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Peta de Jager and Geoff Abbott with a copy of the Infrastructure Barometer report |
Infrastructure is a key and chronically under-recognised resource for public health service delivery. Infrastructure that is both fit-for-purpose and fit-for-service, and located in the right places, provides an enabling environment for the provision of healthcare services.
Very little current consolidated information is available about what health infrastructure exists, what condition it is in and its suitability for the service to be provided. To optimise strategic planning and budgeting, this information is sorely needed.
Geoff Abbott and Peta de Jager of the CSIR were invited to partner with Nolwazi Gasa of the Development Bank of Southern Africa (DBSA) in researching and co-authoring the health chapter for the DBSA's latest biennial Infrastructure Barometer publication. The report, subtitled 'Economic and Social Infrastructure in South Africa: Scenarios for the Future', is a biennial dipstick measure of the state of infrastructure across various sectors. Health and education have been included for the first time in the 2008 Barometer.
"We are delighted to have been involved in this key study initiated by the DBSA. Our chapter on health provides input towards informing debates in the health sector," says Abbott and De Jager, both from CSIR Built Environment.
The DBSA notes that the objective of the Infrastructure Barometer is to measure the effect of the provision of infrastructure on the South African economy. The 2008 report took its focus from government's stated commitment to halve unemployment and poverty by the year 2014. Its focus is on the relationship between infrastructure investment and its impact on economic growth and development.
In addition to the social components of health and education, the Infrastructure Barometer covers a broad range of infrastructure-related issues across the three tiers of government including in housing, water, energy, transport and communications, and is broadly distributed to stakeholders in all sectors in South Africa. The information for all sectors was used to construct imaginary future scenarios for infrastructure investment. This approach was used to bring complex findings into a form that brings home the plight of the general public with particular attention to those who rely most on public health services, namely the vulnerable and the poor.
Health sector
The state of the nation's health has a clear and direct impact on the economic growth and development of the country. Investment in health services is key to securing the nation's health and the health estate - health infrastructure - is an important enabler towards successful healthcare delivery.
"It does not help to just increase budgets and spending on health; to optimise our healthcare infrastructure we need to address a number of interrelated areas. We need to understand the relationships between access to services, investment, affordability, systems and healthcare outcomes. Research programmes can provide the evidence base necessary to inform both long-term strategic planning as well as short-term delivery in health," note Abbott and De Jager.
The health chapter focused on a range of areas impacting on successful stewardship of the health estate, including:
- An analysis of the extent of existing infrastructure
- Capital and maintenance budgets and expenditure
- Public and private sector health services and resource distribution
- Human capacity and skills in the health sector
- The construction sector
- Health policy and the regulatory environment
- Procurement processes
- An overview of some current national initiatives to respond to health infrastructure planning, delivery and maintenance challenges
- Health and infrastructure management information systems.
The health chapter has identified key issues relating to the provision of infrastructure and will provide a basis for informing future planning and research agendas. While the study on health noted the shortfall in budget to meet current and future infrastructure needs, the importance of a multi-factorial approach was emphasised.
The health report clearly shows that there is a risk posed to the sustainability and affordability of the current health service model through potential over-investment in capital expenditure and under-recognition of maintenance needs. All capital outlay in the health sector must be supported by sufficient provision for operational and maintenance spending over the full projected life cycle of the estate.
"While the promise of a biennial health sector review process will allow for tracking performance and impact over time and is a welcome start, it needs to be expanded," comment the authors. "To really support planning for infrastructure investment, more detailed research and sustained oversight of health infrastructure and its affordability are required."
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