Building an effective primary healthcare environment

Healthcare. (Oupa Nkosi)

Healthcare. (Oupa Nkosi)

Professor Diane McIntyre at the University of Cape Town is looking specifically at the economics of public healthcare, both through the Chair in Health and Wealth in South Africa and through the Health Economics Unit she established at the university.
McIntyre says: “The main thrust of our investigations is into the resources required for healthcare in the context of low- to middle-income countries. We are looking at models to finance healthcare in a manner that overcomes the challenges faced by low-income households.”

It is being done through the study of household surveys to determine barriers to access, their financial implications, and how households cope when they require medical care. It is hoped that these insights will help to guide the fine-tuning of the proposed National Health Insurance (NHI) programme, to ensure that funding is not only collected effectively but also applied appropriately to meet the needs of communities who will rely on it. 

“The Chair has enabled me to recruit numerous postgraduate students and postdoctoral fellows into the research projects, with the outcomes published as policy briefs as well as papers for peer-reviewed journals,” says McIntyre.

The research projects undertaken by the students are providing important insights into areas such as school health services and responses to non-communicable diseases — specifically the high medical and societal costs of not intervening to prevent the onset of non-communicable diseases. This is a direct response to the health department’s objective of promoting preventative interventions that not only contribute to communities’ overall health but also to lowering the cost of treating conditions that are preventable.

McIntyre is investigating research into the potential contribution of public financing and improved access to healthcare to the National Development Plan’s aims of reducing poverty and inequality. This work will explore how addressing inequality in access to quality care and funding health services through more equitable means could contribute to poverty reduction and redistribution.

Whereas McIntyre’s research addresses the responsiveness of the country’s primary healthcare systems, Professor Wim van Damme at the University of the Western Cape is working on developing capacity on the ground. He is developing the doctoral programme for the 40 doctoral students at the School of Public Health, as a main focus in his Health Systems, Complexity and Social Change Chair that was initiated in 2013.

Van Damme says: “Our mandate is to build a doctoral programme to train and graduate doctoral candidates who are better able to respond to the challenges of providing primary healthcare on the continent.

“One of our key research areas is into the development of models to address care for chronic, life-long conditions such as HIV,” says Van Damme. Many African countries are struggling with the sheer number of HIV patients, requiring new approaches to dealing with these groups and particularly to ensure that they continue to receive antiretroviral treatment.

His group is working with national and provincial departments of health and community-based organisations to develop policies and strategies to ensure that these patients are not only motivated to remain on anti-retroviral treatments, but also that they are able to access such treatment easily and effectively.

The Africa-wide scope of this work has enabled the group to gain a better understanding of the commonalities and challenges in different regions. This has led to innovative responses that can been applied locally or exported from the South African experience.

According to Van Damme, one of these outcomes is the more effective use of existing personnel on the ground, such as nurses, to provide care that has traditionally been the domain of higher-qualified medical professionals. By adopting similar approaches, the reach of treatments could be extended to provide better care without incurring higher costs or delayed responsiveness.

The Health Policy and Systems Chair of Professor John Eyles at the University of the Witwatersrand straddles the work of McIntyre and Van Damme in that he is concerned with the human resources, financing and governance of the country’s public healthcare system.

Eyles has recruited a number of doctoral and Master’s students and a postdoctoral fellow to help to build an understanding of the best ways to ensure equitable, quality healthcare for all.

This is particularly important to the aims of the proposed NHI programme. The research aims to identify best practices in specific cases that could be rolled out nationally to ensure that healthcare standards are improved and that healthcare is easily accessible.

“Re-engineering the public healthcare system requires a long-term view and it is hoped that our work can produce models that can be easily replicated across the country to introduce a level of uniformity of care,” says Eyles.

One aspect of the NHI that his group is investigating is the relationship between public and private healthcare providers, which is not yet clearly delineated and a potential sticking point in achieving universal health coverage.

For this reason, the group is adopting a holistic view of the health systems to assess and develop responses that make best use of human resources, ensure funding is available and used correctly, and that clear lines of authority are established.

This supplement has been paid for by Department of Science and Technology and its contents signed off by the DST and the National Research Foundation.