Stewardship: protecting the public's health
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South Africa has a large private health sector, dominated by medical schemes, which cover about 14% of the population. Transformation efforts in the health sector have spanned more than a decade, but the problems of inequity remain acute between the public and private sectors. This chapter provides an assessment of how well the Ministry of Health is doing on stewardship of the private health sector in South Africa. The 2000 World Health Organization concept of stewardship emphasises four elements which are used in this chapter to analyse health sector developments in South Africa through a 'stewardship lens'. These elements include: careful and responsible management of the well-being of the population; establishing the best and fairest health system possible; concern about the trust and legitimacy with which activities are viewed by the citizenry; and maintaining and improving national resources for the benefit of the population. The chapter concludes that stewardship is sub-optimal and that there is scope for improvement, given the huge levels of health inequity and disparities between the public and private sectors.