in the private healthcare sector, a large gap exists between private and public hospitals in the country. Such implies that although there is reduced price in the health system to the lower payees in the general segment, it is essential to have a private healthcare plan (Kautzky and Tollamn, 2008). Relatively, the climate in South Africa has most parts with low altitude that play a significant role in the spread of diseases like malaria. Similar to other African countries, South African population has a higher number of AIDs and HIV patients. Equally, the malnutrition prevalence in South Africa varies across various geographical areas as it has about five percent facing undernourishment. The Department of Health under the National Health Act of 2003 offers an outline for a uniform and structured health system for the country (Kautzky and Tollman, 2008). The Act mainly outlines the responsibilities of the three government levels accountable for healthcare services.
Healthcare in South Africa
South Africa is one of the participants to many international obligations like the Millennium Development Goals under the United Nations that addresses the health needs of both children and women. Health issues like maternal health, HIV, and tuberculosis, and child health, but despite these challenges, the health system has made significant progress in resolving the situation. Generally, both private and public healthcare sectors ensure that high-quality health services are available all over the country to effectively fight the health issues. The state employs health practitioners, medical staff, and nurses who are well-trained at the top schools in and outside South Africa.
Maternal Health
WHO statistics shows that South Africa registers a rate of maternal mortality to about three hundred deaths in one thousand live births. In 2010, the infant mortality rate of children under one year was forty-one deaths per thousand live births, while that of those under five years was fifty-seven per thousand live births. However, every pregnant woman in the country is offered free HIV testing and counselling, under the PMTCT program (Zwarenstein, 2017). In case of a woman HIV test comes out positive, she is committed to an anti-retroviral treatment to avert transmission of the virus to the unborn child and receives unstop treatment, support, and care for her and the baby. While anti-retroviral treatment is sufficient to control the maternal health issue, the access and usage of prenatal healthcare mostly impact pregnancy outcome, maternal health, and child survival.
HIV and Tuberculosis
The health care system in this state is under a challenging position due to illnesses, such as HIV, Aids, and other poverty-related diseases. According to the statistics by WHO, in 2011 the HIV incidences registered as 10.6 % as, where roughly more than a third of the women are HIV positive by the time they reach reproductive ages. Equally, more than five million people had HIV, 16.6 % of the adults had HIV and two million orphans due to HIV (Kautzky and Tollman, 2008). HIV and TB are severe infections, as TB is among the common opportunistic infections in patients with HIV. Due to inadequate treatment programs, late detection, and drug-resistant TB, new forms DR-TB and extensively drug-resistant TB have dramatically risen in the country registering 5400 cases in 2016.
Child Health
Under the immunization programs, the rates of childhood immunization have steadily increased; hence acting as the primary barrier against illness and death cases. Thus, the critical aim of vaccination is protecting a child against diseases that can be prevented via vaccines like cholera, TB, and measles (Coovadia et al. 2009). Illness such as acute respiratory infections, measles, and malnutrition has been the leading cause of death in children.
Healthcare Current Structure in South Africa
The health system is structured in five levels, including primary healthcare, regional and district hospitals, tertiary, and central hospitals. The current structure is well-developed to assist in addressing cost-effective healthcare to all citizens to ensure “Better Health for All.” The Department of Health has implemented a strategic plan to identify and prioritize interventions and has made a significant contribution to reduce mortality rates and enhance gender equality and reproductive health (Zwarenstein, 2017). Additionally, as from 2012, the government decreased the mother-to-child transmission charges from 3.5%, which led to a significant drop in the rate of new infections in the eighteen to twenty-four age bracket. South Africa also launched the National Strategic Plan that will integrate the double tormentor of HIV and TB that seek to address the social structure elements that contribute to the increase in HIV/Aids cases, provide care and support, and prevent new infections. Increasing the anti-retroviral stations and certified health practitioners to initiate ARV program has resulted in a significant decrease in the HIV/ Aids infections (Zwarenstein, 2017). The renewed focus on primary healthcare services, which include expanding and enhancing the health system infrastructure should extend into addressing the high mortality rates as well as maternal health. Such would help get South Africa closer to achieving the MDG’s objectives that include minimizing infant mortality deaths by 2030.
