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National Health Act, 2003 (Act No. 61 of 2003)


National Health Insurance Policy towards Universal Health Coverage

Chapter 3 : Problem Statement

3.3 Structual problems in the health system

3.3.2 Service delivery challenges


54. Despite major strides being made since the dawn of democracy in improving access to health care services, the health system is still facing many challenges with regards to poor quality of health services and hospi-centrism. Both the public and private health sectors are encumbered with these challenges whilst the public sector is more predisposed to challenges of quality.


(a) Quality of Healthcare Services


55. Quality of healthcare has been associated with dissatisfaction amongst the users of health services with respect to acceptability of the healthcare services and patient experience32. Public sector facilities are regularly assessed against core quality standards. This has revealed that there are quality problems in the areas of staff attitudes, waiting times, cleanliness, drug stock outs, infection control, and safety and security of staff and patients. Although efforts have been made to address these challenges, they continue to persist in the public sector.


56. Quality challenges are aggravated by high levels of inequity due to health expenditure and other resource misalignment between the public and private sectors relative to the populations they serve, and an under-resourced and overburdened public health system. In the private sector, it has been found that the majority of private general practitioners were not aware of the recommended medications, doses, or durations for treatment of sexually transmitted infection where a private–public partnership to educate providers about national guidelines for sexually transmitted disease prevention and control had no effect on practice33.


57. Furthermore, the lack of a coherent unified health information management system, fragmentation and poor leadership at the different levels of care has exacerbated the situation and resulted in suboptimal conditions of delivering quality health services. The significant increases in utilisation due to the high burden of disease, and associated increased patient loads have further compromised the quality of care. The public's discontent with the quality of services has escalated medico-legal claims in both the public and private sectors, putting enormous strain on the fiscus and healthcare professional. This challenge needs to be adequately addressed within a unified health system , but more so in the public sector.