IZINDABA

The South African Health Reforms 2015 -2020: The Road Ahead

Ed. by Malebona Precious Matsoso, Usuf Chikte, Lindi Makubalo, Yogan Pillay, Robert (Bob) Fryatt. Johannesburg: Trackstar Trading 111 (Pty) Ltd, 2022. ISBN 978-0-6397-2368-6 (print), 978-06397-2369-3 (e-book)

The South African Health Reforms 2015 -2020, which follows a similar review of the previous 5 years, is a wide-ranging and valuable review of the South African (SA) health sector over the most recent quinquennial. While the review understandably focuses to a large extent on the SA public health sector, the current and possible future role of the private sector is discussed in some of the chapters. Much has been written about the health system in SA before and since the democratic transition in 1994, and this publication both references many of these publications and attempts to place them in context over the review period.

It is challenging to review an over 400-page publication of this nature within the space allocated, but of particular interest to a retired clinician and health bureaucrat were the chapters on 'Governance, leadership and management' and 'Health financing', which in my view are key to overall improvement of the quality of healthcare provided to the majority of South Africans. Beth Engelbrecht and Lucy Gilson, in addressing governance, leadership and management and offering alternatives, rightly draw attention to the failures of governance and leadership, in particular in the public health sector, but also acknowledge that there have been 'positive health system governance experiences' and building on these proposed alternative approaches.

Mark Blecher and co-authors in 'Health financing' focus on National Health Insurance (NHI) and trends in public health spending over the review period. They usefully trace the faltering steps towards the goal of providing universal access to healthcare through NHI and provide reasons for the slow progress. They also provide a sobering review of public health expenditure, and under-expenditure in some provinces, while in addition highlighting the relative inequity of expenditure between provinces.

The review, as is often the case with multi-author publications, suffers to an extent from differences in style and format and some repetition, but this does not detract from the publication and in some respects is a benefit for the reader. Those with a critical eye may understandably regard some of the findings and conclusions overly sympathetic to the National Department of Health and the inability of government to implement policies during the time frame of the review. While I similarly may not concur with some of the findings and recommendations, the publication serves as a valuable reference for researchers, managers and policymakers alike. In addition, the recommendations extracted from the chapters and listed in the final chapter of the publication, 'Looking to the future', provide a useful point of departure for further discussion and, it is to be hoped, action-orientated decisions.

This publication is recommended to all with an interest in healthcare in SA and elsewhere.

Craig Househam

Former Head of Health: Western Cape; independent consultant, Cape Town, South Africa. househamkeith@gmail.com