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Anyone studying an online master of public health or a traditional contact master of public health will learn about health systems. While different countries use different models for their pubic health system, all public health systems are used to help strengthen and deliver public health services equitably and efficiently.
In this article we will look at the various types of health systems across the world. We will also look at health systems and structures that are particular to Africa with a specific focus on public health in South Africa.
Please use the article outline below to navigate through this article. If you have a particular question related to public health, health information systems or the various systems used to support public health in South Africa, you can look through our public health FAQs below to jump straight to the answer you’re looking for.
- Health systems guide for a master of public health
- Health systems frameworks studied in master of public health
- Health information systems core indicators to know for an MPH
- South Africa’s health information systems sources to use for your masters dissertation
- District Health Information System (DHIS)
- EDRweb – Electronic Drug Resistant TB Register
- South African Medical Research Council
- Stats SA – mortality and causes of death in South Africa
- National Treasury health expenditure data
- South African Community Epidemiology Network on Drug Use (Sacendu)
- Council for Medical Schemes annual report
- Tips to successfully complete a distance learning masters programme
- Health systems FAQs
- Study a Master of Public Health with UJ Online
Health systems and health system frameworks are an important part of any work done in the field of public health. If you are looking to study a master of public health, then you will learn about them in great detail. Should you opt to study UJ’s online Master of Public Health, you will encounter health systems in three of the nine compulsory modules.
The Principles and Practice of Environmental Health module looks at the relative strengths and weaknesses of various occupational and environmental health systems. This module allows learners to gain a contextual framework of public health.
The Africa Health Systems, Health and Environmental Politics and Management module looks at the impact that existing health systems have on Africa’s demographics while also looking at the influence of both the political and natural physical environment and how they influence each other.
The Health Systems, Funding Model and Health Economics module looks at best practices around the world for health systems in both developed and developing economies. This module looks at the different ways that health systems can be funded, which we also cover in more detail in our FAQs below where we explain the four main funding models for public health systems.
In recognition of the importance or performance assessment in developing public health policy, the World Health Organisation (WHO) has produced a detailed guideline for countries to follow. The 246-page Health Systems Performance Assessment Framework for Universal Health Coverage document outlines best practice for gathering and analysing health system data and measuring this against the health goals.
The WHO places a particular emphasis on looking at both the performance and the final end goals of a public health system. The guide aims to assist health policy decision makers in both identifying areas where performance is poor and in identifying the causes for that poor performance.
As part of its global strategy for health, the World Bank states that it actively supports countries in their efforts to provide universal high quality health coverage to their citizens, regardless of their ability to pay.
The World Bank uses an approach to grouping policy interventions on health systems that it calls the control knobs framework. The aim of this framework is to assess the performance of a health system and to provide guidance on efforts to improve the system’s performance.
You can read more about the control knobs framework in our FAQs section below.
The WHO is another large global organisation that is heavily involved in health frameworks and assisting in developing and improving health systems around the world. The WHO makes use of an analytical framework to assess health systems that involves breaking the overall system into six distinct building blocks.
The six building blocks that the WHO uses in this approach are:
- Leadership and governance
- Service delivery
- Health system financing
- Health workforce
- Medical products, vaccines and technologies
- Health information systems
Core indicators provide the basis for a health information system and are used in both planning of the health system and in monitoring its performance. These core indicators can be roughly split into health system inputs, outputs, outcomes and health status. Knowledge of these indicators and how to apply them is something that you will gain from studying a master of public health (MPH).
The WHO has compiled a list of 100 core health indicators that it describes as a “standard set of core indicators prioritised by the global community to provide concise information on the health situation and trends, including responses at national and global levels”.
One of the measures by which the WHO assesses the overall performance of a health information system is the Health Information System Performance Index (Hispix).
This measure makes use of publicly available data and ranks the data against various standardised indicators to provide a numerical score. This score is intended to provide an objective and comparable assessment that can be used for any country’s health system.
The WHO describes Hispix in far greater detail in Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies.
Measures such as Hispix require reliable data that is publicly available. While much of this data is provided through existing health information systems that record and report on patient data, this is only able to capture data on people who have made use of public health facilities such as clinics and hospitals. Health surveys are used to gather data on the health of a population that includes those who have not sought care at a public health facility.
