– LET US DO IT FOR MADIBA
THE greatest heritage that Nelson Mandela has bequeathed to us is reconciliation. But without social justice, without a genuine quest for true humanity, without narrowing the gap between rich and poor and without the removal racial barriers, reconciliation rings hollow. It is just a word.
The governing party, the ANC, through its new president Cyril Ramaphosa, has declared this year to be the year of our former president Nelson Mandela. Had he lived, Madiba would have turned 100 in July this year.
As the Ministry of Health, we are of the view that the greatest tribute to honour Mandela and his legacy would be to accelerate the implementation of the National Health Insurance (NHI). The NHI is a funding mechanism that will enable all South Africans to access health care regardless of their social and economic status. NHI is our version of the World Health Organisation’s Universal Health Coverage (UHC).
As the icon of our freedom and democracy, Mandela was president when the country adopted its first democratic Constitution in 1996. In terms of the Constitution, access to health is a right. The architects of our Constitution realised that the ultimate dividend of freedom and democracy is access to health.
This is in keeping with the Alma-Ata declaration of the WHO in 1978 which states that “the attainment of the highest standard of health is the most important worldwide social goal, whose attainment needs action from other sectors, economic and social in addition to the health sector”.
That is the reason we have decided to implement the NHI in South Africa. We wanted to end apartheid in the provision of health care and ensure that the resources the country spends on health are shared between the haves and havenots.
Some among us may have forgotten that we used to have a fragmented health systems in the country. There were various departments of health in the homelands and a different one that served mainly white South Africans.
There were hospitals which catered only for the white section of the population and others that served black people. We have been able to establish a single National Department of Health. Race is no longer supposed to be used to determine which hospital can serve a patient.
There is no doubt that Mandela was central in ushering a non-racial democracy in our country. That is why when we dedicate this year to honour his legacy, we should also ask ourselves the question – how have we moved to his ideal of attaining racial harmony and eradicating the legacy of apartheid.
While apartheid has been removed from the statutory books, there is a new form of discrimination that is based not on race but on social and economic status. In health for instance, poor people are unable to access quality health care because of the manner in which the resources of the country are shared. Too much money is being spent on two few people to address their health needs.
It must be a source of great concern to all of us that of the 8,5% of the Gross Domestic Product (GDP) that is spent on health in the country, a whooping 4,4% is spent on only 16% of the population. The remaining meagre 4,1% is spent on 84% of the population. This constitute the biggest inequality which exists nowhere else in the whole world. Clearly unless we radically re-organise the health system, we will not be able to deal with the legacy of inequality in health.
The unfortunate reality in South Africa is that the gap between the rich and poor is widening. The manner in which health resources are allocated further reinforces inequality between rich and poor. NHI seeks to reduce this inequality.
Mandela had special focus on health. His contribution in the fight against the HIV/Aids pandemic will never be forgotten. At a time when our country was trapped in Aids-denialism and high incidents of stigmatization, Mandela came out publicly to attack the HIV/ Aids stigma, demanded ARVs for people infected with the virus and advocated for treatment of people with TB. In the instance, he even announced publicly that his own son Makgatho died of Aids.
As a country, we have come a long way in intensifying the war on HIV and Aids. Our country now has the biggest antiretroviral programme in the world. But the fight continues. In his January 8 address, Ramaphosa said: “We will intensify efforts to improve the health of our people, particularly in the context of the devastating impact of the Aids epidemic and the emergence of other diseases. As South Africans, we must never accept as permanent or irreversible our status as the country with the world’s biggest HIV epidemic.
“We need to take decisive steps to bring an end to the epidemic through systematically implementing the 90-9090 strategy, which will entail, among other things, the addition of 2 million more people to our antiretroviral treatment programme.”
As we honour Mandela, we should ensure that we implement the 90-90-90 strategy so that we free our country from the Aids pandemic. The Department of Health will make further announcement on this strategy in due course.
It was also under Mandela’s presidency that pregnant women and children were given free treatment in public clinics. His administration also built hundreds of clinics throughout South Africa, especially in rural areas.
More than his leadership skills, Mandela was full of compassion, particularly for the weak and vulnerable. Of serious concern to us as the Department of Health are continued reports of ill-treatment of patients in our health care facilities. As we honour Mandela, we urge our health workers at all levels to be true to their professional and treat all patients with the outmost care. We can build new and well equipped hospitals but only warm and professional conduct by our health professionals can make the real difference and improve quality of care of the patients.
It was Mandela who passionately spoke about the RDP (Reconstruction and Development Programme) of the soul. He understood that apartheid and colonialism had damaged our minds and the manner in which we treat one another. He appreciated that we have to change the manner in which we deal with other people. If our health care workers can heed his call, there can be a huge improvement in the provision of health care in the country.
It was because of Mandela and the ANC’s proximity to Cuba that our country developed a strong relationship with Cuba. That relationship saw Cuba sending hundreds of doctors to South Africa to equip our rural hospitals which had critical shortage of doctors.
While the programme started with the importation of Cuban doctors, this has changed. Currently we send hundreds of learners to study medicine in that country and the programme has played a significant role in reducing the shortage of doctors in the country. Because most of those that we place on the programme come from disadvantaged backgrounds, this has also assisted to improve the financial fortunes of hundreds of families.
Given that Cuba is internationally renowned for its primary health care, those who are trained in that country will become priceless assets in the rolling out of the NHI. We have repeatedly stated that primary health care is the heart-beat of the NHI.
When our people fully appreciate and understand the role that can be played by the local clinic, the over-crowding in hospitals will be reduced as many of them would realise that most of their needs can be addressed by the staff at the clinic.
There are few global icons whose love for children can match that of Mandela. Mandela loved children so much that he initiated the construction of a special hospital for children. The Nelson Mandela’s Children Hospital, which was officially opened after he had passed on, is Madiba’s enduring legacy for his love of children.
If we were to give a report to Mandela, we would tell him that his vision of the hospital has become a reality. We would tell him that we are not just fighting the Aids stigma, but that we are giving millions of people ARVs. We would tell him that we are testing everybody for HIV and those that are found to be HIV positive are placed on the ARV programme regardless of their CD4 count.
We would tell him that the idea of Universal Health Coverage is no longer just an idea but is being implemented through the rolling out of the NHI. We would tell him that we have increased the life expectancy by more than 10 years. We would tell him that his dream of a non-racial democracy is a reality.
As we celebrate the life of Mandela, we pledge to move with speed to implement the NHI and ensure that the legacy of apartheid in health is dead and buried.
NHI is our version of the World Health Organisation’s Universal Health Coverage