South Africa has proposed a move to institute a national health
insurance (NHI) programme, and to improve access to primary
healthcare. As part of the project, school health programmes
will be strengthened and specialist teams, including
gynaecologists, paediatricians and advanced midwives, will be
assigned to each of South Africa's 52 health districts. This is
expected to address the country's high rates of infant, child
and maternal mortality. The roll out ward-based primary
healthcare outreach teams of community healthcare workers
(CHWs). Each worker is expected to be responsible for 250
households, or about 1,000 people, according to draft discussion
papers. David Sanders, professor and founding director of the
School of Public Health at South Africa's University of the
Western Cape, says this ratio is far too large. In an interview
with IRIN, Sanders stated "How is one health worker going to
cover 250 households? [It's] impossible." In a country with an
HIV prevalence of about 18 percent, CHWs are also p