Here in South Africa these and other surveys are carried out by Statistics South Africa, otherwise shortened to Stats SA. Examples of many health surveys carried out by Stats SA include the South African Demographic and Health Survey, Trends in selected health indicators regarding children under 5 years in South Africa and The Status of Women’s Health in South Africa: Evidence from selected indicators.
Similarly to how health surveys provide crucial data for the monitoring and assessment of health systems, so too does a reliable record of all the births and deaths within a population. Accurate registration of births and deaths allows for a reliable record of a country’s population at any given time.
In South Africa this is controlled by the Births and Deaths Registration Act of 1992, which requires that all births within the country are registered within 30 days. This also applies to South African citizens living abroad, requiring the registration to be done at the nearest South African diplomatic or consular mission.
Registration of deaths are somewhat more complicated if there is a suspicion that it was not due to natural causes, but the law requires that all deaths are registered as soon as is practical. The recording of details on the cause of death also provides important data for assessing a public health system.
Civil registration refers to the registration of births and deaths as covered in the above section as well as the registration of marriages. While the registration of marriages does not have as direct a relation to public health as for births and deaths, it is nonetheless of great importance.
The African Union celebrates Africa Civil Registration and Vital Statistics Day on 10 August every year. It aims to raise public awareness on the importance of a well-functioning civil registration system to allow for the the timely registration of vital events.
Civil registration in Africa differs somewhat from Western countries as it also recognises traditional cultural marriages as well as polygamy. This is important for spouses to obtain legal recognition and protection for things such as inheritance, pensions and death and disability payments.
Stats SA conducts a national census every 10 years to provide an even more detailed snapshot of the country’s entire population that can be gleaned from the registration of births and deaths. As well as providing a count of all the people living within the country, a census also gathers information on socio-economic factors, such as people’s living conditions, their access to basic services and their income, among others.
Census data is used by the government for planning, policy formulation and for deciding on final budget allocations across local, provincial and national government.
The latest South African census was carried out in 2022 but at the time of writing the results had not yet been made available.
While surveys are useful for gathering general information on the health status of a population, health facilities are able to provide far more detailed data. When health facility reporting is done accurately, and within a well-structured health framework, the health reports of health facilities provide public health managers and other policy makers with crucial empirical data.
This requires that health facilities report in a uniform fashion, while also ensuring accuracy of the information.
One of the roles of a health information system is to ensure that all of the health system’s resources are tracked. This includes human resources and staffing, property management and maintenance, as well as up-to-date tracking of all medical equipment and supplies.
South Africa’s public health system comprises a complex network of organisations, people and facilities. Policy makers as well as students and researchers have access to many different sources of information on the functioning of the country’s health systems and the health of the population.
Below are some of the health information systems and organisations that are crucial to South Africa’s public health system.
District Health Information System (DHIS) is the name of an open-source software platform that is used by many countries to provide a national health management information system.
Although most commonly used for health data, the DHIS2 software can be used for any data collection and management and is used in many other industries. DHIS2 is based in Norway, but the project had its roots in South Africa in 1994.
The Electronic Drug-Resistant TB Register (EDRweb) is a project run by the South African Department of Health, with the support of several organisations, for the surveillance and management of drug-resistant tuberculosis (TB).
Authorised users can either input new data for drug-resistant TB units or access the central database and pull out data reports. The data provided by EDRweb helps to speed up decision making and to determine where interventions are needed.
The South African Medical Research Council (SAMRC) is an important contributor towards public health in South Africa and the country’s overall public health system. The SAMRC carries out medical research with the aim of improving the country’s overall health.
The SAMRC is a public entity that falls under South Africa’s national government. It is South Africa’s largest single local funder of health research as well as medical diagnostics, medical devices and therapeutics.
The council also keeps close tabs on the country’s largest causes of death and it focuses on what it describes as South Africa’s “quadruple burden of disease”. This quadruple burden includes maternal, new-born and child health, HIV/Aids and TB, non-communicable diseases and interpersonal violence.
Although it carries out research in many medical fields, the bulk of its work is directed at the leading health threats to the country. These are tuberculosis, HIV/Aids, cardiovascular and non-communicable diseases, alcohol and other drug abuse as well as issues related to gender and health.
