Commissioner National Planning Commission The Presidency Republic of South Africa.

Transcription

1 ANOVA CONFERENCE. The road to 2030: the National Development Plan. What are the key changes in the health system to implement the National Development Plan by 2030? Hoosen Coovadia Director, Maternal Adolescent and Child Health University of the Witwatersrand. and Emeritus Professor of HIV/AIDS Research University of Kwazulu-Natal. Commissioner National Planning Commission The Presidency Republic of South Africa.

2 Our future - make it work National Development Plan

3 The Highest Priorities Optimizing management and prevention of major causes of mortality, morbidity and disability. Strengthening the Health System. National Health Insurance (Universal Coverage). Major Social Determinants the social gradient stress early life social exclusion work unemployment social support addiction food transport Source: Marmout Social Determinants of Health

4 South Africa: a cocktail of four colliding epidemics Maternal, newborn & child health 1% of global burden 2-3 times > average for comparable countries HIV/AIDS and TB 17% of HIV burden 23 times > global average 5% of TB burden 7 times > global average Non-communicable diseases <1% of global burden 2-3 times > average developing countries Violence and injury 1.3% global burden of injuries 2 times global average for injuries 5 times global average for homicide

5 Data sourced from WHO Global Burden of Disease (2002). DALYs=disability-adjusted life years. DR Congo=Democratic Republic of the Congo. DTP=diphtheria, tetanus, and pertussis. *Low birthweight, birth asphyxia, and birth trauma. Percentage of total 22% 9% 6% 4% 4% 4% 3% 3% 3% 2% 2% 2% 2% 2% 2% 2% 1% SOUTH AFRICA: COPING WITH A VERY HIGH BURDEN OF DISEASE WHICH IMPACTS ON CHILDRENS LIVES Population: 153 M Population: 48 M Population: 45 M Figure 2: National burden of disease

6 Elements of a Decent Standard of Living Collective Services for Social Cohesion Clean environment Nutrition Housing, water, sanitation, electricity Recreation and leisure Employment A decent standard of living Transport Education and skills Health care Safety and security Presentation to 53 rd ANC Conference Mangaung, December

7 Cycle of development Collective Interventions/Programmes for Development STRONG LEADERSHIP ACTIVE CITIZENRY EFFECTIVE GOVERNMENT Development occurs when there is policy clarity AND a set of planned actions Presentation to 53 rd ANC Conference Mangaung, December

8 Elements: social floor and decent standard of living should respond to the following dimensions of poverty Asset poverty Land Credit skills Capabilities Social protection floor Food security Early Childhood- Development Health Education Food security is cross- cutting Income poverty Labour market income Income support measures grants Developmental and income generating (generative) livelihood support Basic infrastructure Utilities including housing, electricity, water and sanitation Social development services community development, social welfare services, social infrastructure etc.

9 SPll Recommendations for poverty alleviation Provision of basic social amenities Introduce minimum wage level Increased social grants to cover needs Skills acquisition programmes Job provision/creating employment opportunities Improved educational system Access to information - critical SP ll :Studies in Poverty and Inequality Institute Reduction in taxes of the poor Increased exportation of goods and services (i.e. greater market access) Increase recycling of products Family planning Spiritual guidance Increase rural development.

10 Social Determinants of Prevention of Mother to Child Transmission of HIV1 Social Determinants for a Comprehensive Approach Corporate Dominance in: Food, Medicines, Food security * Residential environment *Transport Family Stresses *Addictions (alcohol & tobacco) Governance and legal framework *Financing *Efficiencies in financially constrained environment *Access to effective health systems & quality health services *New models of Primary Health Care Employment *Social support *Social poverty gradient *Social exclusion *Community engagement *Stigma Access to quality education Service delivery: *Housing *Potable water *Sanitation *Electricity Overall Targets 1. Reduce the number of new HIV infections among children by 90% 2. Reduce the number of HIV-associated deaths among women during pregnancy, childbirth and puerperium by 60%

11 Household infrastructure by race % with access SOCIAL SERVICES African 1996 African 2007 Non-African 1996 Piped water on site Flush toilet on site Electricity for lighting Non-African % of children below the age of 15 in school Over 700 clinics built 2.6 million subsidised houses built, providing shelter for >10 million people Proportion of black people in higher education up from 27% in 1986 to 78% today SOURCE: Statistics SA: General household survey 1996 and 2007

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14 HEALTH AND DEVELOPMENT CONVERGENCE **There has been a resurgence of interest in overcoming fragmentation on the eve of the Millenium Development Goals in 2015, and..the idea of a grand convergence- a reduction in preventable infectious, maternal, and child deaths to universally low levels- as a sustainable development goal after 2015 **Except for Universal Coverage, there has been no unifying all-encompassing global objective.

15 Global Recommendations universal coverage of health care (1) aim for affordable universal coverage and access for all citizens on the basis of equity and solidarity (2) (1) World Health Report WHO. Health System Financing: The path to universal coverage. Geneva. WHO (2) World Health Assembly. Sustainable health financing structures and universal coverage: 64 th World Health Assembly Agenda, Item 13.4

16 Inequities

17 The definition of fairness may vary considerably for different systems. Perhaps the market mechanism you pay for what -you get is appropriate for most consumption goods. But for health, education, security and some other systems, the concept of fairness in financial contribution may be very different. We are concerned both with the average level of population health and with health distribution inequalities within the population. Christopher JL Murray & Julio Frenk. Bulletin of the World Health Organization, 2000;78(6)

18 South Africa has the largest share in the world of Total Health Expenditure funded through Private Insurance (44%) yet only 16 % of the population benefit from these resources. Mills A, Ataguba JE, Akazili J, Borghi J, Garshong B, Makawia S, Mtei G, Harris B, Macha J, Meheus F, McIntyre D. Equity in financing and use of health care in Ghana, South Africa and Tanzania: Implications for paths to universal coverage. The Lancet 2012 [E-pub May 2012]

19 % share of need/benefits Imbalances Between Need and Benefits in the SA Health System 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Need Total benefits Q1 (poorest) Q2 Q3 Q4 Q5 (richest) Source: Ataguba & McIntyre (2009)

20 Health Financing and Population Coverage The 16% who pay from their pockets see private GPs and dentists but use public hospitals for serious illness; they often spend on over-thecounter medications, and cannot afford catastrophic healthcare expenses. Most out-of-pocket expenditure is on co-payments for those on private insurance. Source: Health Economics Unit, UCT Mills A, Ataguba JE, Akazili J, Borghi J, Garshong B, Makawia S, et al. The Lancet 2012 [E-pub May 2012]

21 Medical Scheme Contributions as a % of Income According to Wealth INCOME % CONTRIBUTION Lowest > 14% Middle +/- 12% Higher > 9% Richest 5.5 %

22 Medical Contribution Inflation vs CPI Meta-analysis of the Council for Medical Schemes (CMS) Annual reports from in Loggerenberg D. Has healthcare inflation eased off yet? SAMA Insider, April 2012.

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24 HIV/AIDS BURDEN Source: SASI Group and M. Newman 2006

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26 INCREASE IN NON-COMMUNICABLE DISORDERS IN POOR COUNTRIES

27 Non-Communicable diseases

28 Sustainable development?