Public health policy in resource allocation: the role of ubuntu ethics in redressing resource disparity between public and private healthcare in South Africa

Madaka, Nosisa Cynthia (2019-04)

Thesis (MPhil)--Stellenbosch University, 2019.

Thesis

ENGLISH ABSTRACT: This thesis under the title “Public Health Policy in Resource Allocation: the Role of Ubuntu Ethics in Redressing Resource Disparity between Public and Private Healthcare in South Africa” explores health care disparities pertaining to resource allocation between public and private sector. It is of relevance and importance in South Africa where 54% of the population live on less than US$3 per day. Although the government has instituted certain changes aimed at transforming the public health care system, the resource allocation gap between the two persists and remains wide. The research gives special attention to the role that Ubuntu ethics can play in redressing the resource allocation disparities between public and private health care sectors in South Africa, pointing out the existing gap in financing, as well as human resource between public and private health care sectors, which leads to poor health outcomes in public sector. Therefore, the problem is the prevalent inequality of resource allocation between private and public health care sectors. The analysis of policy gaps, as well as evaluating the cause of disparities in the health system is the goal of this research. The study endeavours to redress the disparities within the context of Ubuntu ethical principles and proposes a change in public policy so as to enhance healthcare for the benefit of the people. The study is philosophical and ethical, so the methodology used is discursive in nature, majorly focusing on critically reviewing existing literature, that is, the philosophical resources on Ubuntu ethics and justice theories as well as a range of government resources inclusive of public health policy documents. Social determinants of health and their impact in a South African context are discussed with the implication that health is not merely freedom from disease and or incapacity, but rather being well mentally, physically and socially. The attainment of a healthy status goes beyond ability to access healthcare services, and incorporates social determinants including but not limited to conditions in which people have been born into, stay, establish career and grow old in. It also includes the arrangements put in place to deal with illness and determine health. Issues of revenue, literacy, communal safety networks, vocation and conditions under-which vocation is undertaken, lack of work and vocation insecurity, early stages of human development, gender, cultural group, dietary insecurity, housing communal exclusion and disability all come into the picture as factors that determine health. But there is also discussion of the socio-economic status as contributors to health inequity wherein alcohol abuse, sugar intake, and smoking are identified as behavioural factors that complicate public health. One outstanding feature of this research is that it establishes a link between Ubuntu and public health policy. The researcher establishes that Ubuntu ethics is appropriate for not only discussing public morality, but also for formulating public policy that is morally tenable for South Africa, especially for the public health sector. This thesis calls for an application of Ubuntu in a proper context in order to enhance societal well-being for the benefit of many, if not all. The research proposes the fundamental principle of Ubuntu ethics in which the good of the community is as important as the good of every member of the community. Since Ubuntu ethics does not merely seek to fulfil what benefits the majority, as would be the case in a utilitarian society, the researcher advocates for the building of consensus on the common good, which should be understood to imply not just what is good for everyone in the community, but also what is good for the continued well-being of the community as a single unit. In this regard, the research finds it important that deliberate effort be made to integrate Ubuntu ethics into policies, citing the example of the National Health Insurance (NHI). The good health of all the members of a community is an assurance of the well-being and continuity of the whole national community. The research concludes that public health policy should integrate Ubuntu ethical values such as community, sharing, care, solidarity, identity, harmony, respect, and dignity into policy documents and legislation.

