Creating a Blueprint for Healthcare Facility Planning, Construction, Commissioning and Management

South Africa's healthcare industry is on the cusp of a revolution. The recently introduced National Health Insurance (NHI) White Paper lays out a plan which would see the country's under-developed healthcare system changed beyond recognition over a 14-year period.

In a statement released in October 2010, the director general of South Africa's National Department of Health, said: "NHI is one of the most ambitious reforms that our government has introduced and preparatory work for the implementation of the NHI requires a comprehensive and systematic approach."

A recent report from RNCOS, entitled South African Healthcare Market Analysis, noted the healthcare industry in the country will see huge growth over the coming years, thanks in a large part to these supportive government policies.

Yet for this growth to be sustainable a coherent plan must be put in place to ensure future needs are met and the NHI reaches its admirable objectives.

Public and private collaborations

Healthcare in South Africa is currently delivered through both public hospitals and private facilities, a collaboration which is intended to continue as the NHI develops.
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In the preface to the White Paper on the Transformation of the Health System in South Africa, Dr Nkosazana C Dlamini Zuma, minister for health, noted the pressing need to decentralise the management of the healthcare system towards a district network to facilitate better planning.

Provincial and district departments will be needed to assist this.

Alongside the development of the NHI will be the National Health Information System, which "will facilitate health planning and management, and strengthen disease prevention and health promotion in areas such as HIV/AIDS, STDs and maternal, child and women's health."

In establishing its blueprint for a national health service, South Africa is keen to continue the complimentary functions of the public and private health care sectors, which it claims is key to "promote equity in service provision."

However, criticism has previously been levelled against the private sector for what some claim is its overarching values, which could be of serious detriment to the preparations.

Health Minister Aaron Motsoaledi said currently medical aid was only focussing on curing, rather than preventing, health problems.

Dr. Humphrey Zokufa, managing director at BHF [Board of Healthcare Funders of South Africa], told The New Age: "Private healthcare is unsustainable in South Africa. The structure of the system definitely needs to be reviewed. "

He said the system should include "preventative, curative, chronic, catastrophic and quaternary" care.

Creating a plan

South Africa realises if it is to overcome these challenges it must look beyond its borders and learn the lessons from international efforts.

The director general of the National Department of Health said the United Kingdom's National Health Service showed how a healthcare system can overcome challenges relating to quality of care, as well as collaborating with outside bodies, such as the National Institute for Clinical Excellence and the Care Quality Commission.

An international consultative workshop was convened to seek out any gaps in service offered by public healthcare facilities.

This leads on to the other objective the authorities are very clear on; the need to get to the heart of the inequalities which currently exist within the country's healthcare system if the NHI is to ever truly function correctly.

Working alongside the NHI will be a strengthening plan, "starting with a detailed inventory of both public and private facilities, including infrastructure, human resources and technology", the African National Congress explained.

"The inventory will serve to assess the current capacity of the healthcare system to provide services at different levels, and where this capacity is located. Secondly, it will identify gaps for expansion and facilities that require refurbishment," it said in a media briefing.

Assessments are also to be made with regard to the financing of district health systems, as well as efforts to boost access to primary healthcare services – a particular problem in underserved rural areas, which will be the first to benefit from the scheme. Managers of public healthcare facilities are also to be given greater autonomy.

Only once this has been done can the commissioning and construction of the new healthcare infrastructure really begin.