From reactive to proactive management of the South African healthcare estate

Abstract

Healthcare spending in South Africa is inequitably distributed across the private and public sectors. Treasury reports that 49 % of expenditure is attributable to the private sector in the service of 16% of the population. This expenditure pattern has undermined aspirations of equity, access to care and social justice. Furthermore it has been widely acknowledged that much of the public health architecture represents a legacy estate, with poor replacement rates and a generally weak culture of facility maintenance. In light of this, there has been a commitment to transform the healthcare sector through the introduction of the national health insurance system, which is to be phased in over a 14 year period. This, coupled with a renewed focus on infrastructure investment by government, will surely lead "over time" to a substantially transformed healthcare estate. Historical implementation partners "the departments of public works" are increasingly being displaced by the introduction of cadres of built environment specialists in the employment of the respective provincial health departments wishing to meet their own specialised needs more directly. As the core mandate and skill is not built-environment-related this transition is posing interesting challenges.