South African healthcare reforms towards universal healthcare - where to next?

The National Assembly approval of the National Health Insurance (NHI) Bill represents an important milestone, but there are many uncertainties concerning its implementation and timeline. The challenges faced by the South African healthcare system are huge, and we cannot afford to wait for NHI to address them all. It is critical that the process of strengthening the health system to advance universal healthcare (UHC) begins now, and there are several viable initiatives that can be implemented without delay. This article examines potential scenarios after the Bill is passed and ways in which UHC could be advanced. It begins with an overview of the trajectory of health system reform since 1994, then examines the scenarios that may emerge once the Bill is passed by Parliament and makes a case for finding ways in which UHC could be advanced within the country, regardless of any legal or financial barriers that may delay or limit NHI implementation.

Managing the healthcare demand-supply gap during and after COVID-19: The need to review the approach to healthcare priority-setting in South Africa.

Healthcare demands are rising globally, and regardless of the approach to financing and delivering healthcare services, no country can meet all the healthcare demands of its population. The demand-supply gap for healthcare services in South Africa (SA) is large, particularly for the public sector. The objectives of this article are to examine some of the underlying factors contributing to this gap, and how the COVID- 19 pandemic is likely to impact on them, and to describe why SA needs to adopt an explicit and equity-informed approach to healthcare priority-setting to assist in managing the gap.

An evaluation of a school-based comprehensive public oral health care programme.

This study evaluates a comprehensive oral health care programme seven years after it started in 1986 at a public dental health clinic in Cape Town. Five primary schools served by the clinic were selected for a community trial. Three schools were randomly allocated to receive the programme and two to a non-participating control group. An evaluation to assess the effectiveness of the programme was carried out by comparing the mean DMFS scores of the experimental (programme) schools with control (non-programme) schools. One hundred and ten children who entered the programme in 1986 and 102 non-programme children of similar age were examined and compared in 1992. In the experimental group the mean DMFS score was 1.94 compared to a mean DMFS of 6.12 in the control group. The percentage of caries-free children in the experimental group was 62.5 per cent and in the control group 37.5 per cent. The frequency distribution of the DMFS scores showed that one subject from the programme group had a score of > or = 15 and thirteen non-programme subjects had scores > or = 15. All the comparisons between the two groups reported above were highly significant (P < 0.005). The study shows that the programme has been very effective in reducing the prevalence of dental caries in the schools that received the programme.