Abstract
The introduction of a health policy has to be grounded in the principles of good governance, which implies creating and implementing a respective set of actions based on exhaustive, comprehensive research of every factor that may represent an obstacle. Specifically, sociocultural factors that may become the roadblock in advancing patient literacy have to be considered along with socioeconomic, technological, environmental, financial, and political factors. As the case of HIV policy development and implementation in RSA has shown, good governance provides insight into the needs of the target population and the circumstances in which these needs will be met, thus guiding the creation of a policy and its integration in the target setting.
Introduction
Introducing an effective health policy is always a challenging and complicated endeavor, which is mostly due to the presence of multiple factors that have to be addressed in the policy in question to safeguard general audiences from health issues. In South Africa, the problem of public health management is especially concerning because of the lack of resources (Marais & Petersen, 2015). However, the presence of a somehow consistent governance system allows implementing health policies in the way that implies homogeneity of actions across the state and the application of the policy at all levels of its execution. As a result, a uniform manner of managing a particular health concern is developed in order to be later adjusted to the unique environment of a specific healthcare setting. Thus, the role of state governance has a directly positive impact on the increase in health rates among the target population due to the cohesion of actions within the healthcare system and the opportunity to keep the standards for healthcare services high, at the same time monitoring the system and identifying its flaws.
In order to address the effects of proper governance on the development of healthcare bills and introducing sensible guidelines for care, one will need to take a deep look into the notion of governance. Specifically, the principles of good governance have to be outlined. According to Setyaningrum, Wardhani, and Syakhroza (2017), the concept of good governance lies in selecting an appropriate model for action and achieving the results set as the main objectives. Another way of defining this contentious subject included inciting development, in general, whereas Fusheini, Eyles, and Goudge (2016) claim that the very existence of good governance as an absolute is debatable. Given the specified viewpoints, defining good governance as the ability to achieve the defined goals on time with the minimum wastage of resources and negative effects is the best way of defining good governance (Oni et al., 2016). In the context of the South African health concerns, good governance would mean increasing the extent of health literacy by offering its people greater
Review (Body)
Current Situation in South Africa
The present health status of the South African population leaves much to be desired due to the problems in the access to healthcare, namely, the resources that the population requires and the knowledge needed to develop basic health literacy. According to Casale, Wild, Cluver, and Kuo (2015), the current health issues in South Africa are quite vast, with a profoundly adverse effect on citizens. Specifically, the issues of HIV, infectious diseases, undernourishment, mental health, and life expectancy, in general, are the sources of the greatest concern presently (Cooper, Mantell, Moodley, & Mall, 2015). Therefore, steps have to be taken at the legal, economic, and social levels to introduce changes to the South African healthcare landscape.
Health Policy: Addressing the Problem of HIV in RSA
A recent change in the public health policies may turn the tide and affect the current situation in South Africa. The recent policy adopted to fight the increasing rates of HIV in South Africa displays clearly how important good governance is for producing a well-structured, effective, and people-oriented health policy. According to the key tents of the specified RSA policy, the management of the HIV epidemics observed in the RSA community presently should start with the changes in the framework of healthcare measures aimed at addressing reproductive health issues (Casale et al., 2015). In addition, the policy in question strives to encourage vulnerable groups to use contraceptives as the means of preventing not only HIV contraction but also HIV in newborn babies due to the transfer of the virus from the mother to the infant (Casale et al., 2015). The described policy has been established at the legal and political levels, yet it may need greater sociocultural insight in order to gain efficacy. Herein lies the importance of good governance, which would help to elevate the current set of measures to a new level where sociocultural and economic issues would also be taken into account, thus inciting patient education and promoting health literacy.
Effects of Good Governance on Health Policy
As the policy under discussion shows, the presence of good governance allows embracing legal, sociocultural, political, and economic factors that deny people access to health services and impede the development of health literacy. Therefore, with the introduction of good governance, current gaps in health literacy can be filled by restructuring the very model of communication between health institutions and citizens. New communication channels will help to introduce citizens to key health safety issues and hazards along with the strategies that they can use to avoid them. In the South African context, the emphasis on increasing literacy levels as the essential strategy against HIV, the premises for the introduction of the specified change into the public health system of the state was quite promising, yet the few social changes made within the state were insufficient to implement the policy fully.
Taking retrospect at the specified failed endeavor, one will realize that the lack of connectivity as a critical component of good government was the main impediment in implementing the policy. However, it would be a mistake to assert that the case under analysis represents a reverse example of how good governance affects health rates within a state. On the contrary, the recent policy against HIV mentioned above can be seen as the product of good governance since it emerged after a meticulous and accurate assessment of the needs of the target demographic, hence the across-the-board framework that is meant to provide the basis for an outreach program and educate citizens. The described characteristics of the policy are the direct implications of good governance being used to collect data and compile it in order to transform the existing standards for care into the measures that will affect disadvantaged and dispossessed populations.
However, the case under assessment also showcase why the incomplete governance may result in the outcomes of good governance being overshadowed by the lack of understanding of how the current social and health-related processes occur in target society. As the study by Davies, Matthews, Crankshaw, Cooper, and Schwartz (2017) confirms, the lack of support from the authorities responsible for the analysis and assessment of social issues and concerns has been affecting the implementation of the policy quite adversely so far, minimizing its positive effects. Specifically, the research states that “Despite South Africa’s progressive policy and advocacy environment, evidence of demand and pilot project successes, broader integration of safer conception counselling into clinical care has not occurred” (Davies et al., 2017, p. 37).
