Page 3 - Writing Journal

 

Writing Journal

Activity 1.1.5 – Understanding the question

Part 1: I believe that the question is asking that I make a summary of what the ideal health system in South Africa would look like. The summary should be in terms of how it would function, how it would be funded, and what type of care it would be able to provide.

Part 2: To write down the current state of healthcare in South Africa and break it down into its most basic components. Thereafter one would compare it to the ideal health system described in part one. Thereafter one would do research on the current plans being implemented to achieve this and evaluate whether the ideal healthcare system would be able to be implemented in South Africa’s current socio-economic climate.

Part 3: Lastly one should revisit the previous parts and from there come up with a possible stepping-stone that one could implement in order to achieve universal healthcare.

Activity 1.1.5.2 – Searching for literature

Step 1:

·       What is universal health as a concept?

·        What does universal health consist of in terms of components?

·       How does the South African Health System compare to universal health?

·       What are the components of the South African system that would set it aside?

·       What can be done to overcome problems in the health system?

·       Where would be a good place to start?

Step 2:

The difference between the two articles is that the first article focuses primarily on the makeup of universal health coverage, whereas the second article focuses on the progress South Africa is making towards achieving this.

I believe both articles are relevant to the question, seeing as one would first need to evaluate the meaning of Universal Health Coverage before one could compare the South African Health system to it. That being said, I believe I would get more use out of article two as it is more locally focused on the South African healthcare system, which would naturally be the subject of the course paper.

Step 3:

Topic 1 - The South African attempt at achieving universal healthcare

Title:  Achieving universal health coverage in South Africa through a district health system approach: conflicting ideologies of health care provision.
Author: Adam Fusheini, John Eyles.
Year: 2016

Title: Bridging the health inequality gap: an examination of South Africa’s social innovation in health landscape. Infectious Diseases of Poverty
Author: Katshuda de Villiers
Year: 2021

Topic 2 - Current state of the South African Healthcare system

Title: Addressing Social Determinants of Health in South Africa: the journey continues
Author: Vera Scott
Year: 2017

Title: Mortality and causes of death in South Africa
Author: StatsSa
Year: 2017

Topic 3 – The state of Hospitals in South Africa

Title: Health Services in South Africa: A basic introduction
Author: Kerry Cullinan
Year: 2006

Title: People-centeredness in health system reform. Public perceptions of private and public hospitals in South Africa
Author: Lebogang Maseko; Bronwyn Harris
Year: 2018

Activity 1.2.5.1 - Applying SQ3R in Reading Academic Texts

PART 1: SURVEYING - STEP 1A: SKIMMING

Q1 - What is the title of your article and who is the author?
A - Achieving universal health coverage in South Africa through a district health system approach: conflicting ideologies of health care provision by Adam Fusheini and John Eyles.

Q2 - When was your article published? (If your article is more than 10 years old, consider it outdated)
A – 2016

Q3 - Does your article contain an abstract?
A – Yes

Q4 - What are the headings in your text? (These will give you a clue as to what each paragraph or section will cover. Read the first and last sentence in each paragraph, not word for word but quickly to give you an idea what each paragraph is about)
A – Can UHC provide service availability? What is the link between service availability and districts? Why districts; a different ideology? Does UHC reduce inequities? – Evidence from the pilot districts. Ideological tension – a minimal universal benefit and the need for positive discrimination

Q5 - Does your article contain and tables and diagrams? (Not all academic articles contain these, so do not write it off if you do not find this section)
A – No

Q6 - Does your text have an in-text referencing and a reference list at the end of it? (All academic articles should have this, if yours does not, that it means it is not suitable for your course paper)
A – Yes

Q7 - Will this text be suitable for your essay?
A – Yes

PART 1: SURVEYING - STEP 1B SCANNING

Q1 - What are the key concepts/ideas you find in these sections?
A – The article first discusses what UHC entails and how many countries are setting long term plans to achieve this. Thereafter, the article discusses South Africa’s plan for UHC, more specifically, the National Health Insurance plan. The article explains how this would be a plan to pool government funds to be able to support all South African in their quest for health without having them be affected by discrimination, their socio-economic status, or insufficient funds to pay for proper medical care. The article further explains how the NHI will also help to reduce poverty and inequality established by South Africa’s past. The article also mentions that UHC might remain an empty promise, because of difficulties faced by South Africa in terms of economy and poverty. The article goes on about the benefits of UHC regarding service delivery and accessibility of healthcare and is even so detailed as to include challenges regarding service delivery in different districts across South Africa.