Conclusively, South African healthcare systems, public and private healthcare sectors function correspondingly. The federal system attends most of the population in the country; however, those who are habitually underfunded, private industry, on the other hand, have better services but for the wealthiest. Despite significant health issues facing the country, the government has made substantial steps and efforts to put health issues, such as HIV, maternal, and child health under control to reduce death cases.
Summary of the Issue
Impact of health issues in South Africa
As stated earlier, the three main health issues that the healthcare system faces in South Africa are maternal health, child health and, TB, and HIV. In 2015, the maternal mortality rate in South Africa was 138 deaths in 100,000 live births (Tlou, 2018). This represents progress; however, it still has not achieved the levels set by MDG number 5. The primary causes of maternal death are related to pregnancy complications, post-partum bleeding, unsafe abortions, and sepsis. Furthermore, there is a relatively high level of inaccessibility to proper antenatal care and the lack of adequately skilled personnel to deal with birth complications. If the mortality rate is not dealt with, there will be an increase in the deaths of newborn infants as well as an increase in the number of babies who grow up without their mothers.
Current data on child mortality in South Africa shows a reduction in the mortality of children under the age of 5. This is quantified as 37-40 deaths per 1000 live births (Bamford, McKerrow, Baron, & Aung, 2018). The deaths are primarily attributed to diarrhea, pneumonia, HIV infection, and non-communicable diseases. The deaths due to non-communicable diseases have slightly risen in the recent past. High child mortality rates have been linked to lower fertility transition, and a decrease in the socioeconomic status of a community as children are considered a significant source of financial support for the elderly in society (Aksan, 2014).
Control of HIV and TB in South Africa is still a significant issue. South African has a substantial HIV and TB burden, similar to many other Sub-Saharan countries. However, this has had an enormous impact on the socioeconomic status of the country. Much useful workforce is lost through HIV and TB. Additionally, many more people are stigmatized in society due to insufficient knowledge of HIV, which further worsens the epidemic. The continuing spread of HIV and TB is due to the lack of knowledge, risky sexual behavior, prostitution, overcrowding, and non-adherence to antiretroviral treatment. The most affected populations are the youth and the middle age population.
Social and cultural factors that impact healthcare
AIDS and TB are blamed mainly on the apartheid regime in South Africa. Many African workers were forced to reside in overcrowded and poorly ventilated spaces that created sites for the spread of TB. Additionally, individuals in these hostels were served by commercial sex workers who spread HIV to them. The migration of workers between their rural homes, mining sites, and these overcrowded hostels, served a perfect conduit for the spread of HIV to rural homelands (Karim, Churchyard, Karim, & Lawn, 2009).
Furthermore, due to the blacks having to use poor health services due to the apartheid regime, many of the patients died of the disease. Currently, the spread of AIDS and TB is majorly due to risky sexual behavior. Study shows that the average amount of sexual partners that individuals had shown that approximately 40% of individuals typically have more than two sex partners within three months. This reflects the current state of morality in society and that having multiple sexual partners is considered normal.
Maternal and child mortality has mostly been linked to poverty, and the inability to access medical care. Mothers who are pregnant and cannot afford antenatal care are not able to know if they are at risk until after birth. Some of them have to give birth at home, and many also lack the proper nutrition that is needed during pregnancy. This significantly increases the risk of maternal death. Poverty has also had a massive impact on child mortality. The lack of proper nutrition required for a young child to grow, access to clean water, and adequate treatment are to blame for child mortality in South Africa. The lack of knowledge on diseases and treatment of the disorders has led many mothers to frequent traditional healers who are culturally seen as the go-to doctors.
