1. The bird that flies to the past in order to lead us to the future Sharon Fonn

2. South African Health Review  Purpose “Through their research and leadership functions, universities and other institutions of higher learning (and research) generate evidence about the shortcomings of the health system, and about potential solutions.” Health professionals for a new century: transforming education to strengthen health systems in an interdependent world Julio Frenk et al. The Lancet Nov 2010

3. South African Health Review  Worth

4. Visits to HST website in 2010

5. Downloads of 2010 SAHR

6. Complex role of the Ministry of Health  Two jobs Influencing other Ministries to do the things that make health possible – water, sanitation, road infrastructure, jobs, healthy workplaces, an educated population, plus more Running health services where things are not routine and obvious - at any time a range of possible services and ways of delivering them are almost equally legitimate

7. Complex role of the MoH  The system itself is complex: local, metro and provincial levels of government the private sector managing international donors and their agendas  The huge human resource challenge  Our burden of disease

8. SAHR 2010 Themes  Millennium Development Goals Chapters 1 - 14  National Health Insurance Chapters 15 - 20  Health and Related Indicators Chapter 21

9. Goal 1: Eradicate Extreme Hunger and Poverty Goal 2: Achieve Universal Primary Education Goal 3: Promote Gender Equality and Empower Women Goal 4: Reduce Child Mortality Goal 5: Improve Maternal Health Goal 6: Combat HIV/AIDS, Malaria and other diseases Goal 7: Ensure Environmental Sustainability Goal 8: Develop a Global Partnership for Development The Millennium Development Goals

10. SAHR Indicators and the MDGs Goal19902010Status Eradicate extreme hungerUnder fives under-weight Unlikely 9.310.2 Reduce child mortalityUnder five mortality / 1000Unlikely 59104 Reduce maternal mortalityMMR per 100 000 live birthsUnlikely 369625 Combat HIV & other diseases HIV prevalencePossible 9.38.7 Environmental sustainability % pop using improved water source Achieved 6192

11. Significant contribution of the Indicators chapter  The degree to which these data are accurate  Methods of data collection known and reliable?  Different data from different sources with different values  Smart and nuanced understanding of what we “know”  A very significant source of data

12. The Chapters on the MDGs  Chapters looking at the MDGs plus  Companion profiles that give us a commentary related to that MDG

13. MDG Chapters Maternal health 1 and experiences in Tamil Nadu 2 Reproductive health 3 Gender based violence 4 – gender equity Child health 5 and the problem of data accuracy 6 Education MDG 7 and creative ways of approaching children’s education 8 Intersection of hunger and poverty with HIV and TB 9 Combating HIV and TB 10 & Global Health Initiatives 11 Environmental factors and global warming 12 and grey water solutions 13 Policy and legislation 14

14. As a whole 1. HIV is a significant barrier to achieving MDGs – treatment alone not sufficient 2. Creating an enabling environment so that we can deliver quality health services 3. Integration of services 4. Data collection, collation and use as a management tool 5. Health systems approach 6. Process as important as product 7. Leadership towards a common vision is essential

15. National Health Insurance

16. World Health Report 2010  WHA resolution 58.33 2005 “everyone should have access to health services and not be subject to financial hardship in doing so.”  Mechanism is universal coverage

17. Overriding principle  Risk pooling with everyone included  Richer and healthy cross subsidise the poorer and sicker

18. WHO Report - 3 Barriers  Availability of resources – no country has immediate access to every technology and every intervention – choices have to be made  Over-reliance on direct payment at the time of illness  Inefficient and inequitable use of resources

19.  “...no single mix of policy options will work well in every setting..... any effective strategy for health financing needs to be home-grown.” Dr Margaret Chan DG of the WHO, World Health Report 2010

20. Our role  Driving purpose of professionals must be to enhance the performance of health systems for meeting the needs of patients and populations in an equitable and efficient manner

21. THANK YOU Sharon Fonn Guest Editor: South African Health Review 2010 Head of the School of Public Health University of the Witwatersrand, Johannesburg Email: Sharon.Fonn@wits.ac.za Tel:011 - 717 2543