Q2 - Will this text help you write on the topic you are reading it for?
A – Yes

PART 2: QUESTIONING

Q1 - From the previous step, you started sectioning the text by scanning the abstract, introduction and conclusion. Scan these sections one more time and think of 3 questions about the text or your topic?
A – What benefits will UHC provide? Why is UHC necessary in South Africa? Does the South African Government have a plan to provide UHC to its citizens?

PART 3: READING, RECALLING, REVIEWING – STEP 3A READING

Q2 - Answer your questions 3 questions:
A – UHC will provide the best possible quality of healthcare to the people who need it with the added benefit of being affordable and accessible.
UHC is necessary in South Africa, because the current healthcare system does not provide the necessary care to patients. UHC has the potential of eliminating inequality on the front of health and will provide top quality healthcare to everybody regardless of socioeconomic status. Thereby, certain people will not receive better treatment than others, which is a struggle that is still to be rectified.
The South African Government is planning on implementing the NHI. This is a strategy for the government to be more involved in the healthcare system and provides the opportunity to collect larger amounts of funding for the public health sector and thereby improve staffing, equipment, accessibility and affordability.

PART 3: READING RECALLING REVIEWING – STEP 3B RECALL

Q1 - Now that you have read the text thoroughly, choose one section that you read in the text. It can be the introduction, a paragraph in the body or the conclusion. Without reading it again, in 150 – 250 words what are the main points of this section?

The section I have chosen to do is the Abstract. As I recall it mentions Universal Health and how it is growing in popularity and enthusiasm. It then mentions how the South African government are among those who want to implement it. It then mentions how the study is based off documents from the district health systems and will explore challenges and opportunities regarding UHC in South Africa. It then mentions the NHI, and the possibilities associated with it and finally mentions that UHC achievement might be challenging due to practical and ideological issues.

Activity 1.3.5.1 - Activity 1.3.5.1: Create an essay outline

Topics I would like to address:
What are the components of a high-quality health care system, i.e., what should your health system achieve and how?	Main components: Accessibility Affordability Quality Not be prone to discrimination or discriminatory practices to either patients or staff
Can UHC be achieved in South Africa right now?	UHC is difficult to achieve as of right now, but by no means impossible. It would likely take a great many years and involve a lot of raising awareness and changing of attitudes. Furthermore, a redistribution of funds will be necessary, specifically towards education and the healthcare system.
One building block through which to implement the process of reform of the Health System to provide UHC.	The first building block would focus on education. Improving education, raising awareness of diseases, raising awareness of ableist conduct and overall creating a population of people with a better understanding of healthcare and the requirements of the health system.

 

I want my course paper to have an added element of focusing on chronic illnesses, as I feel it is a social justice issue that is often overlooked. From my own knowledge as a person who lives in a family in which all three of my siblings and one of my parents suffer with a very painful and debilitating chronic illness, I know that there are no support structures in the health system for this. For example, medical aid does not pay for the necessary medication. Without this medication, however, this particular disease will cause paralysis and fusion of the spine as the cerebra-spinal fluid calcifies due to inflammation. Furthermore, lack of awareness of this disability causes struggles with ableism in daily life. Furthermore chronic disease is increasing and the health system is not prepared to take it on (IHME, 2020), which will increase the burden of disease on the country. 

My arguments will include:

1.       The importance of healthcare education in raising awareness of chronic diseases and epidemics such as TB and AIDS, which will lessen the strain on healthcare professionals, seeing as the burden of disease greatly affects the functioning of the healthcare system (Allanise Cloete, 2010). By lessening the burden of disease one could be a step closer to the achievement of UHC.