You can read a bit more about the SAMRC in our FAQ below.
Statistics South Africa (Stats SA) plays a crucial role in public health in South Africa. It does this by providing accurate data for the country’s public health administrators. Stats SA provides many different quarterly and annual reports relating to the functioning of the country.
Stats SA produces many health-related reports and reports relating to causes of death in South Africa. One of the more comprehensive of these reports is Mortality and causes of death in South Africa: Findings from death notification. This report provides detailed information on causes of death across the country as well as giving a breakdown by province. Unfortunately these reports take Stats SA quite a long time to compile and the release of information trails behind the dates that are reported on.
At the time of writing, the most recently available mortality report was released in mid 2021 to cover the year 2018. The previous report, released in 2020, gave the leading causes of death and mortality breakdown for 2017.
The National Treasury is responsible for allocating the government’s budget each year and a large part of this allocation is made up of expenditure on public health. Health expenditure receives the second-highest budget allocation, beaten only by what is spent on education.
You can read more about what South Africa spends on health care each year in our FAQ below.
The South African Community Epidemiology Network on Drug Use (Sacendu) is a public entity that monitors alcohol, tobacco and other drug use in the country. It falls under the umbrella of the SAMRC and its goal is to reduce the impact of substance abuse on individuals and their communities by identifying the most effective forms of intervention and support.
The members of Sacendu meet every six months and they produce two reports per year that monitor the trends of alcohol, tobacco and other drug use. At the time of writing, the most recent such report was this alcohol, tobacco and other drug use report for January to June of 2021.
The Council for Medical Schemes was set up by parliament to act as an independent regulatory body for the country’s medical schemes. It ensures transparency and fairness and works towards affordable and accessible healthcare cover for the South African public.
Each year it provides an annual report on its strategic, operational and financial performance. The latest annual report, which came out in October 2022, covered 72 medical schemes.
Distance learning or online learning offers students far more flexibility than traditional contact courses. However, this flexibility also comes with additional responsibility and online learners will need to rely on their own discipline and motivation to put in the work that is required.
Fortunately online or distance learners are not entirely alone. Online programmes such as those offered by UJ provide abundant support for online students. Lecturers are accessible and interaction with other students in the course is strongly encouraged.
Here are some common questions and answers related to health systems.
What is a health system?
A health system is the interconnected network of organisations, people and services that provide health care to a specific population group.
Health systems are also known as healthcare systems and the term is usually used in reference to the healthcare system for an entire country. They also vary widely between countries, with some countries providing comprehensive health care to all citizens while other countries do not. For those countries that do not offer public health care, their health systems are then made up of private institutions.
In South Africa we have a mix of both, with public hospitals and a large private healthcare network for those that are able to afford it.
What are the different health system models?
There are four different types of general healthcare systems that are implemented by countries around the world. They are known as the Beveridge Model, the Bismarck Model, the National Health Insurance Model and the Out-of-Pocket Model.
The Beveridge Model, named after economist Sir William Beveridge, uses a country’s tax revenue to provide full healthcare coverage for all citizens. It is used in the UK, Spain, Cuba and New Zealand.
The Bismarck Model was established by German leader Otto van Bismarck in the late 1800s. It relies on all employers and employees contributing to government regulated insurance funds that do not operate for a profit. This allows for coverage for all those who are economically active in a country, but it does not cover people who are not earning a salary. It is used in Germany, Belgium, Japan, Switzerland, the Netherlands and France.
The National Health Insurance (NHI) model is what the South African government is currently looking at adopting in the future. This combines elements from the two previous models to create a state-controlled and non-profit national health fund that is funded by tax revenue and which covers all citizens. Unlike the Beveridge Model, the NHI model uses private healthcare providers. Canada, Taiwan and South Korea use the NHI model.
The Out-of-Pocket Model places the responsibility of paying for health care entirely on citizens. This model often results in poor people not being able to access health care and is used in less developed countries where the government lacks the financial resources to provide health care to its citizens.
What is the control knobs framework?
The control knobs framework is an approach that has been used and taught by the World Bank to improve the performance of a health system. The framework focuses on five key policy intervention areas that can be adjusted to change health outcomes with the aim of improving a health system’s performance.
