Rationing and children's constitutional health-care rights

Abstract

A commitment to equality of basic opportunities, or equality and equity respectively in the Bill of Rights and the White Paper on Health, provides the legal and moral foundation for future health-care for children in South Africa. In reality, extreme need and scarcity will seriously limit the government's ability to fulfil its commitment to equal health-care rights for children, making rationing inevitable. To achieve equality of basic opportunities on the macro level, we propose a national health policy for children premised on the principles of prevention and non-abandonment. These principles address the formidable tensions in health-care resource allocation generated by considerations of equality and utility, treatment costs, and severity and prevalence of disease and disability. Given that it will not be possible to provide highly specialised or costly health-care services to all children who might benefit, we mention rationing criteria for micro-allocation of resources at specialty level.