The Negotiated Service Delivery Agreement (NSDA)  gives a frank, but brutal assessment of South Africa’€™s healthcare system and at the same time commits ‘€œnot to keep doing things as usual’€ in finding solutions.

The 52-page NSDA document deals with one of the 12 outcomes that form part of government’€™s programme of action, namely outcome 2 which sets as a target ‘€œA long and health life for all South Africans’€. Motsoaledi has already signed a performance agreement with the President undertaking to reach this goal.

In terms of the agreements, the ministers commit to specific interventions. Higher Education will support the training of health professionals, particularly nurses.

 Public Service and Administration will ensure the proper remuneration of health professionals and other workers.

Social Development will join in efforts linked to HIV/AIDS, primary health care (PHC) and poverty-related diseases.  

Water and Environmental Affairs will contribute to safe water, proper sanitation, and environmental health.

Agriculture, Forestry and Fisheries will play a role in food security, cooperation in respect of veterinary services, and the implementation of HIV and AIDS campaigns on farms.

Rural Development and Land Reform will focus on food security and combating malnutrition.

Correctional Services will promote the joint implementation of HIV and AIDS and TB programmes for inmates and personnel.

Basic Education will facilitate PHC coverage in schools, healthier learners and teachers, and the launch of the HIV Counseling and Testing campaign in schools.

‘€œThis is the real deal and we are committing to policies and implementing structures which will have buy-in from all the provinces,’€ Motsoaledi said yesterday.

Asked if he thought the plan would give the country a shot at reaching the Millennium Development Goals by 2015, Motsoaledi responded: ‘€œWe have no choice. This is not a test, it’€™s not a matter for getting 80%, it’€™s human beings’€™ lives, people are dying and it is bad for everything. The MDGs are not a means to an end, it is a means to end suffering.’€

He acknowledged that the task was huge and that some of the outcomes involving other government departments would be ‘€œdifficult’€. ‘€œEnsuring people have access to clean water is difficult and extremely complex and not just an issue of signing an agreement,’€ Motsoaledi said.

The NSDA lays out practical measures that will be taken to ensure that by 2014 four strategic outputs are achieved by the health sector – increasing life expectancy, decreasing maternal and child mortality, combating HIV and AIDS and decreasing the burden of disease from tuberculosis and strengthening health system effectiveness.

Linked to these are specific targets that must be achieved in the next four years:

• Life expectancy must increase from the current 53,9 to 58 years for men and 57,2 to 60 years for women.
• The Maternal Mortality Ratio (MMR) must decrease to 100 (or less) per 100 000 live births.   The Millennium Development Goals (MDG) country report for South Africa estimates MMR at 625 per 100 000.
• The child mortality rate must decrease to 20 deaths (or less) per 1 000 live births. The MDG report estimates child mortality rates at 104 per 100 000.
• The TB cure rate must improve from 64% in 2007 to 85%.
• 80% of eligible people living with HIV and AIDS must access antiretroviral treatment.
• New HIV infections must be halved.

The NSDA re-emphasises Motsoaledi’€™s mantra that the current health system needs to be re-engineered to one that is based on a PHC approach.

The document also stresses the need to overhaul the financing of the health system stating that ‘€œthis will be done through the implementation of the National Health Insurance (NHI)’€. Motsoaledi said that NHI would suffer if the outcomes are not achieved.

The NSDA gives a frank assessment of the failings of the health system including a massive number of people living with HIV; poor health indicators and outcomes despite spending more on health than any other African country; a spiraling non-communicable disease epidemic; high incidence of TB; vaccine preventable deaths among children; high maternal and infant mortality rates; a poor Prevention of Mother to Child HIV Transmission (PMTCT) programme (it has the potential to save 37 200 newborn lives each year if implemented effectively); poor integration of PHC services; overspending in the provinces; poor human resources planning and management; and uncaring health personnel.

Practical interventions offered include among others making available an ambulance for maternal and child cases, able to respond within an hour to obstetric emergencies. This would see an ambulance stationed at each facility where deliveries are conducted.

Community Health Care Workers (CHW), due to play a more central role in the re-engineered health system, will be linked to facilities and conduct post-natal care home visits in an effort to promote safe infant feeding, identify problems and prevent neonatal sepsis.

PHC teams consisting of a doctor, nurses and the CHWs will be assigned to a geographic area or a number of households.

HIV/AIDS and TB services will be integrated. In South Africa, the combination of TB, HIV and drug-resistant TB has led to TB, a curable and preventable disease, being the number one cause of death among HIV positive South Africans. There will also be interventions in districts that perform poorly in curing TB.

In a move to ensure compliance, the National Health Act will be amended to create an accreditation body independent from the health department. The body will be given powers to inspect and obtain information (including patient information) where necessary to support its oversight and implementation functions.