Roadmaps to managed competition: to what extent does South Africa meet the preconditions for equity and efficiency?

South Africa offers universal health coverage through large public and private systems. The private system is characterised by a regulated market for health insurance, referred to domestically as medical schemes. From 2000, the private system was undergoing a reform process consistent with theoretical approaches for regulated competition for health insurance.

Healing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol.

Objective: Investigate MRI evidence of anterior cruciate ligament (ACL) healing, patient-reported outcomes and knee laxity in patients with acute ACL rupture managed non-surgically with the Cross Bracing Protocol (CBP).

Methods: Eighty consecutive patients within 4 weeks of ACL rupture were managed with CBP (knee immobilisation at 90° flexion in brace for 4 weeks, followed by progressive increases in range-of-motion until brace removal at 12 weeks, and physiotherapist-supervised goal-oriented rehabilitation). MRIs (3 months and 6 months) were graded using the ACL OsteoArthritis Score (ACLOAS) by three radiologists.

COVID-19 vaccines - less obfuscation, more transparency and action.

Letter by Venter et al. on editorial  by Schoub (Dial down the rhetoric over COVID-19 vaccines. S Afr Med J 2021;111(6):522-523.

Coracoid stress fracture in an elite fast bowler: description of a technique for CT-guided percutaneous screw fixation of coracoid fractures.

Coracoid stress fractures are a rare sports injury but present a management challenge, with the focus on optimising return-to-play, whilst minimising complications. Potential contributing mechanisms for the injury are briefly discussed and a novel approach to accurate fracture fixation under CT guidance is described. The ability of radiologists to orient themselves in 3D with a volume dataset on a workstation provides an image-guided option for percutaneous fixation that minimises risk of complications.

Outcomes of outpatient ureteral stenting without fluoroscopy at Groote Schuur Hospital, Cape Town, South Africa.

Background: Ureteral stenting is generally a theatre-based procedure that requires a multidisciplinary team and on-table imaging. Limited hospital bed numbers and theatre time in our centre in Cape Town, South Africa, have led us to explore an alternative approach.

Objectives: To see whether outpatient insertion of ureteric stents under local anaesthesia without fluoroscopy was a possible and acceptable alternative to theatre-based ureteral stenting.

Safeguarding maternal and child health in South Africa by starting the Child Support Grant before birth: Design lessons from pregnancy support programmes in 27 countries.

Background: Deprivation during pregnancy and the neonatal period increases maternal morbidity, reduces birth weight and impairs child development, with lifelong consequences. Many poor countries provide grants to mitigate the impact of poverty during pregnancy. South Africa (SA) offers a post-delivery Child Support Grant (CSG), which could encompass support during pregnancy, informed by lessons learnt from similar grants.

South Africa's universal health coverage reforms in the post-apartheid period.

In 2011, the South African government published a Green Paper outlining proposals for a single-payer National Health Insurance arrangement as a means to achieve universal health coverage (UHC), followed by a White Paper in 2015. This follows over two decades of health reform proposals and reforms aimed at deepening UHC. The most recent reform departure aims to address pooling and purchasing weaknesses in the health system by internalising both functions within a single scheme.

The role of insurance in the achievement of universal coverage within a developing country context: South Africa as a case study.

Background: Achieving universal coverage as an objective needs to confront the reality of multiple mechanisms, with healthcare financing and provision occurring in both public and private settings. South Africa has both large and mature public and private health systems offering useful insights into how they can be effectively harmonized to optimise coverage. Private healthcare in South Africa has also gone through many phases and regulatory regimes which, through careful review, can help identify potential policy frameworks that can optimise their ability to deepen coverage in a manner that complements the basic coverage of public arrangements.

Female epispadias managed by bladder neck plication via a perineal approach.

Female epispadias is a rare genitourinary anomaly characterized by urinary incontinence and typical appearance of the external genitalia. Traditional surgical approaches have involved a staged genitoplasty and interval bladder neck reconstruction. We describe further experience of a promising single-stage technique using a cystoscopically guided bladder neck plication via a perineal approach with combined genitoplasty.

Private sector health reform in South Africa.

This paper discusses some of the trends, debates and policy proposals in relation to the financing of the private health sector in South Africa. The public and private sectors in South Africa are of equivalent size in terms of overall expenditure, but cover substantially different population sizes. Within this context the government has reached the unavoidable conclusion that the private sector has to play some role in ensuring that equity, access and efficiency objectives are achieved for the health system as a whole.

Results of the in vitro fertilization programme at Tygerberg Hospital, phases II and III.

Phases II and III of the human in vitro fertilization programme at Tygerberg Hospital are presented. In phase II, 42 laparoscopies were performed and oocytes were obtained from 76% of the follicles aspirated, but with a fertilization rate of only 37%. The viable pregnancy rate per embryo transfer was 4%.

Results of phase I of the in vitro fertilization and embryo transfer programme at Tygerberg Hospital.

Phase I (3 June - 31 October 1983) of the in vitro fertilization (IVF) programme at Tygerberg Hospital is outlined in this article. This programme led to the birth of the first IVF baby in South Africa after fertilization and embryo transfer (ET) took place at this institution. The baby was born on 29 April 1984; a second baby was born on 20 June 1984.

Hepatitis B surface antigen and primary liver cancer.

Sera of 184 patients were examined to determine the incidence of hepatitis B surface antigen (HBsAg). Ninety-two patients had primary liver cancer (PLC) and there were 92 matched controls. Thirty-one of the 92 patients with PLC and 8 of the 92 patients with no clinical evidence of liver disease had radio-immunoassay-positive tests for HBsAg.