Our shared concern that all should have access to a basic level of decent health care is central to the heated debates over health reform in this country. This concern does not just spring from a respect for human life; as economists and health specialists we recognise that the population's health and the country's health care systems have much to do with promoting well-being, empowerment, productivity and development.
We understand, of course, that health services are not the main determinant of health status. Their influence is asymmetric: while good health care cannot guarantee good health, bad health care can be devastating. A life may be lost if an ambulance arrives too late, an emergency queue is too long, a hospital does not have the right equipment or drugs, or a diagnosis is wrong.
The articles in this special issue of Development Southern Africa do not list symptoms of how and where the system is not serving its people but rather delve beneath these surface phenomena. Through their research, the authors have sought a better understanding of the underperformance and malfunctions in our health system and investigated the merits of proposed remedies for these ills.
At a first glance the questions explored in this issue may not seem pertinent to the daily operational headaches of a remote rural clinic, but ultimately they are. When patients suffer or die because they do not receive help soon enough, or the right help, it is rarely a specific doctor or nurse who is to blame. Broader causes can be identified, such as misallocated spending or resource shortages. Our health care system is entangled in intricate information and incentive problems, so we must also consider poor system design, perverse incentives and weak implementation or management as possible culprits.
Our contributors have approached this task by grappling with household surveys to locate the most serious shortcomings and engage critically with system design issues such as risk pooling, purchasing, contracts and rationing.
We hope this collection of articles will help to shape and guide the planned reform of the public health system and the National Health Insurance proposal. We need more vigorous public debate of policy issues, but it must be informed by thorough and systematic analysis. Such informed debate is not only vital for prudent policy making and policy reform but also crucial for the eventual transparency and accountability of our public health system.