Louis Reynolds and David Sanders

The SA National Health Assembly (NHA) takes place at a time that SA faces a growing health crisis with its HIV/Aids and TB epidemics, a growing burden of non-communicable diseases, and high rates of injuries and fatalities.

This quadruple crisis is underpinned by social determinants of health such as persistent poverty, poor service delivery, and growing social and economic inequalities due to neo-liberal macroeconomic policy decisions and insufficient progress towards achieving the social and economic rights enshrined in the constitution.

The private and public health sectors are also in crisis. The private sector serves only 16 percent of the people but consumes almost half the total health-care expenditure. The public sector is less effective than it should be because of chronic underfunding of the primary and community levels of the system; human resource challenges including maldistribution, mismanagement, poor training and incompetence; and poor leadership and corruption.

Both systems are fragmented, dysfunctional and unsustainable.

The SA-NHA brings together civil society, academics, health practitioners, and government members to build solidarity, share experiences, learn from one another, and plan future activities to build a better health system, equally accessible to all, and to strengthen campaigns around social determinants of health.

It will also provide the national Department of Health with the opportunity to engage with a broad range of civil society on relevant health and related social determinants, and in particular on the National Health Insurance initiative.

Its links with the third global People’s Health Assembly (PHA-3) will give people from the government and civil society opportunities to engage with and learn from experiences in other countries including Brazil, Thailand and Ghana, which have implemented or are in the process of implementing publicly funded health insurance, comprehensive primary health care and participatory policy processes aimed at universal coverage of important health interventions.

Furthermore, a broad range of health activists, academics, policymakers and NGOs from about 70 countries, especially Africa and Asia, will attend PHA-3, providing a rich and fertile ground for the exchange of ideas.

The NHA has three themes:

l The social determinants of health.

l Rationale for the National Health Insurance (NHI) and financing of health care.

l Building a comprehensive and equitable health system.

The programme covers key areas relevant to the development of the NHI such as comprehensive primary health care; appropriate human resources such as community health workers; community participation and mobilisation for health; challenges to universal coverage and access; migrant and refugee health; and the political economy of health. It will also consider alternative financing options. Last it will look at key social determinants such as food insecurity, water, sanitation, housing, working conditions, and health sector greenhouse gas emissions.

The PHA brings together 1 200 participants from 90 countries.

Louis Reynolds is the associate professor of the Education Development Unit in the health sciences faculty at UCT and a member of the People’s Health Movement (PHM-SA) steering committee, and David Sanders is the Emeritus Professor of the School of Public Health at the University of the Western Cape, and chairman of the PHM-SA steering committee