Since gaining independence, South Africa has made notable efforts to strengthen the public health system and enhance service delivery. However, most of the policies, programs, and plans that have been implemented to achieve this particular goal remain ineffective. This trend is evident in many South Africans who are still struggling with an increased burden of diseases. One of the significant public health problems facing the South African public health system is the high prevalence of HIV/AIDs. This persistent pandemic is one of the leading causes of morbidity and mortality among young and older people in South Africa (Maphumulo & Bhengu, 2019).
According to the United Nations Programme on HIV/AIDS (UNAIDS), South Africa has the highest HIV prevalence globally, with a staggering 7.7 million confirmed cases (United Nations Programme on HIV/AIDS [UNAIDS], 2020). This issue calls for immediate attention from the Ministry of Health and political leaders to create more targeted policies to save citizens from the ravaging effects of the pandemic.
The high HIV/AIDs incidence is attributable to individual, community, organizational, economic, and policy factors that directly or indirectly affect exposure to, early detection, and treatment of HIV. Poverty at the individual and community levels is a primary contributor to the HIV crisis in South Africa. Economic deprivation enhances the risk of HIV infection because increased access to efficacious prevention and treatment of sexually transmitted illnesses can significantly reduce the risk of contracting this disease.
Unfortunately, many poor communities in the country cannot access the basic preventive treatment and where such health services are accessible, they are inadequate. Inability to access basic healthcare leads to high comorbidity and mortality rates. Moreover, low-income households are at a greater risk of contracting AIDs because their body defense mechanisms have been weakened by preexisting conditions such as diabetes and tuberculosis.
Inefficiency of the public health system contributes significantly to the HIV burden in South Africa. Particularly, chronic shortage of resources, including financing, personnel, and equipment, and poor leadership and governance are a major cause of the unprecedented HIV infections in the country (Malakoane, Heunis, Chikobvu, Kigozi, & Kruger, 2020). These issues manifest in the longer patient waiting times, dilapidated infrastructure, ineffective hygiene and infection control, and prevention measures in the public health system (Maphumulo & Bhengu, 2019). Thus, the causes and risk factors of HIV are complex and multifaceted.
There is a clear need to restructure the public health system to address the prevalent inefficiencies. Particularly, the Ministry of Health should consider advocating for increased funding, and equal distribution of resources, effective management of healthcare facilities. The minister should streamline the healthcare system’s decentralization and ensure strict compliance with relevant policies and legislation and adequate monitoring of healthcare delivery quality. HIV prevention and management initiatives should focus more on reducing exposure to the virus by promoting sex education, protection, and good health, as well as early detection and treatment of the condition.
Efforts to enhance service delivery should focus on integrating, implementing, and evaluating Sustainable Development Goals and Universal Health Coverage. These interventions can reduce the high incidence, morbidity, and mortality rates associated with the HIV/AIDS epidemic. However, it is imperative to note that restructure the public health system is a complex task that requires an integrated, holistic approach that brings together a multidisciplinary team consisting of healthcare providers, administrators, leaders at the community, province, and national levels, and the public.
Since achieving self-rule, South Africa has demonstrated a remarkable commitment to improving healthcare delivery quality in public settings. The Hospital Revitalization Program’s ten-point strategic plan, the Integrated Chronic Disease Management model and the National Core Standards program demonstrate the government’s efforts to improve HIV/AIDs outcomes and efficiency of the public health system (Dramowski, Cotton, & Whitelaw, 2017; Lebina et al., 2019; Malakoane et al., 2020).
However, HIV and AIDs remain a severe public health problem affecting many South Africans. According to the latest data published by the United Nations Programme on HIV/AIDS, South Africa tops the list of countries with the highest prevalence rates of HIV across the world (UNAIDS, 2020). An estimated 7.7 million people in the country have tested positive for the illness, accounting for 20.4% of the country’s population (UNAIDS, 2020). Furthermore, the HIV epidemic is a leading cause deaths in South Africa (Maphumulo & Bhengu, 2019). These alarming statistics illuminate a gap in the fight against this sexually transmitted disease.
Many factors explain the high incidence of HIV among South Africans. Low-income levels, ineffective management and leadership, the high influx of immigrants into the country, inadequate funding, personnel shortages, and lack of equipment and technology contribute to this problem (Maphumulo & Bhengu, 2019; Malakoane et al., 2020). The need for additional resources emerged during a focus group discussion with senior officials in the public health sector facilitated by Dramowski et al. (2017). The public health system is battling longer patient waiting times, dilapidated infrastructure, ineffective hygiene and infection control, and prevention measures (Maphumulo & Bhengu, 2019).
