Scrutinizing the South African healthcare system

The recently released Lancet Healthcare Access and Quality (HAQ) Index shines light on South Africa’s healthcare system. ANLERIE DE WET takes a look at what the index has to say and investigates government plans to improve it

As one of Africa’s three biggest economies, South Africa received a lower index score compared to some of the continent’s smaller economies.

“In the present analysis, we use the highly standardised cause of death and risk factor estimates, generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), to improve and expand the quantification of personal healthcare access and quality for 195 countries and territories from 1990 to 2015,” says the index report.

According to the report, the average index values increased significantly worldwide.

“While most regions recorded narrowing gaps between average HAQ Index values and maximum levels achieved, a subset (southern sub-Saharan Africa, southern Asia, and the Middle East) saw negligible progress, or widening differences,” says the report.

The quality of South Africa’s healthcare system is currently ranked in the bottom 40 percent in the world. The index has ranked the country at 119 out of 195 countries, with a score of 52. This is only a 6,4 point increase since 1990.

African states with smaller economies, such as Algeria (61), Namibia (54) and Mauritius (66), scored higher than South Africa in the index. Mauritania (52) received the same score as South Africa. Egypt, the second-biggest African economy, received an index score of 61, however, Nigeria, the biggest African economy, scored only 51.

South Africa’s strongest healthcare features were in the areas of diphtheria, tetanus, uterine cancer and upper-respiratory infections – which all scored above 90 on the index.

However, the country is performing below par, with an index score of 25, in areas such as tuberculosis (TB), lower-respiratory infections and non-melanoma skin cancer.

According to Stats SA, 460 236 people died from TB in 2015. TB has been the leading underlying natural cause of death in South Africa for a number of years and accounted for 7,2 percent of deaths in 2015, followed by diabetes mellitus at 5,4 percent.

The index gave South Africa’s quality of TB treatment a score of 24, while Stats SA indicated that the proportion of cases has been declining. Proportions for diabetes mellitus, hypertensive diseases, other viral diseases and chronic lower-respiratory diseases have, however, been increasing.

South Africa scored 33 for treatment of cervical cancer. The prospects for this score to increase look very good as the government implemented human pappillomavirus (HPV) vaccination in schools. Since March 2014, Grade 4 schoolgirls, aged nine and ten, have been receiving vaccinations against HPV. The introduction of the HPV vaccine is part of the Integrated School Health Programme, which is expected to reduce cervical cancer and associated mortality within the next two to three decades.

Surprisingly, South Africa – which is known for its specialist training in the field of epilepsy – scored a very low 27 for epilepsy treatment.

The country received a score of 65 for measles treatment, which should be improved in due course by the ongoing measles campaign. The campaign was implemented recently, after the Western Cape and Gauteng provinces experienced measles outbreaks, which were contained through rapid intervention by the Department of Health.

The report stated that health “quality” can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care. Most of the countries that had lower scores than South Africa are war-stricken states, such as Somalia, Afghanistan and the Central African Republic.

Europe dominated the positions for the top-three countries in healthcare quality. These are: Andorra, Iceland and Switzerland. The report suggests that struggling regions should observe these top countries and learn from them to improve healthcare quality.