What is national health planning?
National health planning is not a new concept in South Africa. It has been part of the discourse since at least 1994, when its importance was articulated in the National Health Act (Act 61 of 2003) and reaffirmed by the Department of Health’s Framework for National Health Planning.
The act charged provincial, local, and district governments with developing district-level plans to ensure that all members of society receive adequate health services, particularly those living in rural areas.
District health planning councils were also established under the act, but their existence has remained an empty shell because they have yet to be operationalized across the country. However, several provinces, including Limpopo, Mpumalanga, and Gauteng, are advanced in implementing district-level planning processes.
As part of the Department of Health’s commitment to localizing health services, these plans aim to ensure that all South Africans have access to good quality healthcare within a reasonable distance.
What is the new national strategic plan?
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However, the big question is whether progress towards this goal has been made since 2004, when the draft version of the National Strategic Plan for HIV/Aids was first unveiled. The draft prioritized healthy life expectancy as key measures and highlighted four inter-related objectives – prevention, care, support, and treatment.
It also emphasized achieving universal access to antiretroviral (ARV) treatment by 2010 and preventing vertical transmission of HIV from mothers to children by 2012. These goals remain unchanged in the final version of the plan unveiled last week.
Unlike previous district health plans, many of which were developed separately by each district’s existing structure, the new national strategic plan was developed through an inclusive process that saw the country’s provinces and districts participating at every stage of its development.
This collaborative approach aimed to ensure broad buy-in from different stakeholders throughout South Africa.
More than 20 workshops involving provincial and district representatives and other key stakeholders were held to develop a “consensus” on issues pertinent to HIV/Aids prevention, care, support, and treatment services over the next five years.
These meetings also helped identify priority activities for service delivery, some essential policy priorities; specific objectives; appropriate indicators; time frames, and a budget.
President Jacob Zuma launched the plan last week at a ceremony attended by several other heads of state from Southern African Development Community (SADC) member states and representatives from international organizations such as the World Bank, the Bill and Melinda Gates Foundation, and UNAIDS.
What are its implications?
In many ways, this plan defines how South Africa intends to address HIV/Aids over the next five years, which is quite significant considering that there have been few strategic plans since 1994.
It also means that the government has taken ownership of its HIV/Aids response because it addresses concerns raised by many stakeholders who had questioned whether previous health district-level planning processes were not leading to duplication of efforts and wastage of scarce resources.
Therefore, the plan is the first attempt at developing a cohesive, integrated strategy that will guide all stakeholders throughout South Africa in addressing what is arguably the country’s most prevalent public health challenge.
Crucially, it lays out the way forward for healthcare workers and managers responsible for ensuring effective service delivery to people living with HIV/Aids. These are critical activities because they can act as key incentives for continued commitment by the government and other partners towards preventing new HIV infections and ensuring treatment access to those already infected with the virus.
And finally, this plan reaffirms South Africa’s “twinning” status with several countries, including Botswana, Lesotho, Malawi, Namibia, Seychelles, Swaziland, Tanzania, Zambia, and Zimbabwe. This status gives South African leadership a chance to embark on regional initiatives that emphasize fostering closer collaboration between organizations working together to prevent further HIV infections.
As many countries worldwide struggle to provide adequate healthcare services, it is hoped that the new plan – with its focus on “healthy life expectancy” – will serve as an example of how strategic planning could help ensure continued access to quality health care for all South Africans.
Should this health planning be done again in 2022?
It is important to note that the 2020 plan may have to be reviewed if significant policies affect HIV/Aids. These include the National Strategic Plan on HIV and Aids, which will replace the National Strategic Plan on HIV, TB, and STIs for 2011-2017. The new plan should emerge next year once it has been tabled before Parliament.
If this happens, then our district health plans could be rendered obsolete after only four years of implementation – a situation that could also give rise to duplication or wasteful expenditure because healthcare workers would have already begun implementing new strategies without considering how they fit into existing frameworks.
South Africa has always had its health system perform well within the region, meaning that many district hospitals receive patients from neighboring countries. If this system continues, it becomes essential that individual governments implement no conflicting policies because the healthcare sector continues to pursue common goals.