2.       The understaffing and poor education of healthcare professionals. How their work hours are far too long and strenuous, and that the education system has failed both patients and hospital staff (BusinessTech Staff, 2022). UHC will not be achieved if one can not achieve the acceptability of healthcare, which is an unrealistic expectation if medical staff cannot perform properly.

3.     The mismanagement of the public health sector and the extortive prices of the private sector, leading to health inequity as a result of inaccessibility. Many people struggle to access hospitals because of the prices of travel to hospitals and clinics (Villiers, 2021). This makes South Africa's current health system inaccessible and thereby more difficult to achieve UHC. 

4.   Social justice issues in the healthcare systems such as the effect of poverty as an environmental determinant of health, their impact and how they can be solved (Pierce, 2020). 

    References: 
Allanise Cloete, *. A. S. L. S. B. v. W. N. H. a. A. N., 2010. Challenges Faced by People Living with HIV/AIDS in Cape Town, South Africa: Issues for Group Risk Reduction Interventions. AIDS Res Treat.

    BusinessTech Staff, 2022. Exodus of medical professionals in South Africa – leaving hospitals understaffed. [Online]Available at: https://businesstech.co.za/news/government/620949/exodus-of-medical-professionals-in-south-africa-leaving-hospitals-understaffed/ [Accessed 12 September 2022].

    IHME, 2020. The Lancet: Latest global disease estimates reveal perfect storm of rising chronic diseases and public health failures fuelling COVID-19 pandemic. [Online]Available at: https://www.healthdata.org/news-release/lancet-latest-global-disease-estimates-reveal-perfect-storm-rising-chronic-diseases-and [Accessed 12 September 2022].

    Villiers, K. d., 2021. Bridging the health inequality gap: an examination of South Africa’s social innovation in health landscape. Infectious Diseases of Poverty volume , 10(19).

Course Paper First Draft 

Introduction – What is Universal Healthcare and what does it encapsulate?[CD1] 

Universal Health is a term used to describe a health system in which all people have access to the necessary healthcare. The healthcare in question encapsulates prevention of illness, treatment of illness, rehabilitation and end-of-life care (Adam Fushein, 2016). Universal Healthcare is therefore the concept of an ideal healthcare system, wherein all patients, regardless of socio-economic status, receive not only sufficient care, but the necessary care to achieve health. The aspects of the ideal health system would be accessibility and affordability, quality equipment and staffing, and have satisfactory service delivery void of discriminatory practices.[CD2] 

In recent years the definition of health to the public has changed to include how an individual feels about their “state” (Sartorius, 2006) and hereby allows individuals to have a say in their treatment, which would be another aspect of universal healthcare. The universal healthcare system would allow patients to express their state to healthcare professionals and a solution would try to be found. The emotional state that can be experienced by people is normally caused by their environment. An unhappy, violent or unsafe environment could be cause for a negative emotional state. Therefore, universal healthcare would include campaigns to help people escape negative environments caused by poverty or violence and would therefore need humanitarian projects, such as soup kitchens and women’s homes. Universal healthcare also encapsulates initiatives to improve health as a whole such as with anti-smoking campaigns or campaigns for awareness regarding diseases (Adam Fushein, 2016).

The most important part of UHC would be accessibility. South Africa, however, has a highly unequal and inefficient healthcare system (Rensburg, 2021). With growing enthusiasm surrounding Universal healthcare, the South African government has proposed a national health insurance, which will allow all South Africans to limit the cost of healthcare and thereby make it more accessible (Adam Fushein, 2016).

This does not however solve the problem of quality in the South African healthcare system. One of the problems faced by the health system is understaffing. There is reported to be only one nurse for every 1000 people due to the crumbling economy and a large number of medical staff leaving the country (BusinessTech Staff, 2022). Further displays of incompetence is reflected in scandals such as the life Esidimeni scandal wherein 94 patients passed away due to insufficient care at the hands of the Gauteng Government[CD3] .

