Week 19
Core Domain: Health Systems Sciences
How does South Africa's allocation of its GDP to healthcare compare to other countries?
According to the World Health Organization, South Africa spent 8.6% of its GDP on healthcare in 2020. This is higher than the average of 8.4% for the OECD countries in 2022. However, some countries spend more than South Africa, such as the United States (15.9%), Switzerland (12.1%) and France (11.3%) in 2022.
How can the allocation and distribution of resources promote equity in healthcare services?
According to one source, efficient and equitable resource allocation means that everyone who has a need gets that need addressed, but this is with as few resources as possible. This requires accurate estimates of the true costs of resources and achieving health goals at minimal costs.
Another source suggests that resource allocation through capitation is needed to achieve equity in access to health care or health outcome. Capitation is a payment method where a fixed amount of money is paid per person to a health care provider.
A third source argues that paying attention to justice and fairness can promote the realization of equity and the improvement of human health, as well as the sustainable development of health services.
What are the shortfalls of Universal Health Coverage in the South African Context?
Universal Health Coverage (UHC) is a goal that South Africa is pursuing through the implementation of National Health Insurance (NHI). NHI aims to provide access to quality health services for all South Africans, based on their health needs and irrespective of their socio-economic status.
However, there are some shortfalls of UHC in the South African context, such as:
The existing inequality and inefficiency of the two-tiered healthcare system, where the public sector serves 71% of the population and the private sector serves 27%. The lack of social innovations and community participation in addressing the pressing health needs that are not met by government services. The impact of state capture, poor governance and corruption on the health sector and its entities. The misalignment between stakeholders on the NHI Bill and its implications for health financing reform.
https://health.gov.za/wp-content/uploads/2020/11/some-key-messages-on-nhi.pdf
https://www.gov.za/speeches/policy-dialogue-universal-health-coverage-south-africa-12-dec-2022-0000
https://idpjournal.biomedcentral.com/articles/10.1186/s40249-021-00804-9
https://southafrica.fes.de/fileadmin/user_upload/SA_NHI_UHC_report_20200803_final.pdf
What are the ethical concerns surrounding the administration of Depo-Provera as the contraceptive of choice?
Depo-Provera is an injectable contraceptive that has been used in many countries for decades. However, it has also raised some ethical concerns, such as:
The potential risk of increasing HIV transmission among women who use it. The lack of informed consent and adequate information about its side effects and alternatives. The possible coercion or discrimination of vulnerable groups, such as sexual offenders, poor women, or minorities, to use it.
Competency: Scholarship
Can you describe a few different ways for collecting data from human participants?
Questionnaires and surveys, Interviews, Focus groups, Direct observation, Computer- and internet-based surveys and Social networking sites and mobile devices:
From what you have learnt so far about research problems, research designs and sampling, what do you think are important aspects to consider when deciding how to gather data?
Research problems.
What other practical and logistical aspects do you think play a role in deciding how to collect data?
---
Complementary: Debate
In the context of resource allocation, and with reference to the STEEEP framework should Depo-Provera be the first line of contraception?
Resource allocation is the process of assigning and managing the available resources in an organization or a project in the most efficient and effective way. The STEEEP framework is a variation of the STEEP analysis, which considers socio-cultural, technological, economic, environmental/ecological, political, legal and ethical factors in strategic decision making.
Depo-Provera is a contraceptive injection given every three months that was introduced in South Africa in the 1970s and largely given to black women as part of the apartheid government’s population control agenda. It has been linked to increased risk of HIV infection and other health issues.
To answer the question, you may need to weigh the benefits and risks of Depo-Provera against other contraceptive options, as well as consider the social, economic and ethical implications of its use in South Africa.
Week 20
Core Domain: Health Financing
How is the private healthcare sector structured?
In South Africa, private healthcare can be divided into two main classifications:
Providers refer to those who provide healthcare services, such as hospitals and professional bodies, including:
Private health service providers, such as doctors, nurses, midwives;
Private health facilities such as hospitals;
Laboratories and pathological providers;
Pharmaceutical providers;
The institutions that represent health professionals;
Traditional health practitioners.
and Funders refer to the systems and organisations that are responsible for the financing of private healthcare systems, such as;
Medical Aid Schemes;
Out of Pocket Payments;
Life Insurance;
Short Term Insurance;
Grants or Subsidies.
How is the private healthcare sector funded?
Private healthcare can be accessed and is funded through:
Membership of medical schemes and other forms of health insurance.
Out-of-pocket expenditure.
Access at their workplace, through workplace programs or medical schemes.
Non-profit organisations and NGOs.
High costs in accessing private healthcare make it inaccessible for most people, and thus puts further pressure on the public health system. According to the health finance profile published in 2016, approximately 14% of South Africans receive private medical healthcare through medical schemes, whilst 86% of South Africans depend on the public health sector.
