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World Bank paints a positive picture of health service in South Africa

South Africans are unlikely to face crippling healthcare bills and have fairly good access to services, suggesting the country is well on the path to providing universal health coverage, according to a report by the World Bank and the World Health Organisation.

The Tracking Universal Health Coverage report defines universal coverage as meaning that all people can obtain the health services they need without suffering financial hardship. Achieving universal health coverage by 2030 is one of the Sustainable Development Goals.

The report’s findings on SA challenge the Department of Health’s rhetoric on National Health Insurance, an ambitious set of health reforms that it says are intended to provide universal health coverage. The findings show the country is to some extent there already.

The report found SA’s service coverage index, which gauges the provision of essential health services, was 67, putting it in the top half of the 183 countries surveyed. About 80 countries rank higher than SA.

The incidence of catastrophic health expenditure, defined as the percentage of the population spending more than 10% of their household budget on out-of-pocket health expenses, is just 1.41%. This puts South Africans’ risk of catastrophic health expenditure on a similar level to people living in the UK (1.64%) or Panama (1.4%).

They enjoy better financial protection than people living in the US or India. In those countries, the percentage of the population spending more than 10% of household income on health expenses is 4.77% and 17.3%, respectively.

The report provided an incomplete picture of healthcare coverage as it did not gauge the quality of the services provided, cautioned Alex van den Heever, who holds the chair of social security systems at the University of the Witwatersrand.

"South Africans are not being bankrupted, but it doesn’t mean they are not getting killed," Van den Heever said.

Neither the public nor the private healthcare system provided sufficient information on the quality of the services they provided, he said.

The Department of Health declined to comment, saying it had yet to study the report.

The report said that at least half of the world’s population still lacked full coverage for essential health services and more than 800-million people spent at least 10% of their household budgets on out-of-pocket health expenses, pushing them into poverty.

"The report makes clear that if we are serious — not just about better health outcomes but also about ending poverty — we must urgently scale up our efforts on universal health coverage," said World Bank group president Dr Jim Yong-kim.