The five control knobs or policy levers used under the control knobs framework are financing, payment, organisation, regulation and persuasion. Persuasion is also sometimes called behaviour.
Why are frameworks important in health care?
In their paper for the journal Frontiers in Health Informatics, the authors of Applications of Framework in Health Care: A Survey state that “Frameworks provide the ability to measure and compare health system functions in different countries in order to make better and more meaningful decisions, to make comparisons within and between countries, identifying gaps, and sharing information.”
Here in South Africa, the Department of Health is mandated by the National Health Act of 2003 to provide a framework for a structured and uniform health system for the country.
What are health information systems?
Health information systems are used by healthcare facilities to record, store and manage information about all of its operations. Some elements that are specific to a health information system include tracking and monitoring treatment and the health of patients.
Like many other information systems used by organisations, it will likely also track many other common operations such as payrolls, customer billing, stock inventories and orders as well as building maintenance and the management of other costs.
What is an indicator in health information systems?
Broadly speaking, an indicator is a data point or a measure that is used in analytics to gauge progress or success. In the world of health care, indicators are used to measure the performance of a health system.
Earlier in this article we spoke about the core indicators that are used in health information systems. You can also read the next FAQ to see how indicators are used to measure the performance of a public health system.
How do you measure the performance of the health sector?
Performance of a health sector or a health system is measured through specific indicators. Examples of health indicators for measuring the performance of a health system include mortality rates, disability rates and the prevalence of disease within the population. For a system to perform well, those rates should be low and ideally will show a downward trend.
Other indicators that should be higher for a well-performing health system include factors such as how accessible health care is to the population as well as the ratio of healthcare workers to the rest of the population.
What are the benefits of health information systems?
Health information systems allow for better efficiency in the management of a health system. By providing information on all aspects of the system, from payrolls and cash flow through to patient progress and outcomes, a health information system allows for informed decisions to be made quickly.
The end result is that patients receive better care and ideally that more patients are able to receive care through more efficient use of the system’s many resources, which include staff and equipment.
How much is spent on health in South Africa?
South Africa used to spend about 9% of GDP on healthcare each year, but this has increased in recent years to about 12%. The most recent World Bank data places the exact figure at 9.11% of GDP for 2019.
In the 2022 Budget, a total of R259bn was allocated for health in South Africa for the financial year. This was an increase of 1.1% from the previous year and brought the total percentage up to 12% of budgeted expenditure. This is the second-highest budget allocation by function and economic classification for the year, beaten only by what is spent on education.
South Africa’s budgeted expenditure on health for the financial year is broken down as follows: compensation of employees (R159.6bn), goods and services (R78.9bn), capital spending and transfers (R14.1bn) and current transfers and subsidies (R6.4bn).
What is XDR and MDR-TB?
MDR-TB stands for multidrug-resistant tuberculosis. This happens when the bacteria responsible for TB develop a resistance to what are considered the two strongest anti-TB drugs, isoniazid and rifampicin.
XDR-TB stands for extensively drug-resistant tuberculosis and the term was updated by the World Health Organisation in 2021 to reflect the seriousness of these forms of TB, which require complex treatment regimens.
What does the South African Medical Research Council do?
The South African Medical Research Council (SAMRC) was set up in 1969 to improve health and carry out medical research for the benefit of the country.
The council’s stated mission is: “To advance the nation’s health and quality of life and address inequity by conducting and funding relevant and responsive health research, capacity development, innovation and research translation.”
What does medical research involve?
Medical research is a broad field that spans across multiple fields and is carried out by experts in multiple different specialised fields. Broadly, there are three main types of medical research.
Basic medical research is carried out in laboratories by biologists, chemists, geneticists, pharmacologists, toxicologists and other specialised scientists. It aims to improve understanding of the basic mechanisms of both the human body and diseases.
Preclinical research is also carried out by scientists in laboratories, but it has a more direct aim of preparing for a possible clinical trial. This often involves animal testing to ensure safety for possible clinical research.
Clinical research is carried out by medical specialists such as doctors and nurses. It involves human test subjects and takes place in hospitals or research clinics. Due to the use of human test subjects, clinical trials require ethical approval before they can begin.
What is South Africa’s mortality rate?
