Health and health care in South Africa, 2nd edition
HCJ Van Rensburg (Ed.)
Van Schaik, Pretoria, 2012, ISBN 9780627030130
In South Africa today we are seeing large-scale public sector health care reform, ranging from re-engineering primary health care to establishing an office of health standards compliance, with the aim of achieving a universal health care system. The time is thus ripe for the second edition of this rich compendium of knowledge on health and health care in South Africa. The book will appeal to any reader wishing to understand the history, progress and challenges of health and health care in South Africa. It provides updates on what has changed since the 2004 first edition, information on current health trends and health policy developments, and a useful background of global trends related to the topics discussed in each chapter.
Beyond actual health issues, researchers in the health field often need practical information about the structure of a health care system, the building blocks of the system, and which job functions are located where in the system. This information is not always easy to come by, so we are often obliged to consult multiple sources to get the big picture. This book covers the country's health system from the spheres of health governance and the distribution of hospitals to the spectrum of primary health care facilities.
As academics we rarely afford ourselves the luxury of digesting a whole book. However, this is a book worth reading in its entirety, and worth having on your shelf for its detailed content and copious references. For anyone interested in health issues in South Africa, it has the particular merit of bringing together a mass of relevant information in one place. I do not have space to do justice to all the 12 chapters, but will highlight those that I found particularly valuable.
The second chapter, ‘A history of health and health care in South Africa: 1652–1994’, and the third, ‘Transformation of the South African health system: Post–1994’, provide a thick historical description of the South African social and political landscape. Detailed accounts are offered of how health issues are embedded in this history, going back as far as 1675, when the first midwife practised at the Cape. As the country's political and social history are critical to understanding the country's health and health care, these chapters offer a relevant context for engaging with the book's topics. In fact, any researcher or student from any discipline seeking to learn about South Africa's political and social history should read these chapters; they are most informative and enjoyable.
The book views health and health care through a range of disciplinary or subject lenses. Chapter 4, on ‘The health, environment and development nexus in South Africa’, taught me a lot about our changing biophysical environment and how it affects health in South Africa, including such issues as climate change, water resources, soil degradation and pollution.
Throughout the book, terms and concepts are explained, and real effort is made to bring the reader on board with the issues. For example, Chapter 5 on ‘Health and health status of the South African population’ offers in effect a tutorial on what it means to measure the health and health status of populations, how one can go about doing this, and what the limitations of different measures are. This is useful for non-specialists who need to be familiar with complex issues of health and health care. The chapter also describes the disease burden in South Africa, and includes background information on world health. Chapter 6, ‘HIV and AIDS and tuberculosis in South Africa: Trends, challenges and responses’, goes into more detail about these. Disturbingly, the authors note that the country's TB epidemic, which they say is ‘far from conquered’, is characterised by one of the highest levels of TB/HIV co-infection worldwide and that MDR-TB rates are growing (p. 348).
Chapters that I particularly enjoyed for their diversity and richness and the new perspectives they gave me were Chapter 7, on ‘Human resources for health and the health professions in South Africa’, Chapter 11, on ‘Complementary and alternative medicine and traditional health in South Africa’, and the concluding chapter on ‘Perspectives from bioethics on health care challenges for South Africa’.
A particularly valuable chapter is Chapter 8, on ‘Health care financing and expenditure: Post-1994 progress and remaining challenges’. Many of the current debates in South Africa are centred on health care financing. For those who investigate, promote or work in health and health care but do not have an economics or finance background yet seek to understand health financing in this country, this is the chapter to read. It explains a variety of topics in an accessible way, such as how the country's health system is financed, including progress and problems, how funding is pooled, and how the benefits from using health services are distributed. It considers the unequal distribution of these benefits and the challenges for efficiency, equity and sustainability. It also usefully describes the variety of health financing policy proposals that have been put forward over the years, up to the 2011 release of the Green Paper on National Health Insurance in South Africa, and explains the planned phased approach this Paper outlines for moving towards universal coverage.
In conclusion, this book will provide you with a substantial amount of new knowledge and revive some of your existing knowledge. After reading it, I understood health and health care in my own country better, and it encouraged and inspired me for further research.
http://dx.doi.org/10.1080/0376835X.2012.730976