Article

Health in South Africa: Changes and challenges since 2009

Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
The Lancet (Impact Factor: 45.22). 12/2012; 380(9858):2029-2043. DOI: 10.1016/S0140-6736(12)61814-5

ABSTRACT Since the 2009 Lancet Health in South Africa Series, important changes have occurred in the country, resulting in an increase in life expectancy to 60 years. Historical injustices together with the disastrous health policies of the previous administration are being transformed. The change in leadership of the Ministry of Health has been key, but new momentum is inhibited by stasis within the health management bureaucracy. Specific policy and programme changes are evident for all four of the so-called colliding epidemics: HIV and tuberculosis; chronic illness and mental health; injury and violence; and maternal, neonatal, and child health. South Africa now has the world's largest programme of antiretroviral therapy, and some advances have been made in implementation of new tuberculosis diagnostics and treatment scale-up and integration. HIV prevention has received increased attention. Child mortality has benefited from progress in addressing HIV. However, more attention to postnatal feeding support is needed. Many risk factors for non-communicable diseases have increased substantially during the past two decades, but an ambitious government policy to address lifestyle risks such as consumption of salt and alcohol provide real potential for change. Although mortality due to injuries seems to be decreasing, high levels of interpersonal violence and accidents persist. An integrated strategic framework for prevention of injury and violence is in progress but its successful implementation will need high-level commitment, support for evidence-led prevention interventions, investment in surveillance systems and research, and improved human-resources and management capacities. A radical system of national health insurance and re-engineering of primary health care will be phased in for 14 years to enable universal, equitable, and affordable health-care coverage. Finally, national consensus has been reached about seven priorities for health research with a commitment to increase the health research budget to 2·0% of national health spending. However, large racial differentials exist in social determinants of health, especially housing and sanitation for the poor and inequity between the sexes, although progress has been made in access to basic education, electricity, piped water, and social protection. Integration of the private and public sectors and of services for HIV, tuberculosis, and non-communicable diseases needs to improve, as do surveillance and information systems. Additionally, successful interventions need to be delivered widely. Transformation of the health system into a national institution that is based on equity and merit and is built on an effective human-resources system could still place South Africa on track to achieve Millennium Development Goals 4, 5, and 6 and would enhance the lives of its citizens.

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    • "This needs to be explored in a nationally representative sample. Lastly, life expectancy is rising in South Africa (Mayosi et al., 2012), with implications for the services that need to be provided for a diverse older population, many of whom have specific needs. In this study, we will examine the relationship between depressive symptoms and disability, with a specific focus on how this may vary between younger and older old groups. "
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    ABSTRACT: Objectives This study examined the relationship between depression and functional status among a community-dwelling older population of 65 years and older in South Africa. Method Data from the first wave of the South African National Income Dynamics Study were used, this being the first longitudinal panel survey of a nationally representative sample of households. The study focused on the data for resident adults 65years and older (n=1,429). Depression was assessed using the 10-item version of the Center for Epidemiologic Studies Depression Scale. Functional status, pertaining to both difficulty and dependence in activities of daily living (ADL), instrumental activities of daily living (IADL), and physical functioning and mobility (PFM), were assessed using 11 items. ResultsFunctional challenges were generally higher in the older age group. There was a significant association between depression and functional dependence in ADL (adjusted OR=2.57 [CI: 1.03-6.41]), IADL (adjusted OR=2.76 [CI: 1.89-4.04]), and PFM (adjusted OR=1.66 [CI: 1.18-2.33]), but the relationship between depression and functional status, particularly PFM, appeared weaker in older age. Conclusion The relationship between depression symptoms and function is complex. Functional characteristics between older and younger old populations are diverse, and caution is indicated against overgeneralizing the challenges related to depression and function among this target population. Copyright (c) 2013 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 12/2013; 28(12). DOI:10.1002/gps.3954 · 3.09 Impact Factor
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    • "Concern over the rising co-morbidity of mental disorders with other non-communicable and communicable diseases , particularly in people living with HIV/AIDS (PL- WHA) has served to raise the public health priority of mental disorders in this country [4] [5]. Common mental disorders (CMDs) co-morbid with HIV/AIDS are of concern to the South African Department of Health as they threaten to undermine the success of the country's antiretroviral therapy (ART) programme, the largest in the world [5]. This is because: 1) CMDs increase risk for poor ante-retroviral treatment (ART) adherence. "
    Health 01/2013; Vol.5(No.3A):557-566. DOI:10.4236/health.2013.53A074 · 0.51 Impact Factor
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    First 01/2013; HSRC Press., ISBN: 978-0-7969-2448-3
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