Achieving universal health coverage in South Africa through a district health system approach: conflicting ideologies of health care provisionReportar como inadecuado

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BMC Health Services Research

, 16:558

Health policy, reform, governance and law


BackgroundUniversal Health Coverage UHC has emerged as a major goal for health care delivery in the post-2015 development agenda. It is viewed as a solution to health care needs in low and middle countries with growing enthusiasm at both national and global levels. Throughout the world, however, the paths of countries to UHC have differed. South Africa is currently reforming its health system with UHC through developing a national health insurance NHI program. This will be practically achieved through a decentralized approach, the district health system, the main vehicle for delivering services since democracy.

MethodsWe utilize a review of relevant documents, conducted between September 2014 and December 2015 of district health systems DHS and UHC and their ideological underpinnings, to explore the opportunities and challenges, of the district health system in achieving UHC in South Africa.

ResultsReview of data from the NHI pilot districts suggests that as South Africa embarks on reforms toward UHC, there is a need for a minimal universal coverage and emphasis on district particularity and positive discrimination so as to bridge health inequities. The disparities across districts in relation to health profiles-demographics, health delivery performance, management of health institutions or district management capacity, income levels-socio-economic status and social determinants of health, compliance with quality standards and above all the burden of disease can only be minimised through positive discrimination by paying more attention to underserved and disadavantaged communities.

ConclusionsWe conclude that in South Africa the DHS is pivotal to health reform and UHC may be best achieved through minimal universal coverage with positive discrimination to ensure disparities across districts in relation to disease burden, human resources, financing and investment, administration and management capacity, service readiness and availability and the health access inequalities are consciously implicated. Yet ideological and practical issues make its achievement problematic.

KeywordsUniversal Health Coverage District Health System Inequity Ideology South Africa AbbreviationsANCAfrican National Congress

ANCAntenatal client

ASSIAApplied Social Science Index and


CEOChief executive officer

DCSTDistrict Clinical Specialist Team

DHBDistrict Health Barometer

DHMTsDistrict health management teams

DHSDistrict Health System

DoHDepartment of Health

FITFacility Improvement Team

FSFree state

GDPGross domestic product

GPsGeneral practitioners

IBSSInternational Bibliography of the Social Sciences

IDAInternational Development Agency

KZNKwa Zulu Natal

LMICLow and middle income countries

NDoHNational Department of Health

NDPNational Development Plan

NHINational Health Insurance

OECDOrganization for Economic Cooperation and Development

OOPOut-of-pocket payment

OSCOffice of Standards Compliance

PHCPrimary Health Care

SARRAHStrengthening South Africa’s Response to HIV and Health

SDoHSocial determinants of health

UHCUniversal health coverage

WHOWorld Health Organization

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Autor: Adam Fusheini - John Eyles


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