Moreover, many South Africans face multiple health conditions and outcomes, such as tuberculosis and high maternal and child mortality rates (Maphumulo & Bhengu, 2019). In addition, hospitals experience high health-acquired infections (HAIs) with about one in seven people who enter healthcare facilities in the country are likely to acquire an infection (Dramowski et al., 2017). These issues are exacerbated by structural challenges such as poor leadership and management which impede the ability to provide safe, quality healthcare. The co-occurrence of these problems strains the public health system and lead to the high HIV/AIDs incidence.
These growing concerns provide a strong case for the Health Ministry to create more robust policies, strategies, and plans to strengthen the public health system. The Department of Health should seek to establish a well-functioning health system. According to the World Health Organization (WHO), such a system assures access to “essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use” (as cited in Malakoane et al., 2020). Most importantly, strengthening the South African public health system requires a well-coordinated HIV/AIDs prevention strategy that prioritizes and promotes evidence-based infection and management policies, education, advocacy, healthcare personnel and infrastructure, continuous surveillance, and research.
Successful implementation of this strategy calls for an integrated, holistic approach that benefits from input from diverse stakeholders at all levels: individual, household, community, province, and national. For instance, improving service delivery would require policies to defragment health services, enhance service quality, tackle infrastructural challenges, and implement effective referral systems (Malakoane et al., 2020). Considering the high patient-to-staff ratios, the Ministry should consider addressing the persistent shortages of funding, healthcare personnel, and equipment. The Minister needs to advocate for additional funding to help meet the ever-evolving and growing healthcare needs in South Africa. One possible way of addressing this issue is establishing partnerships with local communities, corporate institutions, not-for-profit organizations, and other parties to secure funds to help reduce some of these gaps.
An important consideration is ensuring equal distribution of resources. South Africa is renowned for having a progressive legal framework that guarantees strong protection of human rights, particularly the right for every citizen to access quality healthcare (Maphumulo & Bhengu, 2019). However, structural discrimination results in an unequal distribution of resources, including healthcare and education. Policies aimed at taming the deeply-rooted racism from employment and resource allocation can help increase access to health services, consequently reducing the morbidity and mortality associated with HIV and AIDs.
Lastly, improving leadership and governance structures in the public health system can boost service delivery. Hospitals need excellent leadership with a clear vision and exceptional priority setting, and strong values to steer change in addressing the VIV epidemic. Outstanding leadership and governance will ensure successful policy implementation, strict compliance with relevant policies and legislation, and constantly monitoring and evaluating patient outcomes and health systems, consequently improving prevention and management of HIV and AIDs.
In conclusion, despite increasing recognition in the country, HIV/AIDs remain a severe problem facing many South Africans. Myriad factors hamper infection prevention and management efforts targeting at-risk populations at all levels – individual patient, institutional, and health system. The Ministry of Health needs to develop more robust, evidence-supported policies to strengthen the South African public health system. The Ministry needs to embrace a coordinated HIV/AIDs prevention strategy that emphasizes evidence-based infection and management policies, education, advocacy, healthcare personnel and infrastructure, continuous surveillance, and research.
References
Dramowski, A., Cotton, M. F., & Whitelaw, A. (2017). A framework for preventing healthcare-associated infection in neonates and children in South Africa. South African Medical Journal, 107(3), 192-195. Web.
Lebina, L., Alaba, O., Ringane, A., Hlongwane, K., Pule, P., Oni, T., & Kawonga, M. (2019). Process evaluation of implementation fidelity of the integrated chronic disease management model in two districts, South Africa. BMC Health Services Research, 19(1), 1-14. Web.
Malakoane, B., Heunis, J. C., Chikobvu, P., Kigozi, N. G., & Kruger, W. H. (2020). Public health system challenges in the Free State, South Africa: A situation appraisal to inform health system strengthening. BMC Health Services Research, 20(1), 58. Web.
Maphumulo, W. T., & Bhengu, B. R. (2019). Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis, 42(1), 1-9. Web.
United Nations Programme on HIV/AIDS. (2020). Seizing the moment: Tackling entrenched inequalities to end epidemics. Web.