South Africa is a country that has been plagued by diseases such as TB and HIV, with the highest numbers of active HIV cases in the world (Centers for Disease Control and Prevention, 2016). Another rising cause for concern is chronic diseases. Chronic illness is predicted to increase, and world health systems are not prepared to take it on (IHME, 2020). For this reason, this paper will have an added focus on universal health care regarding chronic diseases.

The challenges associated with the implementation of Universal Healthcare in South Africa

If one were to try to achieve Universal healthcare in South Africa, there are definite areas of concern that would need to be addressed.

Firstly, South Africa experiences a large burden because of disease. The current healthcare system in South Africa is greatly understaffed and overworked (BusinessTech Staff, 2022). This will likely affect the quality of healthcare that medical staff are able to provide. In order to provide better quality healthcare, one must consider the effect of the burden of diseases. [CD4] 

About 15.5% of all premature deaths are caused by HIV/AIDS and 12.4% thereof because of TB (Vera Scott, 2017). [CD5] The conclusion can therefore be drawn that health in South Africa is not at all yet achieved. These statistics are regarded to be as a cause of social determinants of health including the idea of lack of awareness of the public regarding diseases. Along with the fact that people living with these diseases are not physically healthy, an additional cause for stress for people affected by HIV/AIDs is the stigmatisation thereof (Allanise Cloete, 2010). This is because of a lack of health education in South Africa. The stigmatisation of diseases often causes sufferers to be reluctant to admit that they are afflicted with disease and therefore not get treatment. The conclusion can therefore be drawn that the lack of education regarding these diseases will inevitably worsen the burden of disease. Patients who do not receive treatment will continue being contagious and thereby allow more people to be affected by the disease and subsequently suffer under the same stigma. Another example of a lack of health awareness, worsening the burden of diseases is in the case of TB. The loss to follow up treatment is becoming an increasing problem and the main reason for this is lack of knowledge surrounding the working of the disease (Donald Skinner, 2016). The burden of diseases in South Africa is greatly influenced by a lack of knowledge on the part of the public, which is why it can be concluded that in order to take a step towards Universal Healthcare, one would need to lower the burden of diseases by way of educating the public.

Another burden regarding the health of South African systems and the healthcare system is the prevalence of violence in South Africa. In 2017, 15% percent of non-natural deaths were caused by violence (StatsSa, 2017) . It is furthermore important to address that gender-based violence is very prevalent with 21% of partnered women experiencing violence at the hands of their spouse or partner. Violence is also more prevalent in low-income communities (StatsSa, 2018), which allows for the conclusion to be drawn that this is once again a social determinant of health.

Socio-economic status seems to further impact the health of South African citizens. As discussed in the previous mentions of the burdens experienced due to violence and disease, health seems to be directly influenced by social class with more disease experienced by people in lower income households and areas (Koch, 2018). Poverty can also be seen as an environmental factor affecting health. It is also known that poverty affects mental health and statistics show how aging in poverty is directly related to mental health concerns (Pierce, 2020). [CD6] 

Poverty is an ongoing problem in South Africa despite several attempts to correct it with an unemployment rate of 0.1% (StatsSa, 2018). Poverty not only affects health in and of itself, but it also affects access to healthcare. Despite public healthcare in South Africa being free of charge, many people require transport to hospitals and clinics for which it is necessary to pay. An example being Groote Schuur Hospital in Cape town, which is a long distance from even the closest township with commute cost being a third of many people’s daily wages (Villiers, 2021). This hereby makes healthcare much less accessible to low-income individuals.

