South Africa is an upper middle income country with a mixed economy (mining and agriculture, manufacturing, service and knowledge). There are about 11 million workers in formal employment within large enterprises, and within small medium and micro enterprises (SMMEs). While there is also a strong informal economy with about 4.6 million vulnerable workers, including agricultural and household workers, which necessitates the developmental state agenda of the country. Since the year 2009 under the Government of His Excellency President J.G Zuma, South Africa has accelerated efforts towards health reforms through the implementation of the National Health Insurance (NHI), a form of Universal Health Coverage (UHC); re-engineering of primary healthcare (RPHC) and the establishment of the National Public Health Institute of South Africa (NAPHISA).
The current health reforms in South Africa are nested in the primary health care (PHC) concept as per the Alma Ata Declaration, which defines PHC as – ‘the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work’. The stated aim of the South African health reform is targeted at improving access, coverage, provision of quality healthcare, efficiency and cost effectiveness of the health system. Strengthening of a health system requires inputs into the World Health Organisation’s (WHO) six building blocks of the health system: leadership and governance; healthcare financing; health workforce; medical products and technologies; information and research; and service delivery. These improvements in the South African health system overall, will directly and indirectly impact the occupational and environmental health and safety (OEHS) of workers within PHC in South Africa. Thus the aim of this paper is to assess the delivery and inclusion of OEHS within PHC using the WHO’s six building blocks of the health system.