Economic factors that impact healthcare
The economic environment also plays a significant role in the access to and the quality of healthcare provided. For maternal and child mortality, these are the main factors at play. Reduced economic times have been shown to have a significant impact on maternal and child mortality. A comparison between the GDP per capita and child mortality rates has been demonstrated that child mortality is low, with an increase in GDP per capita (O’Hare, Bar-Zeev, & Chiwaula, 2012). This means that more people have the finances to provide suitable quality housing, good maternal care, and proper nutrition and treatment for their children, hence a lower child mortality rate.
Additionally, the level of literacy is often directly proportional to the GDP per capita. Hence people are more empowered and can better manage their health. The contrary is the reason why South Africa is still lagging on maternal and child mortality.
Poor housing, infrastructure, and sanitation may also be an economic factor that contributes towards the health issues. The pre-apartheid era gave rise to poor housing, overcrowding, and segregation from quality services. This segregation widened the economic gap between the rich and the poor, leaving many citizens dependent on the state for housing, infrastructure, and sanitation facilities. This has contributed to the spread of TB and the increased likelihood of contracting diseases like diarrhea in children.
Current interventions
In managing TB and HIV cases, the department of health has formulated policies that integrate TB and HIV treatment in the primary health care services and further decentralizes the management of MDR-TB to lower levels of care. This decentralization of care has helped strengthen community-based care and generally, has improved health outcomes for those suffering from HIV or TB. Furthermore, it has brought healthcare closer to the people and allowing for better access to treatment and reducing the financial burden that was initially needed to access healthcare. The African Union Commission has also initiated a Campaign on Accelerated Reduction of Maternal and Child Mortality (CARMMA), which aims to reduce child mortality by the implementation of evidence-based interventions critical in improving maternal and child health.
The Influence of Major Stakeholders that Play a role in the Healthcare Environment
The WHO and the African Union play a significant role in reducing HIV and TB as well as reducing the rate of child and maternal mortality. They help provide financial funding as well as innovatively creating new solutions that are useful in tackling the major healthcare issues in South Africa.
Recommend an Intervention or an Improvement to an Action and how it can address the Issue
A different approach towards increasing access to healthcare in remote areas is by the use of mobile clinics. These are caravans fitted with appropriate medication and occupied by medical staff who move around in rural areas and make camp in specific towns, providing much needed medical care. Mothers can be able to deliver in a safe environment, and sick children can get access to medicine, thus reducing maternal and child mortality. Mobile clinics have shown much progress in many countries in Sub-Saharan Africa, and it can be used in South Africa to create much-needed change.
References
Aksan, A. (2014). Effects of Childhood Mortality and Morbidity on the Fertility Transition in
sub-Saharan Africa. Population and Development Review, 40(2), 311-329.
Bamford, L. J., McKerrow, N. H., Baron, P., & Aung, Y. (2018). Child mortality in South
Africa: Fewer deaths, but better data are needed. South African Medical Journal, 108, s25-s32. doi:10.7196/SAMJ.2017.v108i3b.12779
Coovadia, H., Jewkes, R., Barron, P., Sanders, D., & McIntyre, D. (2009). The health and health system of South Africa: historical roots of current public health challenges. The Lancet, 374(9692), 817-834.
Karim, S. S., Churchyard, G. J., Karim, Q. A., & Lawn, S. D. (2009). HIV infection and
tuberculosis in South Africa: an urgent need to escalate the public health response. Lancet, 921-933.
Kautzky, K., & Tollman, S. M. (2008). A perspective on Primary Health Care in South Africa: Primary Health Care: in context. South African health review, 2008(1), 17-30.
Zwarenstein, M. (2017). The structure of South Africas health service. Africa health, (Spec No), 3-4.
O’Hare, B., Bar-Zeev, N., & Chiwaula, L. (2012). Economic growth and child health in Sub
Saharan Africa. Malawi Medical Journal, 87-88.
Tlou, B. (2018). Underlying determinants of maternal mortality in a rural South African
population with high HIV prevalence (2000–2014): A population-based cohort analysis. PLoS ONE, 13(9). doi:https://doi.org/10.1371/journal.pone.0203830