This edition of the South African Health Review (SAHR) coincides
with an unprecedented moment in South African health policy, the
release of the Green Paper on National Health Insurance (NHI).
Not only will accurate data on health status and health services
be necessary to inform the design of the NHI, but such data will
also be used by those responding to the Green Paper. Arguments
about the adequacy and accuracy of health indicator data will
therefore be ever sharper as a final policy for the radical reform
of the health system in South Africa is decided and implemented.
As Harris et al. have noted “In South Africa, health-care access for
all is constitutionally enshrined; yet, considerable inequities remain,
largely due to distortions in resource allocation. Access barriers
also include vast distances and high travel costs, especially in rural
areas; high out-of-pocket (OOP) payments for care; long queues;
and disempowered patients” [J Public Health Policy 32(S102-23)].
Routine health indicators can sometimes illuminate such problems,
but can also obscure them from view. In one of a series of articles
marking the 24th anniversary of the Centre for Health Policy, Ruff
et al. remarked that “[s]ystem performance is best assessed by
the outcomes it produces. Society invests significantly in health
infrastructure and organizations, and it must produce value for
money, especially in respect of desirable ‘hard’ outcomes – including
longevity, and freedom from disability. Thus, the throughput and
quality produced must be measured accurately and effectively;
simple measures of services supplied can easily mask enormous
waste and create the wrong incentives for local management.” [J
Public Health Policy 32(S184-92)]. In the accompanying editorial to
the theme issue of the Journal of Public Health Policy which contained
both these papers, Rispel, Padarath and Walt identified lessons
for public health practitioners and policy-makers [J Public Health
Policy 32(S1-9)]. One of their lessons has particular resonance
for this chapter: “ ... a robust information and evidence base is
indispensable for monitoring both progress towards reducing
health and health-care inequities, and the impact of public health
policy initiatives. However, the existence of information in itself
is not sufficient to ensure implementation of research or policies.
Public health professionals also take on important advocacy and
networking roles, and the facilitation of partnerships with policymakers
and implementers”. It is hoped that this chapter provides a
resource for such advocacy and engagement