South Africa

South Africa’s health system post the apartheid era (1994 onwards) has been characterised by massive transformation based on equity principles, led by the African National Congress government. However, while the government’s concerns about the health system and efforts towards transformation are evident, as seen by its willingness to focus on primary health care and redirect funding from tertiary institutions to rural primary health care facilities, significant challenges exist. These include the substantial segmentation of the health system between public and private, urban and rural, and varied implementation of health policies at different levels of the health system.

RESYST research in South Africa

Financing

• Research focuses expanding fiscal space (the amount of resources government can sustainably spend on health care), through increasing the effectiveness of tax collection systems.
  Research summary
• Researchers will critically assess the performance of health care purchasers in South Africa as part of the RESYST multi-country study on purchasing.

Health workforce

• Research in this area will identify effective, practical interventions to address human resource constraints that are common in many low and middle-income countries, such as a lack of skilled health workers in rural areas where the vast majority of poor and disadvantaged patients live.
  Research summary
• We will investigate how different provider payment mechanisms (fee-for-service, salary and capitation), influence health providers’ clinical behaviour, and consider their relevance in the design of reimbursement mechanisms and the implementation of national health insurance.
  Research summary

Governance

• Within the Governance theme, we have a particular interest in the relationships among frontline actors and mid-level management, and leadership in health policy implementation processes. We are working within Learning Sites located at sub-national level to: conduct action research to support local managers in taking action on issues prioritized by them and of relevance to RESYST; and to investigate critical governance issues in real time, as health system policies are implemented.