South Africa

The National Core Standards for Health Establishments in South Africa

08 February 2017

The government of South Africa has committed itself to further progress on Universal Health Coverage (UHC). Delivering quality health services are a key UHC policy goal. To provide all South Africans with quality affordable health services based on their health needs and regardless of their socioeconomic status, the Governmentdecided toestablish a National Health Insurance (NHI) Fund. The implementation of the NHI started in 2012, and will take place in three phases over a fourteen-year period.

NHI represents a substantial policy shift that will necessitate a massive reorganisation of the current health care system. One of the steps was the establishment of a new governmental body, the Office of Health Standards Compliance (OHSC), to enhanceand maintain the quality of health services. During the last four years, the results of the Inspectorate’s work revealed a critical situation concerned the quality of South Africa’s health facilities and services. Addressing this issue, however, has been a difficult task for the OHSC due to capacity restrictions and the absence of quality standard regulation. The urgent need to increase quality of care across the whole health system drove onward the development of the National Core Standards (NCS) for Provincial Health Authorities in South Africa.

Quality of healthcare needs to be adequately addressed in both the public and private sector. The NCS will be a milestone document for the assessment of health care quality. It aims to achieve three main goals. First, develop a common definition of quality care and health standards. Second, establish a benchmark against which health establishments can be assessed, gaps identified and strengths appraised; and finally introducea national accreditation system based on the standards.

The World Health Organization (WHO), supported by the European Union–Luxembourg-WHO UHC-Partnership has been involved in key phases of the NHI and also the NCS making process. Experts from WHO HQ and the African Regional Office provided support to the Ministry of Health in two main areas. The first involved helping develop the necessary law to implement the NCS, second WHO supported the process of policy dialogue among the key stakeholders involved.

Policy dialogue is one of the key elements for the creation of high quality regulation and the NCS is a good example of it. The result was an inclusive process, in which various stakeholders were engaged contributing to the acceptance of the NCS and the approach to give them legal effect. The actual and perceived legitimacy of the process is critical to sustain the historical reforms that the South African health system is facing.

The health care providers are the NCS primarily audience as they are requested to comply with the required standards. Nevertheless as the NHI will ensure a more responsive and accountable health system, the South African population is equally targeted by the NCS. The patients ought to know their rights, which quality standards are defined and what hence can be expected from providers. A more responsive health system is likely to improve patient satisfaction, leading to a better quality of life and improved health outcomes. This will equally contribute towards improved human capital, labour productivity, economic growth, social stability and cohesion for South Africa.