Public perceptions on national health insurance : moving towards universal health coverage in South Africa

Background. Since 1994, considerable progress has been made in transforming the South African health care system, implementing programmes that improve the health of the population, and improving access to health care services. However, amid escalating health care costs disparities continue to exist between the public and private health sectors. The implementation of a national or social health insurance remains elusive despite three government-appointed committees on the matter. Method and objective. This paper reports on the findings of a national probability household sample of the South African population, drawn as part of the 2005 HIV / AIDS national survey, to gauge public opinion on universal health care coverage. The perceptions of South Africans were assessed on selected health care affordability and financing issues. Results. The majority support efforts to contain medicine costs and one-third are of the opinion that the country can provide everyone with all the needed health care and medical services. A large percentage of participants thought it more important to provide improved health care coverage even if it meant raising taxes, while a small percentage said it is better to hold down taxes despite lack of access to health care for some South Africans. Almost a quarter of participants were unable to comment on questions posed to them, indicating the need for improved public education and communication. Conclusion. The study provides important insights into public opinion on key policy issues. However, greater public awareness is needed to ensure an informed debate, while the design of a universal national health insurance scheme must take into account both the current context and public opinion. South African Medical Journal Vol. 96(9) 2006: 814-81

Marital status and risk of HIV infection in South Africa

Objective. Available evidence on the relationship between marital status and HIV is contradictory. The objective of this study was to determine HIV prevalence among married people and to identify potential risk factors for HIV infection related to marital status in South Africa. Methods. A multistage probability sample involving 6 090 male and female respondents, aged 15 years or older was selected. The sample was representative of the South African population by age, race, province and type of living area, e.g. urban formal, urban informal, etc. Oral fluid specimens were collected to determine HIV status. A detailed questionnaire eliciting information on socio-demographic, sex behaviour and biomedical factors was administered through face-to-face interviews from May to September 2002. Results. HIV prevalence among married people was 10.5% compared with 15.7% among unmarried people (p-value < 0.001). The risk of HIV infection did not differ significantly between married and unmarried people (odds ratio (OR) = 0.85, 95% confidence interval (CI): 0.71 - 1.02) when age, sex, socio-economic status, race, type of locality, and diagnosis of a sexually transmitted infection (STI) were included in the logistical regression model. However, the risk of HIV infection remained significantly high among unmarried compared with married people when only sex behaviour factors were controlled for in the model (OR 0.55; 95% CI: 0.47 - 0.66). Conclusions. The relationship between marital status and HIV is complex. The risk depends on various demographic factors and sex behaviour practices. Increased prevention strategies that take socio-cultural context into account are needed for married people. S Afr Med J 2004; 94: 537-543

Job Stress, Job Dissatisfaction and Stress Related Illnesses among South African Educators

A ZJER study on job dissatisfaction and job related stress amongst South African educators.The aim of this study was to explore the relationship between self-reported job stress and job dissatisfaction and the prevalence of stress related illnesses and risk factors amongst educators. A cross-sectional survey was conducted in a representative sample of21,307 educators from public schools in South Africa. Self-reported measures of job stress, job satisfaction, and stress-related illnesses (including mental distress) were taken. HIV-antibody tests (ELIZA) and CD-4 count was taken from those educators who agreed to blood specimens. Results indicate that the prevalence of stress-related illnesses were 15.6% for hypertension, 9.1% stomach ulcer, 4.5% diabetes, 3.9% major mental distress, 3.8% minor mental distress, and 3.5% asthma. The study found considerably high stress levels among educators. Job stress was weakly associated with seven out of ten stress related illnesses but none was significant considering effect size calculations. Stress from teaching methods seemed to have higher impact on stress related illnesses than other components of the job stress scale. From three components of the demand-control model two, namely work stress from teaching methods and the educational system, but not low peer support was related to heart disease. The components of the effort-reward model of low socio-economic status and lack of career advancement were both not related to heart disease and only lack of career advancement was inversely related to Hypertension. Most components assessed here of the demand-control model (including stress with teaching methods and educational system, low peer support) and effort- reward model (including job insecurity and lack of career advancement) were related to stomach ulcer and mental distress. It is recommended that changes to the organization of work with particular attention being paid to increasing control and reward conditions be implemented and stress management may be included in work health programmes for educators. Key words: Job stress; job dissatisfaction; risk behaviours; stress-related illnesses; public educators; South Afric

Public perceptions on national health insurance: Moving towards universal health coverage in South Africa

Background. Since 1994, considerable progress has been made in  transforming the South African health care system, implementing  programmes that improve the health of the population, and improving  access to health care services. However, amid escalating health care costs disparities continue to exist between the public and private health sectors. The implementation of a national or social health insunmce remains elusive despite three government-appointed committees on the matter.Method and objective. This paper reports on the findings of a national probability household sample of the South African population, drawn as part of the 2005 HIV I AIDS national survey, to gauge public opinion on universal health care coverage. The perceptions of South Africans were assessed on selected health care affordability and financing issues.Results. The majority support efforts to contain medicine costs and one-third are of the opinion that the country can provide everyone with all the needed health care and medical services. A l&lt;1rge percentage of participants thought it more important to provide improved health care coverage even if it meant raising taxes, while a small percentage said it is better to hold down taxes despite lack of access to health care for some South Africans. Almost a quarter of participants were unable to comment on questions posed to them, indicating the need for improved public  education and communication.Conclusion. The study provides important insights into public opinion on key policy issues. However, greater public awareness is needed to ensure an informed debate, while the design of a universal national health insurance scheme must take into account both the current context and public opinion

Government's changing reponses to HIV/AIDS

In this chapter we review the changing responses of the governments of South Africa, during and after apartheid. The focus is on the post-apartheid government, and particularly the debates and disputes which have shaped the management of the epidemic of this country.

AIDS: A threat to human security

In this chapter it is argued that a health issue constituted a security threat. The authors argue that that AIDS like other epidemics such as bubonic plague, smallpox and influenza, has the potential to annihilate human populations, destroy communities, and stifle economic growth, especially in heavily affected countries. Thus, it constitutes a clear threat not only to national security or the security of states, but more importantly to human security, security of individuals and communities. The authors discuss the cumulative impact of AIDS on social, economic, political, and military sectors and suggest specific policy options aimed at reducing this threat to human security

HIV/AIDS in South Africa: entitlement and rights to health-implications of the 2002 household survey

Paper presented at the "Remaking law in Africa: transnationalism, persons and rights": annual international conference, Centre for African Studies, University of Edinburgh, 21-22 Ma

Projects funded by the WK Kellogg Foundation on HIV/AIDS in southern Africa: report of the colloquium 26-27 November 2003

In November of 2003, the Human Sciences Research Council (HSRC) and the WK Kellogg Foundation (WKKF) hosted a colloquium to present and review the research that the HSRC has conducted with the support of the Foundation in projects across six southern African countries namely, Botswana, Lesotho, Mozambique, South Africa, Swaziland, and Zimbabwe. The two-day event was designed to cover the two focal areas of the work; thus the first day focused on the policy research that has been done across the six countries in southern Africa, and the second day looked at the work that has been done with orphaned and vulnerable children (OVC) in Botswana, South Africa and Zimbabwe. The colloquium was seen as an opportunity to report back to the WKKF and to local stakeholders, including representatives from government, service providers in health and social development, state policy and regulatory bodies, academics and researchers, intervention workers from both NGOs and state services, policy makers and interested advocates around policy and children.Work at the colloquium was directed at using the forum to facilitate as much discussion and debate as possible. The event was also designed to serve as a space for networking and social connection between all the organisations involved