By: Annette Sheckler
Since 1996, South Africa has been working to build an equitable public health system accessible to all out of the remnants of its apartheid past—essentially racially-based services delivered by a highly fragmented and bureaucratic system. Today’s approach to healthcare is rights-based with the goal of creating a comprehensive and integrated health system. Equitable access to quality medicines and medical products, vaccines and technologies that are safe, efficacious and cost-effective are one of the six building blocks of a proper health system. [i] The South African pharmacist, working alongside partners such as USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS), is playing a key role in building a first-class, reliable public health system that can serve the needs of the South African people.
South Africa’s Pharmacists: On the Frontlines of Healthcare Reform
“The central challenge to the stability and well-being of our nation is reducing the deep inequality between rich and poor, between privilege and deprivation. This goes to the heart of South Africa’s future,” said South Africa’s Health Minister Aaron Motsoaledi. [i] The government of South Africa is committed to ensuring access to quality healthcare for all South Africans, regardless of their ability to pay. This is not easy in a country said to have one of the highest rates of inequality in the world. South Africa’s healthcare system consists of a large, resource-constrained public sector and a small private sector for those able to pay premium prices for premium healthcare. The majority of South Africans, however, are largely uninsured and unable to pay for private healthcare. Although primary healthcare is free, specialized healthcare is available only in the private sector for those who can afford it.
In order to meet the challenge of expanding access to healthcare for all, the South African government has embarked upon an ambitious plan to implement a national health insurance (NHI) system. Universal health insurance is expected to increase the consumer’s access to healthcare. However, equally challenging will be the quality of healthcare available to the consumer. Since 1994, South Africa has been putting resources in building its healthcare system—its health facility infrastructure, regulatory system, supply chain, and human resources. In all of these efforts, pharmacists have made significant contributions from national initiatives to community care.
SIAPS in South Africa: Promoting Country Ownership and Sustainability
SIAPS’s systems-strengthening approach is based on a fundamental recognition that, in order to be sustainable, countries must lead the process of building health systems within the context of country ownership. In South Africa, SIAPS developed a robust partnership with the South African government at all levels, as well as with a number of pharmacy schools and governing bodies such as the South African Pharmacy Council (SAPC).
Good governance drives quality service delivery. Good governance is a function of strong and viable institutions that can deliver public services equitably, transparently and efficiently. SIAPS, in partnership with the government, has worked to develop and implement systems for: standards and accreditation; pharmaceutical licensing; tender management; supply management ; pharmacovigilance; compliance with standard treatment guidelines; and pharmaceutical management information systems. These elements together work to build a unitary, comprehensive, equitable and integrated public health system that can deliver quality health care to all South Africans, regardless of ability to pay.
South Africa’s commitment to providing access to healthcare for all of its citizens through the NHI is a positive step forward in transforming the public health system. The challenges ahead are maintaining the momentum for building the health system infrastructure, creating the regulatory environment, and improving service delivery. However, by investing in South Africa’s people with quality healthcare, South Africa will be able to take fulfill its economic, political and socially progressive potential on the global stage. SIAPS will continue to support these efforts.
Annette Sheckler is the Communications Manager for the Center for Pharmaceutical Management at Management Sciences for Health.