Can disease control priorities improve health systems performance in South Africa?

Improving health systems performance in order to achieve good health care outcomes and meet the Millennium Development Goals (MDGs) has received increased global attention. Using the World Health Organization (WHO)'s framework on health system strengthening, an overview is presented of key aspects of performance of the South African (SA) health system that are likely to impact on the Disease Control Priorities (DCP) initiative. SA is gripped by a complex disease burden, consisting of the twin epidemics of HIV and tuberculosis, as well as non-communicable diseases and injuries. Despite an enabling legal and policy framework, health system challenges include sub-optimal leadership, insufficient resources for many national policies, lack of a broad public health approach to service delivery, and poor utilisation of existing information for decision-making. Provided that these and other health systems issues are addressed, cost-effectiveness studies and interventions may be beneficial in improving the functioning of the health system in SA and in getting better value for money.