The Department of Health (DoH) provides leadership and coordination of health services to promote the health of all people in South Africa through an accessible, caring and high quality health system based on the primary healthcare (PHC) approach.
The department contributes directly to achieving the gov- ernment’s goal for a long and healthy life for all South Africans. In line with the vision of the National Development Plan (NDP) of ensuring a long and healthy life for all South Afri- cans, the department focuses on sustainably expanding HIV and AIDS and tuberculosis (TB) treatment and prevention, revitalising public healthcare facilities, and ensuring the provision of specialised tertiary hospital services.
South Africa has reduced the HIV-infection rate from 8% in 2008 to 1,5% in 2015.
Increased life expectancy of the population demonstrates that the number of AIDS-related deaths and infant mortality rates have dropped over the past few years.
More women are getting into government’s Prevention of Mother-to-Child Transmission Programme. The country runs the biggest HIV-treatment programme in the world, with more than 12 million people tested in 2015 and close to 170 000 babies tested at the crucial six-weeks stage.
According to the results of the General Household Survey released by Statistics South Africa in June 2016, seven in every 10 (70,5%) households went to public clinics and hos- pitals as their frst point of access when household members fell ill or got injured.
By comparison, a quarter (25,3%) of households indicated that they went to private doctors, private clinics or hospitals. Most households (92,8%) went to the nearest health facility.
Innovative health solutions
By mid-2016, the DoH was piloting a self-service dispensing machine for medicines at the Thembalethu Clinic in Johan- nesburg.
The Pharmacy Dispensing Unit (PDU) is a self-service machine where patients can obtain their medication in the same way people withdraw money at an ATM. To use the machine, a patient needs to register for the service and receive a PIN-protected card similar to a bank card.
To “withdraw” their medication, users simply insert their card into the PDU machine, enter their PIN and select the medication they require from their prescription list.
The machine immediately dispenses the selected medica- tion, eliminating the need for the patient to wait in queues.
The PDU also allows patients to communicate directly with a trained pharmacist directly from the machine using a built-in video conferencing function.
Other technologies include the Stock Visibility System, a mobile application that enables medicine availability information at PHC clinics to be uploaded to a central online data repository. The camera on the phone can be used to scan the medicine barcode and update stock levels, thus enabling healthcare workers to easily monitor the quantity of medication they have in stock and timeously order medication that might be running low. This will help to reduce the number of stock-outs at clinics.
The DoH has also launched MomConnect, a free sms service that provides pregnant mothers with regular foetal development updates throughout their term of pregnancy. By mid-2016, the service had more than 800 000 registered users.
The Mother2Mothers is a service that connects new mothers to experienced mentors to help them through their pregnancy.
The Medication Adherence app reminds users of their clinic or hospital visits and to take their scheduled medication. The B-Wise is a youth focused online service that provides young people with health information and allows them to have their health-related questions answered by an expert adviser within 48 hours.
The main NCDs in the country include diabetes, cancer, chronic respiratory diseases, mental disorders and cardiovascular diseases.
Africa remains the only World Health Organisation (WHO) region where communicable diseases still account for more deaths than NCDs, according to a 2010 global status report.
The main risk factors associated with NCDs are tobacco use, alcohol abuse, an unhealthy diet and physical inactivity. Hepatitis B is widespread in sub-Saharan Africa and South Africa. Past studies have found that about 8% of children under the age of one and almost 16% of children under the age of six are infected with hepatitis B.
Between 10% and 18% of South African adults are hepatitis B virus carriers. Infection has been more common in the Eastern Cape and KwaZulu-Natal.
South Africa has increased the number of people who receive ARVs to over 3,4 million people in 2016.
The department expects ARV therapy to reach fve million South Africans by 2018/19. This expansion is part of South Africa’s progressive scaling up towards 90-90-90 targets for 2020 of the Joint United Nations Programme on HIV and AIDS, namely: 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained ARV therapy, and 90% of all people receiv- ing ARV therapy will have viral suppression.
Further increases in the HIV and AIDS, TB, Maternal and Child Health Programme of R60 million in 2017/18 and R140 million in 2018/19 will be used to scale up HIV-prevention programmes, such as condom distribution, medical male circumcision and social behaviour change communication campaigns.
With effect from 1 June 2016, selected sex-worker programmes around the country were expected to offer oral antiretrovirals (ARVs) as PrEP, in addition to the other HIV-prevention interventions. They would also offer treatment upon diagnosis for HIV positive sex workers.