The World Bank, which provides data up until 2020, measures mortality rates by calculating the number of deaths per 1,000 people.
In 2020, the mortality rate in South Africa was nine deaths per 1,000 people, down sharply from a 2005 peak of 14 deaths per 1,000 people. The lowest that the country’s mortality rate has been was eight deaths per 1,000 people for the years 1990 to 1992 and prior to that it had come down steadily from 17 deaths per 1,000 people in 1960, which is the earliest date for which data is given.
Which disease is causing many deaths in South Africa?
Tuberculosis (TB) is responsible for more deaths in South Africa than any other disease. TB is followed closely by diabetes as a leading cause of deaths in South Africa..
The latest data on natural causes of death provided by Statistics South Africa (Stats SA) was released in 2021 but gave data for the year 2018. In that year, Stats SA processed 454,014 deaths in the country due to natural causes. Of these, 27,450 deaths were caused by TB, making up 6% of the total.
In total, 10 diseases were together responsible for almost half of South African deaths by natural causes (44%). These 10 diseases are, in order of mortality rate: TB (6%); diabetes mellitus (5.9%); cerebrovascular diseases (5.1%); other forms of heart disease (5.1%); HIV (4.8%); hypertensive diseases (4.5%); influenza and pneumonia (3.9%); ischaemic heart diseases (3%); chronic lower respiratory diseases (3%) and malignant neoplasms of digestive organs (2.4%).
What is Sacendu?
Sacendu stands for the South African Community Epidemiology Network on Drug Use and it was established in 1996 to report on alcohol, tobacco and other drug use in the country.
Sacendu’s findings are used by the government in formulating and adjusting its policies on drugs, such as the government’s current 2019 to 2024 Drugs Master Plan.
What is the drug policy in South Africa?
This is a difficult question to answer. Not only can it be interpreted differently depending on whether the term drugs refers to medical pharmaceuticals or to illegal narcotics, but also because different policies are set at different levels of government.
For pharmaceuticals, South Africa set up a National Drugs Policy in the 1990s that has informed more recent policy. For illegal drugs, the latest policy is informed by the national government’s current 2019 to 2024 Drugs Master Plan.
In addition to these two master documents, the Department of Health also states that it “is committed to ensuring that all essential medicines are available, at the appropriate level of care, to all patients in need”.
What are the most used drugs in South Africa?
As with the above question on drug policy, this question is open to interpretation in at least two ways.
According to a 2020 Business Insider article on the United Nations 2021 World Drug Report, cannabis is the most used drug in South Africa and is used by 3.7% of the population, followed by cocaine (1%), amphetamines (1%), opioids (0.5%), opiates (0.4%), ecstasy-type drugs (0.3%) and prescribed opiates (0.1%).
Although open to interpretation as to whether they are considered as drugs, it is worth noting that, although legal for adults, both nicotine and alcohol are used by far higher portions of the population.
For pharmaceuticals there is little in the way of public information available for South Africa. Globally however, this list gives an indication of the most commonly prescribed medications.
The most commonly used pharmaceutical globally is Hydrocodone, which is used in prescription painkillers and cough mixtures. This is followed by Metformin for treating diabetes; Losartan for high blood pressure; antibiotics for fighting off infections; Albuterol for asthma and other respiratory troubles and antihistamines for allergies.
As a leading distance learning university in SA, the University of Johannesburg offers some of the most advanced online degrees and online diploma courses in South Africa. In addition to two undergraduate degrees and five advanced diplomas, UJ offers four online masters courses and one honours course.
Much like all the other other available online courses from UJ, the Master of Public Heath degree programme is designed for the working professional. Lectures are recorded and students are able to study at whatever time is most convenient, so you don’t have to pause your career.
Study a master in public health
UJ’s masters programmes in South Africa offer the same core content as other internationally accredited universities, but with a focus on South Africa. The online Master of Public Health offered by UJ’s health sciences faculty has a curriculum that has been specifically tailored for public health in in South Africa. The programme covers South African and sub-Saharan legislation, health imperatives and economic environments.
The programme takes a minimum of two years to complete, with modules offered in a way that you can start your studies at any of of six starting dates during the year. This means you can get studying within no more than two months from any given date.
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