Promotion of equity is a cherished ideal of key policy documents relating to health care. It is regrettable that in respect of the most basic prerequisite for equity in the public sector, financing, the trend towards increased equity which took place during the first few years of democratic government appears to have been reversed as a result of changes in mechanisms of funding. Resource distribution between the public and private sectors remains the site of greatest inequity. The introduction of Social Health Insurance as it is presently construed will have only limited impact on this gap, and there is a need for re-examination of the objectives and design of existing policy. Attention to the process, and to effectively involving stakeholders is crucial to the future of both Social Health Insurance and to the effective implementation of the Medical Schemes Act.
Transformation is ongoing in a number of critical areas.
The transformation of Local Government heralds the opportunity for successful establishment of the District Health System, with the potential to improve the quality of life of many poor South Africans. A number of complex issues have to be addressed as part of this process and without a clearly articulated strategic plan there is the possibility that devolution of PHC will result in increased inequity. An overarching chapter on Health Status and Determinants provides an overview of mortality and morbidity data, and more detail is provided in chapters concentrating on programmatic issues such as Tuberculosis and Child Health. There are a few examples where small differences appear in data that is presented. These result from authors and researchers drawing upon different databases and sources of information.