The discussion continues to highlight challenges faced in the healthcare system. Firstly, the South African healthcare system is burdened by a lack of infrastructure, the burden of diseases and the inadequate healthcare provided (Villiers, 2021). Hospitals and clinics are understaffed and overworked seeing as healthcare needs exceeds the amount of care that the public healthcare system is equipped to provide (Rensburg, 2021), which means that the healthcare does not meet the required criteria for “acceptability”. Public hospitals in South Africa have been described as “in shambles” by the chairperson of the South African Medical Association. Examples of conditions include the recently released images of mothers and children lying on the floor in Rahima Moosa Hospital, the fire in Charlotte Maxeke Academic Hospital, which is still awaiting repairs and the events that occurred following the termination of the Gauteng Government’s contract with the Life Esidimeni hospital. Furthermore, the Gauteng Department of health is R3.1 billion in debt to their suppliers. The Charlotte Maxeke hospital has further experienced 220 staff resignations and currently have 677 vacant posts (Maromo, 2022).  This information goes to show just how far removed the South African healthcare system is from achieving Universal Healthcare.

The South African healthcare system further perpetuates health inequities via the two-tiered healthcare system which encapsulates the private and public sectors. The Public sector is grossly underfunded but is the only form of healthcare that can be afforded by lower income individuals, who happen to make up 71% of the South African population (Rensburg, 2021). The private sector also has more qualified healthcare professionals in relation to the public sector (Villiers, 2021). This causes an exponential form of inequity. Lower-income individuals experience more diseases and determinants that may cause ill health; however, it is the higher-income individuals who can afford quality healthcare from the private sector.

The South African Government’s solution to the health inequities caused by the two-tiered healthcare system is the idea of national health insurance. National Health Insurance is a government project started in 2012 and involves the pooling of funds to allow everybody an equal change[CD7]  to receive adequate healthcare (South African Government, n.d.). The NHI is supposed to be implemented in 2026. However, one of the problems associated with this project is once again a lack of knowledge thereof by the public, with a study showing that the campaigns to raise awareness of this plan being inadequate (Peter S Nyasulu, 2015). This could prove problematic as many people would avoid hospital visits on account of not having enough money, because they are not aware of the fact that the government would be willing to pay. As previously mentioned, the Department of Health is already in debt, which raises the question of how the government is planning on raising sufficient funds for this project. Further concern surrounds the mismanagement of public hospitals by the government and raises questions surrounding the government’s capability of managing the NHI.

The burden caused by poverty is also increasing over time (StatsSa, 2017), which will allow for more serious health concerns to increase, further worsening the burden of disease on the healthcare system.

With all this in mind, it can be concluded that Universal Healthcare cannot be implemented if one follows the current trajectory. That is not to say that Universal Healthcare is not achievable.

For South Africa to achieve Universal Healthcare, the first problem that would need to be addressed is poverty. Poverty acts as a social and environmental determinant of health, which can either alleviate or worsen the burden of disease, mental health concerns and violence on the healthcare system. One of the main differences between the public and private sectors is that the private sector only treats 27% of the population (Rensburg, 2021), whereas the public sector treats the rest. One could assume that one of the reasons the private sector functions more effectively is because they are not overwhelmed by the large number of patients. If poverty can be solved, one would see a decline in the burden of disease as well as violence and would therefore not overwhelm the healthcare system. [CD8] 

Poverty is largely as a result of the unemployment rate in South Africa. Many people are struggling to find jobs without tertiary education. A solution to this could be the improvement of the education system. The plan would be three-part. The first would be to implement a better education system so that more people could have the opportunity to study and hopefully be allowed to be able to create jobs. The second would involve teaching children about diseases such as TB and HIV and allow them to not fall victim to stigmatisation and further allow them to understand illnesses and what would be required of them as patients during their treatment. The final part of the plan would be to properly teach people about the NHI and how it will work, so that they will understand that they will no langer need to worry about the financial burden that ill health will bring.

The NHI is a very important plan, and the implementation thereof will likely allow for major differences in the state of South African Health but will not be effective if the Government is in debt, which is why it is important to first focus on alleviating poverty[CD9] .

References

Adam Fushein, J. E., 2016. Achieving universal health coverage in South Africa through a district health system approach: conflicting ideologies of health care provision. BMC Health Services Research.

Allanise Cloete, *. A. S. L. S. B. v. W. N. H. a. A. N., 2010. Challenges Faced by People Living with HIV/AIDS in Cape Town, South Africa: Issues for Group Risk Reduction Interventions. AIDS Res Treat.

