Access to a reasonable level of health care is a fundamental human right which is entrenched in the Constitution of South Africa. Although health services in certain parts of the country have become more accessible due to the provision of additional clinics, the overall quality of health care is perceived to be declining.
Principles for health care provision
IFP health policy has evolved from the following principles:
- Responsibility for ensuring delivery should be devolved to the lowest appropriate and competent level of government;
- Public sector services should be targeted to those most in need;
- Except in certain cases, services should be fee-related;
- The health service should recognise and exploit the respective competencies of the public and private sectors;
- Primary health care should be the foundation of, and entry level to, health care services;
- The health service should be information driven, and should employ optimal levels of technology to promote evaluation and performance etc.;
- Evaluation of performance should be based upon peer review and should include relevant professional bodies;
- Training should be an integral component of service at all levels;
- Freedom of choice concerning the utilisation of health services should be assured;
- Government regulation should ensure minimum standards; and
- Licensing of health providers should be according to uniformly applied criteria.
Optimal devolution of responsibility
National government should be responsible for setting overall policy, determining minimum standards and for ensuring delivery of selected services e.g. international health matters and academic standards.
Provincial government should be the principal tier responsible for ensuring health care service delivery to the population. Provinces should be answerable to national government in respect of minimum standards.
Local government should be responsible for the delivery of primary health care services within their areas of jurisdiction, and should, on negotiation, be appointed as agents of the provinces for the delivery of such services outside their areas of jurisdiction in cases where acceptable levels of competence do not exist. Local government will be answerable to the provincial government in respect of minimum standards.
Primary health care
Primary health care through clinics and other appropriate facilities is the foundation of the public health service, and the gateway to higher level services. Special attention should be directed to:
- Maternal and child health, and the treatment and prevention of infectious diseases;
- AIDS prevention through counselling;
- Care of the elderly. The escalating AIDS epidemic will result in increased numbers of orphaned children who will look to the elderly for care; and
- School health services, in order to promote early detection of illness and disease.
Public and private sector health care partnerships
The private sector should be encouraged to share the burden of providing affordable health care. Certain government funded health care services should be managed by private sector organisations or NGO’s.
Community health workers and NGO’s should be more extensively utilised in specific areas of health care i.e tuberculosis, AIDS and geriatrics.
Health care quality
Methods of evaluation of health care quality must be determined in association with experts and professional bodies.
Government should focus its limited resources on deprived areas, thereby improving the quality of health care in the areas of greatest need.
Until new clinics can be adequately provided in rural areas, greater use should be made of mobile clinics.
The application of information systems relevant to improving the efficiency and quality of care, at every level, should be made a requirement of the health services.
The current four year nursing diploma should be replaced by a three year diploma, followed by a year of specialisation.
There should be greater autonomy for decision making, with regard to nursing services, at the level of hospitals and district health authorities.
Nursing should be declared an essential service, and regulations governing nursing strikes should be established. In the event of industrial disputes, arbitration should be mandatory. Nursing salaries should be improved relative to those of other health care professionals.
Control of the nursing profession, and the setting of educational and ethical standards should be the responsibility of registered nurses, who should constitute a majority within the Nursing Council. Nurses who contravene the nursing code should be struck off the roll, and those who endanger the lives of patients should be charged with the appropriate offence.
Private hospitals should be obliged to contribute to nursing education through accredited private colleges.
Redistribution of human resources
In order to rectify the present maldistribution of health care personnel, the relevant public service regulations should be amended to allow for the creation of substantial incentives, financial and otherwise, for those working in unfavourable areas.
Foreign medical practitioners
Notwithstanding the preference for medical personnel trained in South Africa, and familiar with the local environment, the shortage of medical professionals should be addressed through the recruitment of foreign doctors. A more liberal policy regarding the registration of foreign doctors, for employment in the public sector, is required. Registration criteria should be fair, reasonable and unbiased.
Parallel imports of pharmaceuticals, where this is in conflict with registered patent rights, should not be permitted. However, the IFP supports pharmaceutical imports where these imports are subject to the same controls which apply to locally manufactured items.
Competitive transparency along the entire chain of pharmaceutical supplies should be encouraged, as should the use of generic medicines.
Private management of drug distribution, on behalf of the state, would reduce costs incurred through excessive theft.
Health care payment
The state should provide free basic health care for pregnant women, children, sufferers of communicable diseases, and selectively targeted programmes i.e. AIDS and immunisation.
Free health care should be available to those who cannot afford to pay for this service. The application of a voucher system for free health care should be investigated.
All working individuals should be obliged to purchase health insurance – of their own choice. The options should include insurance with a savings component and pre-funding for retirement, pay-as-you-go schemes, managed care or a national health insurance. All health care funds should be regulated to ensure financial stability, and to provide incentives for efficiency.
Unrestricted access to abortion is not considered by the IFP to be in the best interests of society. The conceptualisation of abortion as a form of contraception is ethically dubious, and of considerable danger to a population which is experiencing an AIDS epidemic. Government should spread the message that sexual activity has concurrent responsibilities. Notwithstanding the above, the IFP believe abortion should be available in the following cases:
- Scientifically determined deformity to the foetus;
- Danger to maternal health;
- Pregnant children, with the consent of their parents and medical practitioners.
The threat of AIDS should be managed through intensive and purposefully targeted public awareness campaigns, and the reinforcement of society values. This will necessitate the participation of all representative groups in society i.e. churches, schools and community organisations. Condoms should be provided through primary health care services. HIV infection should be a notifiable condition, as is the case with tuberculosis. This will assist in monitoring the progress of the epidemic, and the tracing and counselling of contacts.
There should be no unfair discrimination the basis of HIV/AIDS. The disease should be treated like any other medical condition as regards testing, with patients being informed of their HIV status. Confidentiality by health workers should be assured. Greater openness with regard to HIV/AIDS should be encouraged. There should be a sanction against sufferers who withhold their HIV/AIDS status from a sexual partner.