From Commitment to Action: Accelerating Progress towards Universal Health Coverage (UHC) in South Africa
The Athlone Call to Action of the PHASA 2019 Conference
We, the more than 300 delegates, gathered in the township of Athlone, in the City of Cape Town from 16-18 September 2019 for the 15th PHASA conference, coinciding with 25 years of constitutional democracy in South Africa. We recognise our responsibility as the only non-governmental organisation representing the interests and voice of public health in South Africa to contribute towards the acceleration of progress towards UHC.
We are deeply concerned about a range of determinants that detract from the goal of Health for All. These include widespread corruption; recurrent manifestations of racism and racial discrimination; violence and crime – particularly directed at women and children; and deepening inequity, rising levels of poverty and unemployment and weakened social cohesion. We are disturbed by the wide disparities between the public and private health sectors in the midst of escalating health costs.
Building on the past
• We acknowledge the global and national initiatives to improve health through, interalia, the 1978 Primary Health Care Declaration of Alma-Ata, the 2015 UN Sustainable Development Goals, South Africa’s Constitution, enshrining the Bill of Rights, the National Development Plan: Vision 2030, and the proposed National Health Insurance System which aims to revolutionise health financing towards UHC.
• We recognise the positive relationship between democracy (notably free and fair elections, and accountability) and reductions in adult mortality.
• We celebrate the life and work of David Sanders, a PHASA founder member, who worked tirelessly to ensure that equity, social justice and population-based approaches were translated into health programmes, especially for those most vulnerable and marginalised in society.
• Our vision is to achieve equitable population health outcomes for all, and a resilient, accountable health system, that places communities and health workers at its centre, and that leaves no one behind.
• We remain committed to the principles of solidarity, social justice, human rights, equity, evidenced-informed policy and practice, and the need to address the underlying social and political determinants of health.
• We commit to contribute to:
◦ Good governance, which includes accountability and transparency.
◦ Improving public health capacity.
◦ Effective public health advocacy for sustainable and healthy development for all, and an economic and political system that serves a community of healthy people on a healthy planet.
◦ Dissemination of accurate public health information.
Our call to action
We call on Government to:
1. Deepen democracy in health
• Implement the provisions of the National Health Act on community participation.
• Ensure that all provinces give communities a meaningful voice in health system governance.
• Ensure that health care managers and providers are trained and equipped with the skills and knowledge to make community participation a reality
2. Prioritise human rights as a guiding principle in health reforms and programmes
• Prioritise children, women, communities affected by emergencies, refugees and migrants, and marginalised, stigmatised and minority populations (e.g. individuals with mental illness, sex workers, LGBTIQ+) in the design and implementation of health reforms.
3. Democratise NHI reforms and involve all relevant stakeholders
• Adopt an overall health systems transformative framework that prioritises a public health approach of prevention, health promotion and protection, and inter-sectoral actions to address the social determinants of health.
• Build on existing good practices in the public health system, to strengthen it towards UHC.
• Prioritise human resources for health as the key towards achieving UHC.
• Provide all communities, regardless of location, with access to high-quality, integrated, “people-centred” health services.
• Transform leadership and management for UHC, emphasising ethics, accountability and service to the people.
• Acknowledge that UHC is a direction, not a destination.
4. Community health systems – Bringing the citizenry back in
• Recognize the multiple ways in which households and multiple actors in communities contribute to health.
• Empower all people in improving and protecting their own health.
• Implement a ‘people centred health services’ and ‘people centred health systems’ because health systems are, ultimately, human systems.
5. Ensure a health workforce for UHC and for the future
• Invest in a socially accountable health workforce and ensure quality job creation that pays attention to working conditions, labour protection and respect of rights at work.
• Develop a human resource development plan as a necessary component of health systems reform.
• Recognise that investments in youth—particularly health and education— can foster opportunities for developing a skilled and healthy labour force. Education allows young people to learn skills to take on higher-quality jobs in a changing and growing economy.
6. Enhance evidenced-based policy and practice
• Prioritise implementation and close the research/evidence to practice/action/policy gap by increasing ownership, legitimacy, and improved research translation.
• Invest in research that will contribute to the successful implementation of UHC, including that related to the development of health systems that incorporate multisectoral interventions, mechanisms for enhanced social participation and intersectoral action.
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