Please let me congratulate you on an excellent proposal.
I am very pleased that access to essential health services is highlighted, and that you note that social protection must be embedded in a wider matrix of appropriate social policies.The contrast between South Africa's generous cash transfers and limited engagement with non-communicable diseases is a striking example of this.
Last week, I published a paper in the International Journal of Epidemiology which shows that South Africa has the highest rate of hypertension for people aged 50+ ever recorded for any country. As we know, South Africa has an excellent set of cash transfers for older people. Less that 40 per cent of hypertensives were aware that they had dangerously high blood pressure and only 8% had the condition controlled through medication. Control rates were as low as 3% for the poorest wealth quintile. Hypertension is the leading cause of mortality globally, so this is clearly an important issue. Stroke, which often results from hypertension, is the leading cause of disablity in LMICs.
This clearly demonstrates the need to see cash transfers as part of a wider set of interventions aimed at enhancing the wellbeing of groups such as older people. It is good to know that the government of South Africa is now piloting what should become a new national health insurance scheme. That said, our study found that health insurance does not automatically enhance health outcomes. This requires supply-side interventions and good health awareness.
All the best,
Professor of Social Policy and International Development
University of East Anglia, UK