National Health Insurance
The Burden of Disease on the Health System
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In a paper entitled “Conceptual Framework for Chronic Diseases of Lifestyle in South Africa.”, Steyn argues that “The quadruple burden of diseases in South Africa has serious consequences for the prevention and cost-effective management of chronic diseases and the unhealthy lifestyles and risk factors that precede them. The disease patterns in this region are characterised by a combination of poverty-related diseases together with the emerging chronic diseases associated with urbanisation, industrialisation and a westernised lifestyle. This double burden of diseases is exacerbated by high injury rates associated with the social instability of violence or high crime rates, and by the exploding epidemic of HIV/AIDS across the African continent. This multiple burden represents a demand on the health services of South Africa far beyond those experienced in developed countries and what the limited resources can accommodate.”
“Because little recognition is given to the magnitude of the burden of chronic diseases of lifestyle (CDoL) in South Africa, and prevention of unhealthy lifestyles, early diagnosis and cost-effective management of CDoL risk factors are low on the list of priorities in relation to the other competing groups of diseases.” “The consequences for health care are inadequate preventive measures and care for CDoL. Therefore, it has become critical that South Africa utilise its limited resources optimally and implement cost-effective health-promotion interventions to prevent the predicted epidemic of CDoL in the face of all the other health needs in this region”
Units attached to the Medical Research Council of South Africa that focus specifically on chronic disease issues are:
An interesting public sector initiative to understand and reduce the burden of disease was commissioned in the Western Cape. In his foreword to the project, Professor Craig Househam, the Head of the Western Cape Department of Health, said: “The Western Cape Province currently experiences a multiple burden of disease including infectious diseases (such as tuberculosis and AIDS, injuries from interpersonal violence and motor vehicle accidents), and chronic disease (such as diabetes, heart disease, and cancer). Mental-health disorders provide a further, unseen burden of disease, which are not generally reflected in mortality data but result in a major load on health facilities, especially with the burgeoning abuse of substances and in particular with regard to alcohol and “tik” in the Western Cape.”
“Understanding the burden of disease is fundamental to the planning and decision-making processes in health departments. Rather than being reactive to the pressures placed upon the health system, information is actively sought that will enable Government to act in a manner that begins to address - and indeed reduce - the burden of disease. The challenge remains as to whether, by intervening “upstream”, it is possible to reduce the burden of disease and significantly influence the disease profile in the province for the better. Seen from a health-sector perspective, if such actions are successful, it will enable resources to be directed to address diseases that currently cannot be managed because of resource constraints.” “This first report from the Burden of Disease study ... also indicates a commitment on the part of the Department of Health both to institutionalise the measurement and monitoring of the burden of disease ...”.
CDL in the original paper but termed CDoL here to differentiate to the Chronic Disease List (CDL) in Prescribed Minimum Benefits (PMBs).
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