A challenging year ahead for healthcare services

Welcome to our final issue of 2023! In this issue, we have included three original studies, a small case series from India and a case report. Interestingly, the original studies each focus on different aspects of the three major causes of blindness in our country, viz. cataracts, glaucoma and diabetic retinopathy. Two of the original studies were performed at state hospitals in South Africa, which may be an opportunity to highlight the financial crisis facing our state healthcare service at present.

The right of access to healthcare services is guaranteed to everyone under Section 27 of the South African Constitution. It appears that South Africa has made good progress over the last 20 years in terms of healthcare on a population level. There has been an increase in overall life-expectancy, a decrease in maternal mortality rates, a decrease in mortality in the under 5-year age group and an apparent increased coverage in essential health services, including infectious diseases and reproductive healthcare. However, there are still substantial challenges to be met in the management of non-communicable diseases.

In the current financial year, around R260 billion is allocated to the funding of healthcare, of which 23% (about R60 billion) goes to the National Department of Health. Of this, 85% is transferred to provinces to fund national health in the form of grants. These include Health Facility Revitalisation grant – for funding maintenance and building of health facilities; Tertiary Services grant – funding central hospitals for services rendered to provinces; Human Resources Training grant – funding the training of health professionals and covering the salaries of medical interns and community service medical officers; and the National Health Insurance direct grants – for funding the contracting of mental health practitioners and oncology services. There is also the District Health grant (formerly the HIV/AIDS, TB and STI grant). To access these grants, provinces are required to develop business plans, which are funded subject to provinces meeting certain conditions. (Taken from: Budget 2023 – opportunity missed to refocus public health spending? February 2023, Russell Rensburg).

Our country’s economy is not doing well following the Covid-19 pandemic and now loadshedding is adding more stress. The financing of the state healthcare service is seriously negatively affected by this situation. The 2023/24 budget allocation to the National Department of Health was cut by R4.4 billion, from R64.5 billion in 2022/2023 to R60.1 billion in 2023/24. Even though the R4.4 billion decline can be attributed to discontinuation of conditional grants, which were allocated for the fight against Covid-19 including vaccination, the fact is that there has been no inflation-related adjustment. National Treasury acknowledges that the health sector is under-funded to a minimum of R11 billion. Provincial administrations continue to shoulder significant cost pressures, most notably in the funding of human resources for health, which accounts for between 60 to 65% of provincial health budgets.

In a nutshell, these cuts translated to an initial R88 million budget reduction for a tertiary hospital like Groote Schuur. This amount then grew to a R240 million deficit when staff salary increases were factored into the equation, and currently stands at R264 million due to overspending by certain departments. Since the largest part of the budget is spent on staff salaries, as indicated above, any post that is vacated is currently subject to delayed filling for three to six months to save money. In all likelihood, posts at state facilities will be reduced to make ends meet next year. There are further budget cuts planned for the National Dept of Health in 2024, meaning that the outlook for healthcare services for the coming year is bleak, to put it mildly. We should focus on developing stronger partnerships with NGOs and building public-private partnerships to fund posts and enable continued service provision in future, thereby improving our healthcare services.

Please continue to support us by submitting your valuable work for publication in the SAOJ. 

The CPD questions now have to be completed online.
To complete the questionnaire, go to 
https://www.medicalacademic.co.za/courses/sa-ophthalmology-journal-cpds-spring-2023

South African Ophthalmology Journal 
guidelines for authors

The SA Ophthalmology Journal is a peer-reviewed scientific journal and the official mouthpiece of the Ophthalmological Society of South Africa. It appears on a quarterly basis. 

