Christo Heunis

Christo Heunis

University of the Free State, South Africa

Title: Public hospital challenges at the onset of national health insurance in South Africa


Christo Heunis is a senior researcher at the Centre for Health Systems Research & Development (CHSR&D), Faculty of the Humanities, University of the Free State (UFS). His career-long focus is on the health systems and social aspects of TB, HIV and TB-HIV, on the one hand, and hospitals and hospitalisation, on the other hand. His Ph.D. research assessed hospitalisation for TB in the Free State. He has since participated in 38 R&D projects, 14 as principal investigator/project leader/coordinator.


South Africa is currently in the early stages of implementing national health insurance (NHI) in a quest to ensure universal health care coverage. While the NHI has come under heavy criticism, there is consensus that health care in SA needs an overhaul. Concerns have however been raised that the public health care will fail the NHI. A recent report from one province, the Eastern Cape showed that six health institutions that were already condemned continued to operate out of necessity; 17 hospitals lacked piped water; 68% of hospitals lacked essential medical equipment; and overall staff vacancies stood at 46% (mostly clinical posts). Nevertheless this and four other provinces had underspent their allocations to the hospital revitalisation programme by almost R2 billion (US$141.1 million). South Africa’s 2011 Policy on the Management of Public Hospitals is part of a broader undertaking to improve the management of the public health system in South Africa. It aims to ensure that the management of hospitals is underpinned by the principles of effectiveness, efficiency and transparency and sets out to ensure, amonst others, appointment of competent and skilled hospital managers and training of managers in leadership, management and governance. The NHI system is meant to address the disparities in the distribution of human and infrasructual resources – and ultimately the differences in the quality of care between the public and private sectors. However, the implements of NHI have to address a number of public hospital-related challenges elaborated in this presentation.

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