Combination prevention has been demonstrated to prevent new HIV infections. Early initiation on ARVs contributes to both better health and decreases the possibility of HIV trans- mission to their clients and partners.
An estimated 20% of the 350 000 people annually infected with HIV in South Africa are connected with sex work. HIV prevalence amongst female sex workers in South Africa is estimated to be 59,8%. The SA Health Monitoring Survey of Female Sex Workers estimated that the prevalence of HIV among female sex workers was 71,8% in Johannesburg, 39,7% in Cape Town and 53,5% in eThekwini.
To ensure that PrEP is offered in programmes that already provide comprehensive services to sex workers (including general health screening, STI screening and treatment, provi- sion of condoms, contraceptives, HIV counselling and testing, ART treatment, PrEP and circumcision for male sex workers), the DoH had assessed and approved the following sites for the initial rollout of PrEP:
- Esselen Street Clinic in Hillbrow, City of Johannesburg.
- SSWP Wellness Centre in Soweto.
- Sediba Hope Medical Centre in Pretoria.
- TB/HIV Care Clinic in Durban.
- North Star Alliance Trucker Wellness Centres in Musina (Limpopo); Pomona (Gauteng); Ngodwana (Mpumalanga); Pongola (KwaZulu-Natal); Upington (Northern Cape), and Hoedspruit (Limpopo). Additional sites were expected to be provided in the future.
The 21st International AIDS Conference was held in Durban from 18 to 22 July 2016 and South Africa hosted it for the second time in the same town since 2000.
In 2015, the Ministry of Health released the Cabinet-approved White Paper on the NHI for public comment. The aim of the NHI is to provide access to quality and affordable healthcare services for all South Africans based on their health needs irrespective of their socio-economic status.
The NDP envisions a health system that works for every- one, produces positive health outcomes and is accessible to all.
By 2030, the NDP expected South Africa to have, among other things, raised the life expectancy of South Africans to at least 70 years; produced a generation of under-20s that is largely free of HIV; achieved an infant mortality rate of less than 20 deaths per thousand live births, including an under five mortality rate of less than 30 per thousand; achieved a signifcant shift in equity, effciency and quality of health service provision.
The NHLS is mandated to support the DoH by providing cost-effective diagnostic laboratory services to all state clinics and hospitals.
It also provides health science training and education, and supports health research. It is the largest diagnostic pathology service in South Africa, servicing more than 80% of the population, through a national network of 268 laboratories.
Its specialised divisions include the National Institute for Communicable Diseases, the National Institute for Occupational Health, the National Cancer Registry and the Anti-Venom Unit.
By September 2016, there were about 87 medical schemes in South Africa, with around 8,8 million beneficiaries.
The Compensation Commissioner for Occupational Diseases in Mines and Works is mandated to compensate workers and ex-workers in controlled mines and works for occupational diseases of the cardiorespiratory organs and reimburse for loss of earnings incurred during TB treatment.
- The Council for Medical Schemes is a regulatory authority responsible for overseeing the medical schemes industry in South Africa. Its functions include protecting the interests of benefciaries, controlling and coordinat- ing the functioning of medical schemes, collecting and disseminating information about private healthcare and advising the Minister of Health on any matter concerning medical schemes.
- The Office of Health Standards Compliance is mandated to monitor and enforce the compliance of health establishments with the norms and standards prescribed by the Minister of Health in relation to the national health system; and ensure the consideration, investigation and disposal of complaints relating to non-compliance with prescribed norms and standards in a procedurally fair, economical and expeditious manner.
- The South African Medical Research Council is mandated to promote the improvement of health and quality of life through research development and technology transfer. Research and innovation are primarily conducted through council funded research units located within the council and in higher education institutions.
On 14 April 2015, President Jacob Zuma launched the Sefako Makgatho Health Sciences University in Ga-Rankuwa, Gauteng. This university, which incorporates the former Medical University of South Africa’s campus of the University of Limpopo, started its frst academic year in 2015 with 5 000 students.
The establishment of the Sefako Makgatho Health Sciences University provides an excellent opportunity for the development and training of a new generation of health professionals who will make a positive impact on the lives and livelihoods of the many South Africans still marginalised by poverty and lack of access to health services.
The Sefako Makgatho Health Sciences University is the frst stand-alone health sciences university to be established in the country. Government will continue to invest in education and skills development as a key driver to economic growth and development.