1. The South African Ophthalmology Journal invites review articles, original studies and case reports for submission. Articles should be the original, unpublished work of the stated author. All materials submitted for publication must be submitted exclusively for publication in this journal. Written permission from the author or copyright holder must be submitted with previously published figures, tables or articles. Authors are solely responsible for the factual accuracy of their work.
2. A cover sheet is to be submitted with each manuscript. It should contain the title of the manuscript, the names of all authors in the correct sequence, their academic status and affiliations. The ORCID ID number for each author should be supplied (https://orcid.org/). The corresponding author should include his/her name, address, phone and email address. 
3. Articles should be between 2 000 and 3 000 words in length. A 200-word abstract should state the main conclusions and clinical relevance of the article. Use the headings Background, Methods, Results and Conclusion. Five keywords are to be supplied at the end of the abstract.
4. Authors should declare any interests, financial or otherwise, regarding the publication of their article, under the headings of Funding and Conflict of interest. If none, this should be stated. An ethics statement regarding patient consent and/or Ethics Board approval should be included. Authors should also indicate whether the submission forms part of an ‘MMed dissertation by publication’ by stating so clearly on the title page.
5. All articles are to be in English and are to follow the Vancouver style of referencing. References should be numbered consecutively in the order that they are first mentioned in the text and listed at the end in numerical order of appearance. Identify references in the text by Arabic numerals in superscript after punctuation, e.g. … trial.¹³ 
6. The following format should be used for references:
   Articles: Kaplan FS, August CS, Dalinka MK. Bone densitometry observation of osteoporosis in response to bone marrow transplantation. Clin Orthop 1993;294:173-78.
   Chapter in a book: Young W. Neurophysiology of spinal cord injury. In: Errico TJ, Bauer RD, Waugh T (eds). Spinal Trauma. Philadelphia: JB Lippincott; 1991: 377-94. 
7. Tables should carry Roman numerals,
   I, II etc., and illustrations Arabic numbers 1, 2 etc. 
8. Abbreviations and acronyms should be defined on first use and kept to a minimum. 
9. All figures, tables and photographs should also be submitted electronically. Each figure must have a separate self-explanatory legend. The illustrations, tables and graphs should not be embedded in the text file, but should be provided as separate individual graphic files, and clearly identified. Photographs should be saved as a 300 dpi JPEG file. Graphs and algorithms, which need to be editable, should be saved as MS Word documents or in PowerPoint. Tables should be saved either in MS Word or in a PowerPoint document. Photographs and X-rays need to be suitably anonymised. Permission should be obtained for the use of patient photographs.
10. Articles are to be submitted by email to the Editor-in-Chief, Prof Nagib du Toit at the following email address: journaleditor@ossa.co.za The text should be in MS Word. Pages should be numbered consecutively in the following order wherever possible: Title page, abstract, introduction, materials and methods, results, discussion, acknowledgements, tables and illustrations, references. 
11. The Editor reserves the right to shorten and stylise any material accepted for publication. 
12. For all accepted articles, authors will be requested to provide five (5) multiple choice CPD questions related to their paper.
13. Authors need to disclose whether they used artificial intelligence (AI)-assisted technologies (such as Large Language Models, chatbots, or image creators) in the production of submitted work. Authors who use such technology should describe, in both the cover letter and the submitted work, how they used it. Authors should not list AI and AI-assisted technologies as an author or co-author, nor cite AI. Chatbots (such as ChatGPT) should not be listed as authors because they cannot be responsible for the accuracy, integrity, and originality of the work. Authors should carefully review and edit the result because AI can generate authoritative-sounding output that can be incorrect, incomplete, or biased and all plagiarism that may have been produced by the AI, should be excluded.
14. Authors are to insert the following copyright notice on their article submissions:
    Copyright © 2022 [insert the Author(s) name(s)].
    All rights reserved. Copyright subsists in the Author of this work. No part of this article or included photographs may be reproduced, published, performed, broadcast, transmitted or adapted in any form or by any electronic, mechanical or other means without the written permission of the copyright holder. This article is published by New Media, a division of Media24 (Pty) Ltd with consent of the Author. Any unauthorised reproduction, publishing, or adaption of this work will constitute copyright infringement and render the doer liable under both civil and criminal law. 