AFRIKAANSE OPSOMMING: Hierdie proefskrif onder die titel "Openbare Gesondheidsbeleid in die toekenning van hulpbronne: die rol van ubuntu-etiek om die hulpbronverskil tussen openbare en privaat gesondheidsorg in Suid-Afrika reg te stel" ondersoek gesondheidsverskille ten opsigte van hulpbrontoewysing tussen openbare en private sektor is van belang en belangrik in Suid-Afrika waar 54% van die bevolking minder as US $ 3 per dag leef. Alhoewel die regering sekere veranderinge ingestel het wat daarop gemik was om die openbare gesondheidsorgstelsel te transformeer, bly die hulpbrontoekenningsgaping tussen die twee voort en bly wyd. Die navorsing gee besondere aandag aan die rol wat Ubuntu-etiek kan speel om die hulpbrontoewysingsverskille tussen openbare en private gesondheidsorgsektore in Suid-Afrika te herstel, en wys daarop dat die finansiële gaping tussen openbare en private gesondheidsorgsektore gefinansier word, wat lei tot swak gesondheid uitkomste in die openbare sektor. Daarom is die probleem dat die heersende ongelykheid van hulpbrontoewysing tussen privaat en openbare gesondheidsorgsektore. Die ontleding van beleidsgapings, sowel as die oorsake van ongelykhede in die gesondheidstelsel, is die doel van hierdie navorsing. Die studie poog om die ongelykhede binne die konteks van Ubuntu etiese beginsels reg te stel en stel 'n verandering in openbare beleid voor, ten einde gesondheidsorg tot voordeel van die mense te verbeter. Die studie is filosofies en eties. Die metodologie wat gebruik word, is diskursief van aard. Hoofsaaklik fokus dit op die kritiese hersiening van bestaande literatuur, dit wil sê die filosofiese bronne van Ubuntu-etiek en geregtigheidsteorieë, asook 'n verskeidenheid staatshulpbronne, insluitende openbare gesondheids beleidsdokumente. Sosiale determinante van gesondheid en hul impak in 'n Suid-Afrikaanse konteks word bespreek met die implikasie dat gesondheid nie bloot vryheid van siekte of onbevoegdheid is nie, maar eerder geestelik, fisies en sosiaal goed is. Die bereiking van 'n gesonde status gaan verder as die vermoë om toegang tot gesondheidsorgdienste te verkry, en sluit sosiale determinante in, insluitende maar nie beperk nie tot die omstandighede waarin mense groei, leef, werk en ouderdom en die stelsels wat in plek is om siekte te hanteer, gesondheid bepaal. Kwessies van inkomste, onderwys, sosiale veiligheidsnetwerke, indiensneming en werksomstandighede, werkloosheid en werksonsekerheid, vroeë kinderontwikkeling, geslag, ras, voedselonsekerheid, behuising sosiale uitsluiting en gestremdheid kom almal in die prentjie as faktore wat gesondheid bepaal. Maar daar is ook 'n bespreking van die sosio-ekonomiese status as bydraers tot gesondheidsaardigheid waarin alkoholgebruik, suiker inname en rook geïdentifiseer word as gedragsfaktore wat die openbare gesondheid bemoeilik. Een uitstaande kenmerk van hierdie navorsing is dat dit 'n verband tussen Ubuntu en openbare gesondheidsbeleid vestig. Die navorser stel vas dat Ubuntu-etiek gepas is om nie net openbare moraliteit te bespreek nie, maar ook om openbare beleid te formuleer wat vir Suid-Afrika moreel aanvaarbaar is, veral vir die openbare gesondheidsektor. Die tesis vereis dat ubuntu in gepaste konteks aangewend word om maatskaplike welsyn tot voordeel van almal te verbeter. Dit stel die fundamentele beginsel van Ubuntu-etiek voor, waarin die gemeenskap se belang net so belangrik is as die voordeel van elke lid van die gemeenskap. Aangesien die Ubuntu-etiek nie net probeer om te voldoen aan die voordele van die meerderheid, soos die geval sou wees in 'n utilitariese samelewing, bepleit die navorser vir die opbou van konsensus oor die gemeenskaplike goed, wat verstaan moet word, impliseer nie net wat vir almal goed is nie in die gemeenskap, maar ook wat goed is vir die volgehoue welsyn van die gemeenskap as 'n enkele eenheid. In hierdie verband vind die navorsing dit belangrik dat doelbewuste pogings aangewend word om Ubuntu-etiek in beleid te integreer, met verwysing na die voorbeeld van die Nasionale Gesondheidsversekering (NHI). Die goeie gesondheid van alle lede van 'n gemeenskap is 'n versekering van die welsyn en kontinuïteit van die hele nasionale gemeenskap. Die navorsing het tot die gevolgtrekking gekom dat die volksgezondheidbeleid Ubuntu se etiese waardes soos gemeenskap, deel, sorg, solidariteit, idenititeit, harmonie, respek en waardigheid in beleidsdokumente en wetgewing moet integreer.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/105836
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