South Africa is at a critical juncture with regards to financing the health sector to improve health and to deliver quality health services to all. This paper provides a personal view of some of the key next steps the country will need to consider as it moves forward with its changes to health financing. The commentary draws on experience from other countries as well as South Africa and focuses on some of early challenges that may need to be considered.
The options for additional ‘innovative financing’ that could be considered in South Africa, covering both raising new funds and linking funds to results, are discussed here. New funds could come from: the private sector, including the mining and mobile phone industry; voluntary sources, through charities and foundations; and through further expanding health (‘sin’) levies on products such as tobacco, alcohol and unhealthy food and drinks. As in other countries, South Africa could earmark some of these additional sources for investment in interventions and research to reduce unhealthy behaviours and influence the determinants of health. South Africa could also expand innovative linking of funds to results to improve overall performance of the health sector, including mitigating the risks for non-state investment and exploring different forms of financial incentives for providers and patients. All such innovations would require rigorous monitoring and evaluation to assess whether intended benefits are achieved and to look for unintended consequences.
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