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HST Blog

Dec 12
Universal Health Coverage Day 2023: How HST's health system strengthening supports health for all

​by Judith King – HSS Copy and Content Editor and Joslyn Walker – HSS Programme Manager

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Commemorated on 12 December every year, Universal Health Coverage (UHC) Day focuses attention on Sustainable Development Goal targets 3.8.1 (health service coverage) and 3.8.2 (financial hardship), to be reached by 2030.

This focus arises within a global year-end season of human rights campaigns, such as the 16 Days of Activism for No Violence Against Women and Children, HIV and AIDS on 1 December, and Human Rights Day on 10 December, which foreground the call for action against commitments – hence this year's theme of 'Time for Action'.

Although centred on health as a human right, UHC also encompasses broader factors of well-being, such as social inclusion, equality, economic growth and human dignity, signifying that a whole-of-society response is required to fulfil the ideal of a supportive environment for health, wherein people have the knowledge and access needed to control and improve their health.

Striving for stronger health systems

Ensuring access to good-quality, affordable health services has been elemental for Health Systems Trust's vision and mission since its establishment in 1992, and is the foundation for the health systems strengthening work conducted by the organisation during the past 31 years in partnership with the Department of Health (DoH).

Supported by a range of funders and in collaboration with civil society, this work has entailed research and implementation projects spanning a range of priority programme areas, bolstered by consistent and comprehensive knowledge-sharing, with reviews of and input into health policy and legislation. Alongside direct service delivery, technical assistance is rendered in the form of training, mentoring and coaching on supportive interventions, and innovation for good practice, in tandem with monitoring and evaluation services and development of health information systems.

Building effective, efficient and equitable national health systems in a responsive manner characterises HST's engagement with DoH programming, with an increasing focus on community-orientated Primary Health Care (PHC) and supporting communities to participate and lead in reinforcing aspects of governance that address inequities in health and health care at facility, sub-district and district levels.

The Health Facilities Baseline Audit – 2011 to 2012

Funded by the National Department of Health, HST led this seminal, year-long project. The audit covered every public health facility in South Africa to provide data for analysis of how the type, quantity and quality of services was meeting the population's needs, identify health system strengths and gaps, and assess current and future requirements for quality improvement strategies such as National Health Insurance (NHI). Based on the findings, recommendations were made for the National Core Standards database in relation to facilities' functional descriptions, compliance with ministerial priority areas, service provision, human resources, and health technology.

HST projects supporting UHC

HST's more contemporary suite of projects reflects deployment of our institutional knowledge and expertise towards achieving UHC Day's sub-themes of creating resilient health systems, expanding PHC, working across sectors and communities, and promoting innovation to reach everyone.

  • Over the past eight years, HST has supported the National Health Insurance Information System (NHI-IS) programme to provide and train users on digital health systems for patient registration, reaching 3 205 facilities across 46 districts in eight provinces.

  • Now in its third cycle of five-year grants from the US President's Emergency Plan for AIDS Relief/Centers for Disease Control and Prevention (CDC), the SA SURE PRO Project contributes to the country's rapid scale-up of HIV and TB prevention, treatment and care responses, with HST serving as District Support Partner in four KwaZulu-Natal (KZN) districts to transfer skills for sustainable capacity and quality service delivery. Our approach to integrated healthcare and systems strengthening, and our focus on people-centred care in this project reinforces the approach to UHC across the programme.

  • Our role extends to that of Provincial Support Partner to the KZN-DoH, offering technical support for Strategic Health Programmes delivered in all 10 districts and the eThekwini Metro. Key activities include Ideal Clinic Realisation and Maintenance (ICRM) reviews, COVID-19 provincial operations, a baseline assessment of the province's readiness for full UHC implementation through NHI, and a KZN Online Data Visualisation Dashboard which enables various components of the NHI Unit to track and monitor metrics, trends, actionable insights and consolidated data.

  • Funds are leveraged through SA SURE PRO grant to support health systems strengthening through the Central Chronic Medicines Dispensing and Distribution Programme (CCMDD), and the Synchronised National Communication in Health (SyNCH) electronic information system that automates CCMDD process management – these being key programmes for differentiated models of care that represent the synergy between the public and private health sectors required to manifest UHC through NHI.

  • The Unfinished Business for Adolescent and Paediatric HIV (UB) Project, funded by ELMA Philanthropies, operates in three KwaZulu-Natal districts to refine and test strategies for accelerating the identification and enrolment of HIV-positive children and adolescents on treatment, and ensuring that they remain in care. Nested within this programme is the Electronic Integrated Management of Childhood Illness (eIMCI) Project to improve child survival.

  • With funding from the Bill & Melinda Gates Foundation, the Delivery Optimization of Antiretroviral Therapy (DO ART) Demonstration Project has provided comprehensive HIV screening services, treatment initiation, and ongoing community-based management of patients on antiretroviral therapy in eight KZN sub-districts – achieving notable results that complement clinic-based services.

  • Layering on HST's HIV/TB footprint for accelerated community entry, the Global VAX Project seeks to improve uptake of COVID-19 vaccination in six KZN sub-districts, particularly in rural and hard-to-reach areas. Demand-creation activities focus on those most at risk of COVID-19 infection, with the aim of reaching a total of 27 000 people.

  • The Cervical Cancer Prevention, Access and Control (CCPAC) Project in Zululand, funded by the Bristol Myers Squibb Foundation, addresses the challenge of high cervical cancer incidence and mortality by improving access to early screening, diagnostic treatment and palliative services in the district. This work is grounded in capacity-building and skills development for clinical staff and community structures.

  • HST provides clinical and non-clinical capacity-building and HWSETA-accredited skills programmes to enable expansion of UHC through NHI and initiatives such as PHC re-engineering.

HST's vision is for improved health access and outcomes in South Africa and beyond, and we continue to strengthen health systems for equitable access. We pride ourselves on our collaborative and multi-disciplinary approaches to improved health outcomes for all, and our projects – both historic and current – are testament to our commitment to universal health coverage.


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