An integrated analysis of health facilities in the nine provinces of South Africa.

The development of a comprehensive national health plan must take into account an analysis of the provision and distribution of health facilities. This study collected and verified data from a number of different sources, on the number and types of hospital beds, the number of fixed clinics, and the population sizes in each of the nine new provinces of South Africa. A comprehensive database of these figures was compiled for the years 1988 and 1993. Integrated analyses were made of the distribution and types of health facilities in South Africa by using population/facility ratios. Notable disparities were found to exist between provinces in the total (public and private) distribution of hospital beds per 1,000 population, but the distribution of acute hospital beds between provinces is more even. In provinces where there is more than one medical school, there is a marked imbalance between the levels of care, with greater emphasis placed on tertiary care, at the expense of the secondary level. Given the World Health Organisation recommendation of 10,000 people per clinic, there is a shortfall in most provinces. Recommendations are made with regard to the rationalisation of academic and referral beds, and the factors to be considered in the addressing of shortages of clinic facilities. However, the limitations of a resource-based planning approach must be recognised, and it is recommended that comprehensive analyses be carried out at regional and sub-regional levels to determine the appropriate delivery of health care.