The financing of the private sector also comes from various sectors such as the pharmaceutical (largest in the African continent) and medical supplies industries, which together with the private healthcare sector, are in a symbiotic relationship where both benefit. The pharmaceutical industry, for example, makes a lot of profit from its relationship with the private sector through procurement.
How does a medical aid scheme work?
Medical Aid Schemes function by pooling contributions from members and using these pooled funds to pay healthcare providers. They are responsible for conducting all administrative functions and provide the necessary infrastructure for its administration. Medical Aid Scheme charge administration fees and make profits from their services for:
Undertaking Risks;
Benefit design;
Underwriting;
Service;
Collection of contributions;
Processing of claims.
They provide cover for medical expenses such as medicine, hospitalisation and treatment (depending on the plan) for the members who pay monthly premiums. There are various types of medical aid plans from which one can choose, and the monthly premium will vary based on the plan that a member chooses. It varies with the different medical aids, for example, a member of the Momentum medical aid scheme does not pay the same rate as a member of the Discovery Health medical aid scheme even though they might have the same plan. There are also closed medical aid schemes, which are provided to staff by their companies, and open medical aid schemes, which are for any public person who can afford them.
Competency: Scholarship
From what you have learnt so far about research and research methods, what do you think are important aspects to consider when analyzing data?
Through the process of data analysis, researchers summarise and make sense of the raw data they have collected in relation to the research question/s, and start the important process of making their findings accessible to others. The data analysis strategies that researchers choose need to address their research question and correspond to the research design and data collection tools used.
How do you think quantitative and qualitative data analysis differ in their objectives and output?
The first analysis type, quantitative data analysis involves information in the form of numbers. Quantitative data analysis is the organisation, summarisation and interpretation of numerical information, usually through the use of statistics. The second analysis type, qualitative data analysis, involves data where information is in the form of words.
Qualitative data analysis is the systematic reading, description, understanding and interpretation of (usually non-numerical) data.
Why do you think it is important to plan for your data analysis in your research protocol?
Yes
Resource Allocation: National Health Insurance
What are the ethical arguments surrounding the implementation of NHI?
NHI stands for National Health Insurance, which is a proposed system of universal health coverage in South Africa. There are different ethical arguments surrounding the implementation of NHI, depending on one’s perspective and values. Here are some of the main ones:
The argument for NHI: Quality healthcare for all. NHI aims to address the massive inequalities in the current access South Africans have to quality healthcare, where only 16% of the population can afford private medical care and the rest depend on the state’s health services. NHI would create a single pool of healthcare funding for both public and private providers, and ensure the same standard of care for everyone. This argument is based on the principles of justice, solidarity and human rights.
The argument against NHI: The state can’t afford it or taxes will need to pay for it. NHI critics question the state’s ability to fund NHI, which will have mammoth costs, and fear that the taxpayers will have to bear the burden of financing it. They also doubt the state’s capacity to manage NHI efficiently and effectively, given the corruption and mismanagement that plague the public health sector. They argue that NHI would undermine the autonomy and choice of individuals, and that it would harm the private health sector and the economy.
Do you think that the NHI will be successfully implemented by 2026?
NHI stands for National Health Insurance, a health financing system that aims to provide access to quality affordable health services for all South Africans. The NHI Bill was passed by the National Assembly in June 2023 and the implementation is expected to be completed by 2026. However, there are some legal and logistical challenges that could delay the process.
https://www.gov.za/about-government/government-programmes/national-health-insurance-0
https://www.sanews.gov.za/features-south-africa/national-health-insurance-all-you-need-know
https://www.citizen.co.za/lifestyle/health/explained-when-will-the-nhi-be-implemented/
https://health-e.org.za/2022/12/13/nhi-implementation-headaches-loom-for-health-dept/
Is the proposed approach to NHI a viable option for South Africa?
Achieving universal health coverage is an important goal for South Africa. South Africa is currently transitioning to a Universal Health Coverage (UHC) healthcare system, using the National Health Insurance (NHI) and Primary Healthcare (PHC) as vehicles to achieve UHC. The main aim or expected outcome of this transition is to improve the quality and accessibility of healthcare services for all South Africans.
However, there are also many challenges and criticisms regarding the implementation, funding, governance and impact of the NHI. Some of the arguments against the NHI are that it will be costly, inefficient, unaccountable, unsustainable and detrimental to the existing medical schemes and private sector.
Week 21
Core Domain: Human Resources in Health
What is the local, regional and global picture regarding the distribution of human resources for health?
The distribution of human resources for health (HRH) varies widely across countries and regions, depending on factors such as population health needs, health system capacity, health workforce policies and investments, and health labour market dynamics.
