An unequal society: tackling differences in health between rich and poor in South Africa
The Essential Steps to Manage Obstetric Emergencies (ESMOE) project, which I mentioned in my last post, is linked to a larger programme of support that the Department for International Development (DFID) provides to the Government of South Africa called Reducing Maternal and Child Mortality through Strengthening Primary Health Care (RMCH).
By the time I met the team members of the RMCH programme on a Monday afternoon after a Sunday night on a plane, I was fired up with questions that had been prompted by my meeting with Dr Khaole that morning (see my last post) and from facts gleaned from an excellent series of articles on health in South Africa published in the Lancet in 2009.
The RMCH programme is managed by a group of different agencies led by the Futures Group, and including Save the Children, the Health Systems Trust and Social Development Direct.
The RMCH Team, Pretoria, South Africa. Picture: Neil Squires/DFID
This team formed just six months ago to support the National Department of Health. It is a dynamic and committed group of individuals working effectively under the leadership of Dr Ngubane (pictured).
DFID will be providing support through this group over the next four years to help the Government of South Africa strengthen its primary health care system. Progress is already being made as a result of the government’s legislation, which has encouraged a number of senior health workers to move from the cities to district level and strengthen services where the needs are greatest.
On Tuesday 16 October I met with Dr Yogan Pillay, Deputy Director General of the Department of Health and Dr Peter Barron, Special Adviser to the Department of Health. Dr Pillay has oversight of the RMCH programme and highlighted the national commitment to strengthening maternal, newborn and child care at the district level.
Focusing on the poorest
Like the ESMOE project, the RMCH programme has prioritised those districts in South Africa with the worst health indicators. It will be focusing on the 15 districts with the highest maternal and newborn mortality in its first phase and then expanding to cover 25 of South Africa’s 52 districts as agreed by the National Health Council.
The programme will help in building District Clinical Specialist teams, which will have the skill set to improve the quality of service delivery. These teams will work with health facilities in districts to strengthen the quality of care, and ensure that those trained through programmes such as ESMOE are putting their training to good effect.
Listening to patients and improving services
The initiative will also try to strengthen systems of accountability at the district level, so that patients who are not satisfied with care can complain. It will also help ensure that communities get a better understanding of the level of services they should expect and hear about newly planned initiatives, such as schemes to expand the range of contraceptives to increase the choice of family planning methods.
This programme is still in its early stages but it has established a solid foundation and is working closely with the National Department of Health on an important issue that will help tackle the significant differences in health between rich and poor that continue to make South Africa an unequal society.