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SA ups its game but still ranks in bottom half of global healthcare access survey

FocusHealthcareSouth Africa was ranked 119 out of 195 countries in the latest Healthcare Access and Quality Index, one rank below Namibia.It was, however, among the countries that had improved their healthcare access and quality the most in the 25 years between 1990 and 2015.

The country with the best score, Andorra, received 95 followed by 94 for Iceland and 92 for Switzerland. Central African Republic received the worst score of 29, with Afghanistan and Somalia rounding off the bottom three, with scores of 32 and 34 respectively.

The report says although South Africa was ranked in the bottom half, the researchers rated it among the countries that had improved their healthcare access and quality the most in the 25 years between 1990 and 2015. While the report was released in 2017, the most recent data dates back two years. Lancet releases the index every five years.

South Africa’s score improved from 46 in 1990 to 52 in the latest report, the research showed.

The report says the index has 30 constituents. South Africa’s lowest score was 23 for non-melanoma skin cancer, followed by 24 for both tuberculosis and lower respiratory infections. South Africa’s best score was 98 for diptheria, followed by 95 for tetanus.

"Several countries, particularly in eastern and western sub-Saharan Africa, reached index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and South Asia, lagged behind what geographies of similar development attained between 1990 and 2015," the report said.

Summary
Background: National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.
Methods: We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r =0·88), an index of 11 universal health coverage interventions (r =0·83), and human resources for health per 1000 (r =0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time.
Findings: Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015.
Interpretation : This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system

Authors
GBD Healthcare Access and Quality Collaborators

 

The number of people dying from curable illnesses is "disturbing"‚ Business Day reports the study found. While significant gains have been made in the past 25 years‚ the study found "massive inequity of access and quality healthcare".

The study, authored by Dr Christopher Murray‚ director of the Institute for Health Metrics and Evaluation at the University of Washington used data from the Healthcare Access and Quality Index‚ which collects information on deaths from 32 causes that could be avoided by timely and effective medical treatment. The study is the first effort to assess services in 195 countries.

"What we have found about healthcare access and quality is disturbing‚" said Murray. "Having a strong economy does not guarantee good healthcare. Having great medical technology doesn’t either. We know this because people are not getting the care that should be expected for diseases with established treatments."

The report says he cited Norway and Australia as examples. Each scored 90 overall‚ among the highest scores globally‚ but Norway scored only 65 in treating testicular cancer‚ while Australia scored only 52 for treating non-melanoma skin cancer. ‘In the majority of cases‚ both of these cancers can be treated effectively‚’ Murray said. ‘Shouldn’t it cause serious concern that people are dying of these causes in countries that have the resources to address them?’

It is not all doom and gloom‚ however, the report says. The paper does offer some signs of improvement in access and quality. Countries such as Turkey‚ Jordan‚ South Koreathe Maldives‚ Niger‚ Jordan and several western European nations‚ including Switzerland‚ Spain and France‚ have, since 1990, achieved progress that meets or surpasses levels reached by other nations of similar development.

The report will be updated annually with the aim of using the results to better understand gaps and opportunities for improving health access around the world. Some of the causes of death identified among the 32 causes are TB‚ lower-and upper-respiratory infections‚ tetanus‚ measles‚ a number of common cancers‚ as well as appendicitis and the adverse effects of medical treatment.

[link url="https://www.businesslive.co.za/bd/national/health/2017-05-19-sas-healthcare-ranked-119-out-of-195-countries/"]Business Day report[/link]
[link url="https://www.scribd.com/document/348832771/Lancet-Healthcare-Quality-Journal"]The Lancet article summary[/link]
[link url="https://www.businesslive.co.za/bd/national/health/2017-05-19-people-still-dying-from-curable-diseases–but-sa-ranks-quite-high/"]Business Day report[/link]

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