BusinessTech Staff, 2022. Exodus of medical professionals in South Africa – leaving hospitals understaffed. [Online]
Available at: https://businesstech.co.za/news/government/620949/exodus-of-medical-professionals-in-south-africa-leaving-hospitals-understaffed/
[Accessed 12 September 2022].

Centers For Disease Control and Prevention, 2016. CDC in South Africa: Why We're Here. [Online]
Available at: https://www.cdc.gov/globalhealth/countries/southafrica/why/default.htm
[Accessed 12 September 2022].

Donald Skinner, M. C., 2016. It’s complicated: why do tuberculosis patients not initiate or stay adherent to treatment? A qualitative study from South Africa. BMC Infect Dis., 16(1), pp. 1-9.

IHME, 2020. The Lancet: Latest global disease estimates reveal perfect storm of rising chronic diseases and public health failures fuelling COVID-19 pandemic. [Online]
Available at: https://www.healthdata.org/news-release/lancet-latest-global-disease-estimates-reveal-perfect-storm-rising-chronic-diseases-and
[Accessed 12 September 2022].

Koch, K. O. O. &. S. F., 2018. Assessing changes in social determinants of health inequalities in South Africa : a decomposition analysis. International Journal for Equity in Health, 17(1).

Maromo, J., 2022. State of SA Hospitals: ‘Gauteng hospitals are a mess’. [Online]
Available at: https://www.iol.co.za/news/south-africa/gauteng/state-of-sa-hospitals-gauteng-hospitals-are-a-mess-2e81d072-d017-425b-ad0f-e20f04542765
[Accessed 12 September 2022].

Peter S Nyasulu, 2015. Public awareness and knowledge of the National Health Insurance in South Africa. Pan African Medical Journal, 19(22), pp. 1-10.

Pierce, C., 2020. THE INFLUENCE OF POVERTY ON MENTAL HEALTH IN SOUTH AFRICA. [Online]
Available at: https://borgenproject.org/poverty-and-mental-health-in-south-africa/
[Accessed 12 September 2022].

Rensburg, R., 2021. Healthcare in South Africa: how inequity is contributing to inefficiency. [Online]
Available at: https://www.wits.ac.za/covid19/covid19-news/latest/healthcare-in-south-africa-how-inequity-is-contributing-to-inefficiency.html
[Accessed 08 September 2022].

Sartorius, N., 2006. The Meanings of Health and its Promotion. PubMed Central, 47(4), p. 662–664.

South African Government, n.d. National Health Insurance. [Online]
Available at: https://www.gov.za/about-government/government-programmes/national-health-insurance-0
[Accessed 12 September 2022].

StatsSa, 2017. Mortality and causes of death in South Africa:, Pretoria : Statistics South Africa.

StatsSa, 2017. Poverty on the rise in South Africa. [Online]
Available at: https://www.statssa.gov.za/?p=10334
[Accessed 12 September 2022].

StatsSa, 2018. Crimes against women in South Africa, an analysis of the, Pretoria : Statistics South Africa .

Vera Scott, N. S. H. S. D. S., 2017. Addressing social determinants of. SAHR, p. 78.

Villiers, K. d., 2021. Bridging the health inequality gap: an examination of South Africa’s social innovation in health landscape. Infectious Diseases of Poverty volume , 10(19).

[CD10] 

---

 [CD1]In your introduction you should state your thesis and provide evidence to support your thesis. State the structure that your paper is going to follow.

 [CD2]Font size should be 12, line spacing should be 1.5.

 [CD3]Good point Bea, the life esidimeni scandal also showcases the colossal role that corruption plays in hindering the achievement of  UHC.

 [CD4]Don’t forget to include page numbers.

 [CD5]You did a good job by substantiating your point with evidence.

 [CD6]Good point

 [CD7]Chance.

 [CD8]You did not only state the problems bedeviling the health sector but you went on to provide solutions that can assist with achieving UHC, well done.

 [CD9]In your conclusion you should state briefly what your paper unpacked and also your thesis.

 [CD10]Place the references in a new page.