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What we need is health system transformation and not health system strengthening for universal health coverage to work: perspectives from a National Health Insurance pilot site in South Africa

Michel, J. and Obrist, B. and Bärnighausen, T. and Tediosi, F. and McIntyre, D. and Evans, D. and Tanner, M.. (2020) What we need is health system transformation and not health system strengthening for universal health coverage to work: perspectives from a National Health Insurance pilot site in South Africa. South African family practice, 62 (1). a5079.

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Abstract

Background: Globally, universal health coverage (UHC) has gained traction as a major health priority. In 2011, South Africa embarked on a UHC journey to ensure that everyone has access to quality healthcare services without suffering financial impoverishment. National Health Insurance (NHI) and primary healthcare (PHC) re-engineering were two vehicles chosen to reach UHC over a 14-year period (2012-2026). The first phase of health system strengthening (HSS) initiatives to improve the quality of health services in the public sector began in 2012. These HSS initiatives are still being carried out by the Department of Health in conjunction with other partners. Methods: A qualitative case study design utilising a theory of change (TOC) approach was employed. Data were collected from key informants (n = 71) during three phases: 2011-2012 (contextual mapping), 2013-2014 (Phase 1) and 2015 (Phase 2). In-depth face-to-face interviews were conducted with participants using a TOC interview guide, adapted for each phase. All interviews were audio-recorded and transcribed verbatim. An iterative, inductive and deductive data analysis approach was utilised. Transcripts were coded with the aid of MAXQDA 2018. Results: Six broad themes emerged: make PHC work, transform policy development, transform policy implementation, establish public-private partnerships, transform systems and processes and adopt a systems lens. Conclusion: A third great transition seems to be sweeping the globe, changing how health systems are organised. Actors in our study have identified this need also. Health system transformation rather than strengthening, they say, is needed to make UHC a reality. Who is listening?
Faculties and Departments:03 Faculty of Medicine > Departement Public Health > Sozial- und Präventivmedizin > Malaria Vaccines (Tanner)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Former Units within Swiss TPH > Malaria Vaccines (Tanner)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Household Economics and Health Systems Research > Health Systems and Policy (Tediosi)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Society, Gender and Health > Gender and Inequities (Merten)
UniBasel Contributors:Michel, Janet and Obrist van Eeuwijk, Brigit and Tediosi, Fabrizio and Tanner, Marcel
Item Type:Article, refereed
Article Subtype:Research Article
ISSN:1026-9177
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
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Last Modified:19 Dec 2022 08:57
Deposited On:19 Dec 2022 08:57

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