Private and public sector role players are going to need to put their differences aside to make sure that South Africans are not left behind in the race for a more efficient healthcare offering.
The 2015 deadline of UN’s Millennium Development Goals (MDGs) will put things into context. In terms of MDG targets, countries such South Africa have to reduce child mortality of children (aged five and younger) by two-thirds from what it was in 1990. The deadline for universal access to HIV/Aids treatment was in 2010, but South Africa missed it. The MDGs also call on governments to cut, by 75%, the maternal mortality ratio.
But, this provides only a snippet of the hardships faced by those who, perhaps out of financial circumstances, depend on the public sector which supports 35m to 40m people on a shoestring budget.
Long lost in the healthcare debate is a question of access to quality and reliable service, for the masses dependant on the public sector. And, with the medical aid sector, hospital groups and government officials locked in a never-ending finger-pointing game, South Africans without medical aid are far from receiving what’s due to them: decent medical care.
Like the healthcare charter – which, among others, sought to remedy chronic skills shortages, the low-income medical scheme (Lims) has become distant memory. Lims, which solicited praises for its potential to cover blue-collar workers, who ordinarily find traditional medical aid unaffordable, didn’t make it passed the research stage. Many other industry- or government-led initiatives, aimed at bridging the healthcare divide between the haves and the have-nots, have been quietly shelved.
It’s also lamentable that medical aid firms which, thanks to their nature of work, hire healthcare professionals in numbers have done little to replenish the skills base.
Discovery, on the other hand, is an exception. Its social investment arm has, over the past five years, invested tens of million of rand to fortify the country’s medical skills base. Other players in the R100bn medical aid industry also poach nurses and doctors from an already exhausted skills base. No prize for guessing that it’s the poor and medically uninsured population that feels the pain, or the effects of this selfishness, most.
Government, which already spends no less than R1m of taxpayers’ funds to train each doctor, can hardly afford to churn out the numbers at a sustainable pace. So, where is the private sector?
Certainly, these kinds of issues – and, no less, seemingly obligatory zigzag movements when it comes to implementation – have kept the Minister of Health Aaron Motsoaledi hectic since he took the leadership baton three-and-a-half years ago. On the debit side, the output isn’t quite apparent.
But, given perennial problems that afflict public hospitals, compounded by perennial underfunding and staff shortages, it’s unsurprising that Motsoaledi has spent quite a bit of his tenure looking at the issue from several perspectives. Instead of investing a bit of his time on harnessing public-private partnerships (PPPs), a working formula as examples such as Inkosi Albert Luthuli, Durban, and Bloemfontein’s Pelonomi hospitals show. As partners to the Government of Lesotho, in a PPP project, Netcare operates a world-class health centre in Maseru.
Netcare chief executive officer Richard Friedland reckons South African government should consider a bigger role for PPPs in to improve healthcare delivery. Referring to the Lesotho PPP – whose upshot is that patients from this mountain kingdom don’t have to travel to Bloemfontein, for instance, for some procedures – Friedland reports that this model is “affordable and workable” for developing countries, including South Africa.
Melanie da Costa, new chairman of the Hospital Association of South Africa (Hasa), notes a trend, around the globe, whereby “public health systems… outsource to the private sector where they realise it (outsourcing) to be more efficient than building new additional capacity”. Regarding inter-stakeholder relations, she says Hasa “desires to work closer with the department of health, especially on technical matters relating to health reform”.
While a senior public servant, who prefers not to be named, felt that Government – following Motsoaledi and his top brass’ open-ended requests for co-operating with the private sector – as “abdicating its duty”. While we can’t pass a judgment on this remark, we’d assert that that’s perhaps taking it too far. However, it does underline what the Netcare boss describes the “suspicious” views of the private sector by certain quarters in Government.
It also doesn’t help that Motsoaledi’s request to private sector was a little too vague, sparking a question from an observer: “What do the minister and the DG want (the private sector) to do?”
One area in which the minister’s diagnosis was that the “quality of within the public sector (is a) concern”. But, beyond rhetoric and powerful sound bytes, which hardly heralds action, it’s unclear to what extent government has improved health outcomes – something that can also be measured by increased life expectancy levels and lowered child mortality.
As recently as June, Mosibudi Mangena, a former Cabinet Minister and Azapo leader, told the nation how the ailing public healthcare system claimed the life of his brother, Mashaole. “The situation at the hospital is over-crowded, not user-friendly and unwelcoming,” he wrote in The Star. He also pointed out that the entire Limpopo province doesn’t have a machine to unblock bile duct. Provincial health MEC Norman Mabasa, who last month had to deal with non-payment of ambulance attendants and paramedics, has the right approach. But, like all his other peers at the top, Mabasa can do with a healthy budget.
The importance of sensible budgeting in healthcare is fortified by UN Secretary General Ban Kin Moon’s decision, to “summon” – as Motsoaledi puts it – health ministers from across the world to urge them not to succumb into temptations of cutting expenditures but “to protect people’s health” even in the face of “the deepening financial crisis” that has led to austerity measures being applied across the board.
Four months down the line, it’s unclear to what extent the Mangenas episode spurred Motsoaledi – especially since he was “dismayed and saddened by the Mashaole story and frankly (admitted) that (such instance was) not the only one.” Still, it’s fair to say that the narrative, as the steady minister would acknowledge, is all too familiar.
It’s happening in every province, so mere mortals can only hope for respite – one day. The Limpopo example illustrates a lack of three things: will, funding, and human resources.
Horror stories from the likes of the Eastern Cape’s Mthatha General (part of Nelson Mandela Academic) and Soweto-based tertiary hospital, Chris Hani Baragwanath, a microcosm of the country’s public sector, are an unspoken indictment on government officials than the facility’s over-worked staff and management. To be fair, management at such facilities hardly gets enough support from Pretoria.
If he’s to get to the bottom of the problem, and live a healthy legacy behind, Motsoaledi would need to spend more time on the ground – visiting hospitals and clinics from across the country and engaging with ordinary people. It would also help if he’d get Finance Minister Pravin Gordhan to understand the plight of uninsured South Africans. Until that happens, this nephew of Elias Motsoaledi – a stalwart in the liberation struggle – will keep talking about a need to close the medical divide, known as healthcare apartheid , but have little to show for it.
Quoting an official from the World Health Organisation, Motsoaledi told the 300 delegates at the Hasa indaba, recently, that universal coverage sought to address issues of exclusion. He contrasted rising health costs with “poor access to essential medicines” and how an emphasis on cure has left “prevention by the wayside”. The upshot is “costly private care for the privileged few, but second-rate care for everybody else”. Medical schemes, on the other hand, Motsoaledi added, punish the poor.
Shoks Mnisi Mzolo