Making primary health care work for the poor

South Africa’s poor health outcomes have traditionally been attributed to poverty, unequal and ineffective spending and the high disease burden, but increasingly it is recognized that the public health system may also be contributing to such problems by delivering services that do not always conform to the stipulated standards.

The envisaged public health reform (promoted under the banner of the National Health Insurance) acknowledges that health outcomes are disappointing; that there are notable quality problems in the public health care system; and that change is therefore required (7). For this reason “improvement of quality in the public health system is at the centre of the health sector’s reform endeavours’’, according to the to the National Health Insurance green paper (7). Locally, this focus is also aligned with the Western Cape province’s Vision 2030, emphasizing a client-centric approach and encouraging transparency and governance.

The proposed study focuses on primary healthcare facilities (PHC) because visits to such facilities represent a large proportion of health care visits in South Africa. PHC is to a large extent the face of public health care for many and it thus appears to be a sensible starting point for an assessment of the health system’s implementation capacity. We assess effective service delivery by tracking a range of measures, including waiting times, user acceptability and compliance with TB, antenatal and HIV protocols. We build on existing health facility surveys that have been rolled out in other countries (8) and draw on literature from various disciplines, including medical literature and literature from public health and development economics, to create a facility level survey and qualitative tools to measure quality and acceptability of PHC services.

This project forms part of the STIAS long-term theme project Health in transition.

Project leader(s):
  • Servaas van der Berg and Ronel Burger (Stellenbosch)
STIAS fellow(s):
  • Eddy van Doorslaer (Erasmus University Rotterdam), Ulf Gerdtham (Lund University)

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