The observed issue is exemplary of how good governance needs to embrace not only health-related, political, financial, technological, and economic factors, but also social ones. The current attitudes toward health management are quite rudimental among RSA citizens, especially those from remote areas where the provision of healthcare services is hampered by the lack of awareness about the social impediments to policy implementation, mainly, the absence of willingness to engage in the dialogue with healthcare providers and accept change. Remarkably, the case of the identified HIV [policy in RSA also shows the importance of establishing connections between different factors in order to define the probability of comorbidities and, therefore, create a cohesive health management strategy:
We understand that there are many co-morbidities and we cannot continue to just treat diabetes or HIV for example, on its own. If there is specialised care for diabetes, for HIV and all the other common co-morbidities, how many different vertical and parallel services would we have?
However, it is the connection with citizens and a proper understanding of the sociocultural challenges that prevent healthcare policies form having a proper effect is what eludes the RSA authorities currently, devaluing the effects of their governance. As a result, the current HIV management policy lacks the critical aspect of communication with vulnerable groups. Good governance, in turn, would have established and implemented methods for improving communication and establishing a feedback channel through which patient education and awareness promotion would have been possible. However, the RSA authorities still have the chance at adjusting the current policy to make it targeted toward the specific circumstances in which the vulnerable groups have found themselves, namely, the problems related to the consistency of communication with healthcare providers.
Nonetheless, the policy for HIV management produced in RSA also offers several examples of how good governance can improve the effectiveness of the public policy and affect health issues productively. For example, the program in question has served it function in managing one of the major concerns within the healthcare system of RSA, which is extraordinarily long waiting time (Werfalli et al., 2017). According to Werfalli et al. (2019),
The programme has been shown to reduce the need for stable HIV, hypertension and diabetes patients to visit public primary health-care clinics on a monthly basis to collect their medicines, with the positive effect of decongesting the clinics and reducing waiting times. (p. 5)
Therefore, good governance encourages patients to develop health literacy and the habit of frequenting local healthcare services for regular health checks, as well as visits in case of any deviation from the set norm for public health. However, with the lack of awareness about the symptoms and possible sources of threats to which an individual may be exposed when living in the environment that does not allow for the immediate and uninhibited access to health resources. For this reason, the policy adopted by the RSA in relation to HIV also indicates that establishing broad and efficient communication channels to converse with the target population is how good governance affects the formulation and implementation of health policies.
Conclusion
The ability to include every significant factor into the development of a health policy and implement it in the ay that will offer access to health services to every citizen from any social background is the core aspect of good governance that allows creating and running a good public health policy. As the case of RSA has shown, the analysis of sociocultural obstacles toward building health awareness and literacy is what constitutes the core of the positive impact of good governance on health policies. One might note that the case under analysis cannot be called a complete triumph since it still fails to reach out to some of the most disadvantaged members of the RSA population.
Nonetheless, it proves that the presence of good governance helps to connect different aspects of health policy implementation at the social, economic, financial, technological, and legal levels in order to produce a deeply positive impact on public health. Specifically, good governance provides the platform for educating patients, assessing the environment that defines their health status, and integrates every possible resource in order to shed light on a specific health issue and, therefore, make citizens and authorities recognize a respective policy as a crucial mechanism in managing the outlined health concern. In regard to the RSA HIV policy, future changes are necessary to improve communication between healthcare providers and the RSA population in order to encourage health literacy. However, the foundation has been created with the help of good governance based on allocating resources and arranging them in the way that will incite change.
References
Casale, M., Wild, L., Cluver, L., & Kuo, C. (2015). Social support as a protective factor for depression among women caring for children in HIV-endemic South Africa. Journal of Behavioral Medicine, 38(1), 17-27. Web.
Cooper, D., Mantell, J. E., Moodley, J., & Mall, S. (2015). The HIV epidemic and sexual and reproductive health policy integration: Views of South African policymakers. BMC Public Health, 15(1), 217-225. Web.
Davies, N. E., Matthews, L. T., Crankshaw, T. L., Cooper, D., & Schwartz, S. R. (2017). Supporting HIV prevention and reproductive goals in an HIV‐endemic setting: Taking safer conception services from policy to practice in South Africa. Journal of the International AIDS Society, 20, 36-42. Web.
Fusheini, A., Eyles, J., & Goudge, J. (2016). The social determinants of health and the role of the health care system: a case study of the significance of good governance in public hospitals in South Africa. Health, 8(12), 1288-1306. Web.
Marais, D. L., & Petersen, I. (2015). Health system governance to support integrated mental health care in South Africa: challenges and opportunities. International Journal of Mental Health Systems, 9(1), 14-34. Web.
Oni, T., Smit, W., Matzopoulos, R., Adams, J. H., Pentecost, M., Rother, H. A.,…van der Westhuizen, C. (2016). Urban health research in Africa: themes and priority research questions. Journal of Urban Health, 93(4), 722-730. Web.
Setyaningrum, D., Wardhani, R., & Syakhroza, A. (2017). Good public governance, corruption and public service quality: Indonesia evidence. International Journal of Applied Business and Economic Research, 15(19), 327-338.
Werfalli, M., Murphy, K., Kalula, S., & Levitt, N. (2019). Current policies and practices for the provision of diabetes care and self-management support programmes for older South Africans. African Journal of Primary Health Care & Family Medicine, 11(1), 1-12. Web.