According to a recent study, the global HRH stock in 2020 was estimated at 59.2 million full-time equivalent (FTE) workers, of which 23.6 million were physicians, 19.3 million were nurses and midwives, 5.9 million were other health professionals, and 10.4 million were health support workers. The study projected that the global HRH stock would increase to 68.5 million FTE workers by 2030, but with significant regional disparities.
For example, the study estimated that the African region would have the lowest HRH density in 2030, with only 1.4 FTE workers per 1000 population, compared to 14.8 in the European region and 12.9 in the Americas region. Similarly, another study found that India had a HRH density of only 2.3 FTE workers per 1000 population in 2016, with large variations across states and districts.
Some countries have developed national strategies or plans to address the challenges of HRH distribution and development, such as the Philippines, South Africa, and others. At the global level, the World Health Organization has launched the Global Strategy on Human Resources for Health: Workforce 2030, which aims to improve health outcomes, health equity, and health security by ensuring a sufficient, competent, responsive, and well-distributed health workforce.
What are the different cadres in the delivery of health care services and how is a ‘health worker’ defined?
Health Service Providers and Health Management and Suppourt Workers. The health workforce can be defined as “all people engaged in actions whose primary intent is to enhance health. The structure of the health workforce can be classified into two sectors: The Health Sector- which encompasses all those that are involved in the provision of goods and services to treat patients. Other Sectors- are those industries which do not provide goods and services to treat patients.
What are the main challenges regarding the production and retention of human resources for health in South Africa?
Insufficient stewardship of Human Resources for Health planning across the entire healthcare system; lack of a national integrated HRH information system, and inadequate information on overall HRH supply to address historical inequities between urban and rural areas and the public and private health sectors; gaps, and at times failures, in HRH governance; fragmentation, weak coordination and suboptimal governance of health sciences education; and poor and ineffective operational management across all types of health facilities and provincial health departments.
Health Systems Trust. (2018). South African Health Review. [online] Available at: https://www.hst.org.za/publications/South%20African%20Health%20Reviews/SAHR%202018.pdf
Competency: Scholarship
What do you think is meant by the “quality of research” and what parts of the research process is it applicable to?
The quality of research can be defined as the extent to which the research meets the standards of rigor, relevance, and impact [1]. It is applicable to all parts of the research process, from planning and design to data collection and analysis to reporting and dissemination [2][3].
How do you think criteria differ between quantitative and qualitative research for establishing research quality?
---
You have learnt a lot about ethics - do you know what aspects of research ethics need to be explained in a research protocol/proposal?
Informed Consent
Have you considered how you would like to disseminate your research?
No
Complementary: Ethics
What circumstances may lead to a healthcare worker choosing to work at more than one place of employment (known as dual practice)?
Low income
Development of skills and Work experience which is provided by different working environment and patients.
Flexibility
Training and professional benefits
What are the possible benefits of dual practice?
Work experience
Increased income
Improve skills
What are the possible drawbacks of dual practice?
May create challenges for the public health system such as:
General high absenteeism.
Abuse of sick leave privileges.
High stress levels (headaches, insomnia, fatigue, heart problems and endocrine disorders).
Low morale.
Fewer services offered and long patient queues.
Aggression, resignations, group conflicts and group coalitions.
Abuse of medical aid facilities.
Abuse of state assets to treat private patients.
Affect public service by:
patient neglect
medical negligence
poor quality of services
patient experience and patient satisfaction is negatively affected
What ethical principles could be helpful in guiding dual practice?
The principle of beneficence: the practitioner has a moral obligation to act in the best interest of the patient.
Virtue Ethics: Focused on the character of the person, with regards to dual practice it is Professional integrity, Integrity meaning the quality of a person.
Week 22
Core Domain: Human Resources in Health
What is the reasoning behind the decision for the South African Government in recruiting the Cuban Medical Brigade to support the COVID-19 response?
Improving the capacity of the health workforce can play a crucial role in ensuring that each country can respond to emergencies, such as COVID-19. The outbreak of the coronavirus has exposed the gaps in the health systems of many countries and has shown the importance of having a well-established health workforce. Furthermore, it has emphasised the importance of investing in and improving the capacity of the health workforce and its role in building a strong and resilient health system.
What strategies can be implemented to improve the production and retention of health workers?
Human Resource for Health Strategy South Africa
Nursing Strategy
Human Resource Strategy
How can building the capacity of the health workforce contribute to achieving UHC?
By increasing health workers there will be a decrease in shortage in the public health sector and therefore an increase in accessibility of care to some extent.
Competency: Scholarship
Do you feel more confident in your teamwork for Presentation Report 5 after incorporating the feedback you have received from previous work?
Yes.
Is your team collaborating successfully to meet deadlines, or do you need to adapt your work strategies to ensure the successful completion of Presentation Report 5?
My team is collaborating successfully to meet deadlines.
Are you becoming confident in proposing a research project as it would be written up in a research protocol?
Yes.
Comments