Health: looking after the Nation's health

Abstract

Health infrastructure is essential to the successful delivery of health services. With a normal planned lifespan of over 50 years, such capital investment endures for extended periods and major changes in the estate take a long time to achieve. The existing health estate in South Africa - made up of over 4000 facilities with a current replacement value of over R180 billion - is a complex mixture of facilities and is challenged, in many cases, by a combination of inherited imbalanced from the apartheid era and new investments made since the transition in 1994. A range of initiatives has been introduced to address the backlogs initially identified by the 1995 - 1996 National health Facilities Audit. These include the strengthening of strategic and project planning to ensure that the estate meets current and changing health service needs; a drive towards an equitable and inclusive health service; strategies to address affordability concerns, and initiatives to strengthen capital procurement processes. Capital investment levels have increased significantly and are projected to increase further over the current Medium Term Expenditure Framework (MTEF). However, investment levels - for new capital and especially for the operation and maintenance of the estate - remain suboptimal; that is, below the levels required to address the required changes and maintain the estate at an acceptable level. Progress has been further constrained by the erosion of staff over time and by challenges in attracting and retaining professional and key functional staff in both the health and public works departments. These features make it difficult to deliver quality health care that meets community needs. More broadly, if the potential for improved health outcomes is not realised, the Accelerated and Shared Growth Initiative (AsgiSA) objectives of systematically reducing poverty and unemployment may not be met. Since infrastructure is essential to healthcare delivery good public health, strengthened capacity to plan for infrastructure delivery and maintenance, accelerated investment and coordination are imperative