Health care in South Africa comprises of three aspects: a private health system, public health system and non-governmental organizations, which are classified as part of the private health system in literature. These are discussed below.
3.6.2.1 Public health care system
Green and Matthias (1997) define public health as controlled and financed through the government. In 2003/4 the public sector captured 38% of the total health sector (McIntyre et al., 2006). This means that the South African public health care sector is under-resourced and over used as it has to use this budget to deliver a health service to 80% of the population (SouthAfrica.info, 2010). People using the public health sector complain about the long waiting times, drugs not being available, rude staff, being turned away, opening times not being convenient, facilities not being clean and receiving the incorrect diagnosis (Burger and Grobler, 2007).
The public health care system is state-funded, meaning that it is free to all the citizens of South Africa who cannot afford to pay to receive medical attention. That is why the afore-mentioned complaints arise as there are many people reliant on free treatment. Some patients could end up being turned away if there are too many patients already at the health facility or if there are not enough drugs to dispense to the patients.
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3.6.2.2 Private health care system
Private health refers to all non-state organisations whether profit motivated or not (Green and Matthias, 1997). The private sector of the South African health care system was introduced as a way to reduce the demand of service that faced the public sector (McIntyre et al., 2006). According to McIntyre et al. (2007), in 2003/4 the total national health expenditure on the private health sector was 62% and it catered to only 20% of the population. Comparing the statistics from the public sector with the private sector it is clear that the private sector has more financial resources, services a much smaller percentage of the population and therefore can provide a higher quality of care to patients compared to the public health sector. Burger and Grobler (2007) conducted a household survey that indicated that private health care users‟ main complaints were the prices that they had to pay to receive the private care. In South Africa, patients must pay out of their own pockets or join a medical aid scheme to gain access to private health care. In a medical aid scheme, a certain amount of money is paid per month depending on the extent of cover. Medical aid members may then visit private doctors and hospitals utilising the available medical aid benefits.
The private health system is divided into two parts: profit making and voluntary (Burger & Grobler, 2007). Medical aid schemes are mostly profit making, while voluntary private health is where NGO‟s are found. Therefore, according to this definition, NGOs are part of the private sector.
3.6.2.3 Non-governmental Organisations (NGOs)
In order for an organisation to be labelled an NGO it must possess the following five key characteristics as pointed out by Lewis and Kanji (2009):
- It must be formal. The organisation must be institutionalised in that it must have regular meetings;
- It must be private in that it must be separate from the government even if it does receive some support from it;
67 - It must be non-profit distributing meaning that if there is some financing being
generated these finances must not be accrued by the owners or directors;
- It must be self-governing as it must have the ability to control and manage its own affairs; and
- It must be voluntary.
Services offered by NGOs
The Department of Health in South Africa (DOH, 2001) affirms that NGOs have their own responsibilities, such as: identifying community needs including financial needs and providing the required help; acquiring resources and using these accordingly; developing care plans to ensure continuity of care and supporting the CHCW. The types of NGOs that this research study is interested in are those that provide health services and home community based care programmes to communities. These NGOs have CHCWs that carry out the health services offered by the NGOs. CHCWs working under NGOs that operate in the home community based care environment usually have to provide services such as basic care (rehabilitation and hygiene), support to the patient, counselling, health education and assist in the household if required (DOH, 2001).
Types of NGOs in the health sector
NGOs operating in the health sector have the five characteristics named above and have the same common purpose of wanting to improve health conditions. Green and Matthias (1997) describe the operation of NGOs as follows as related to their operation in different geographical areas:
International NGO‟s operate within more than one country. This type of NGO is usually based in a developed country but operating in a developing country. A national NGOs‟ mandate is country-wide while community NGOs are based in the community. A national NGO is different from a community NGO as the Community NGO is informally constituted, operates solely within a prescribed sub-national locality and is run solely by members. On the other hand, a national NGO possesses both a legal entity and has professional staff. Each of these types of NGOs are capable of providing home community based care but it is usually the community
68 NGOs that implement this type of care as they are in the same community as the people that need the service and better understand the people and the challenges they face.
3.6.2.4 Point of entry to private or public healthcare
Two scenarios are used to illustrate what the first point of entry for primary health care in either the public or private health sector is for a patient and how these sectors network with the non-governmental organizations.
Scenario A: Public health care sector
Figure 3.3 illustrates how a patient would gain access into the public health system and eventually into a home community based care programme.
Figure 3.3 Entry point into Primary health care in Public Health Care Sector
The first point of contact into the public health care sector is the clinic (DOH, n.d). The clinic can provide services such as HIV/AIDS testing, screen for other diseases such as Tuberculosis and also administer antiretroviral drugs if necessary (DOH,
69 2010). Patients are usually referred from the clinic to an NGO that runs a home community based care programme due to various reasons such as: shortage of beds and overcrowding in the clinic or hospital; inadequate number of medical professionals to cater to demands of patient in the public sector and lack of resources for treatment and shortages of drugs (DOH, 2001). The home community based care programmes are utilized to lighten the burden that clinics and hospitals face.
Scenario B: Private health care sector
Figure 3.4 gives the reader an idea of what the first point of contact for a patient would be in the private health care sector.
Figure 3.4 Entry point into Primary health care in Private Health Care Sector
In the private health care sector the first point of contact is with a doctor or general practitioner. The doctor can then refer the patient to a hospital or clinic if his or her condition is too serious to be treated. The private health care sector is aimed at middle and high income earners and these are usually people who are members of medical aid schemes (SouthAfrica.info, 2010). There are currently about 200
70 hospitals and clinics that cater for the private health sector (SouthAfrica.info, 2010). If a patient who uses the private health sector requires home care, they can receive home care from a privately paid home care service provider. This home care service will be paid for by the medical aid or out of the patient‟s own pocket.