To drum up support as South Africans head to the polls, President Cyril Ramaphosa reportedly vowed to"end the apartheid that remains in healthcare" when he hit the campaign trail. Professor Bob Mash has three health reforms on his wishlist for the incoming administration to prioritise.
The WHO also recommended that integrated primary care be combined with essential public health functions. In other words, we don't just worry about the people who enter the doors of the clinic but think about the health needs of all the people living in the catchment area. Finally, they recommended transformation of the leadership in health to make it more collaborative and to dialogue on policy with multiple stakeholders.
Family physicians are known to improve the quality of primary and district hospital care. They bring expertise closer to the community, capacitate the whole clinical team, improve quality, patient safety and reduce litigation. Adding a family physician to the clinical team is a cost-effective intervention. Despite this, only one province has really gone to scale with the employment of family physicians. This is a wasted opportunity and a low-hanging fruit in terms of reform.
Firstly, there must be a clear delineation of the community served and CHWs given responsibility for designated households . Facility-based and community-based health care workers must operate as one multidisciplinary team and offer a comprehensive approach as described earlier. The team must make a careful analysis of the health needs in their community and also the resources available to address these needs.
Diabetes is now the leading cause of death in women in South Africa. Hypertension, heart disease and stroke are together the largest cause of deaths across all causes. Mental health, substance abuse and psychosocial problems may not cause death, but are a huge cause of morbidity and illness.