No quick cure for SA’s sick healthcare
But the national health scheme will go some way towards alleviating the current dire state of affairs
Screams and the crashing sound of a roof collapsing. Emergency services conducting a search and rescue operation for people trapped in the rubble. These were scenes earlier this month at the Charlotte Maxeke Johannesburg Academic Hospital, after the roof in the foyer collapsed. Several people were injured but there were no fatalities. The roof had recently been waterproofed and early claims from Gauteng’s infrastructure development MEC suggest poor workmanship may have been to blame.
But the state of hospital infrastructure is not the only problem facing healthcare in Johannesburg and elsewhere in South Africa.
Despite being a middle-income country, we have seen consistently poor health outcomes directly linked to the quality of our healthcare. Widespread stock-outs of critical medication, shortages of equipment, rampant corruption and huge surgical backlogs are the order of the day.
The rights and dignity of patients are ignored, particularly those who struggle to make ends meet at the best of times, let alone when faced with illness.
Recently, I experienced these problems first hand. In September last year, after a recurring sinus infection refused to clear up, I was referred to an ear, nose and throat (ENT) specialist at a private hospital in Johannesburg. The doctor told me I urgently needed a CT scan, which would cost R2000 — a figure slightly more than half of South Africa’s recently adopted minimum wage.
So I tried to get care through the public system to save the expense. At Charlotte Maxeke hospital I was told the next available opening for the scan would be in March this year. Because of my rapidly deteriorating condition, I paid the fees at the private facility and had the scan done. I was told that there was a growth in my head and I would need surgery.
The cost of the surgery would be about R75 000. As high as that sounds, it was a reduced price because the ENT specialist and another surgeon decided to do the multiple procedures required in one operation. To put this price into context: the annual household income for black South Africans stands at an average of R92893, according to Statistics South Africa’s Living Conditions Survey.
Despite having already spent what was just under two months’ worth of my salary on healthcare and not having the funds for surgery, I was fairly confident that I would get the care I needed. My friends and family would not let me suffer. A group of them rallied around and raised the money and, on January 31, I had my surgery.
But my story is not the story of the seven in every 10 households that use public clinics and hospitals. It is not the story of Sylvia Kubheka who, at 55, will reportedly have to wait until 2023 to get hip replacement surgery. If I were any other black person, I may not have been diagnosed. My ability to do so was determined by my socioeconomic status and proximity to those with resources. It shouldn’t be this way.
In his recent budget speech, Finance Minister Pravin Gordhan announced that the much-anticipated National Health Insurance (NHI) fund would be set up later this year. Correctly implemented, the NHI is a huge step towards securing universal healthcare coverage for all South Africans, irrespective of their socioeconomic status. But it will not happen overnight. As the minister of health has noted, it’s “an ultramarathon, not a sprint”.
It will also not be enough on its own. The government must do three things: halt the gradual decline in expenditures for provincial health services; improve investment in health infrastructure (buildings and equipment); and ensure strong management at public health facilities. This will not only improve healthcare while the NHI is in its infancy but will also build a foundation so that, once implemented, its effect not only improves access and equity, but also the quality of care.
Without a doubt, providing highquality universal healthcare is a complex undertaking, one many countries still struggle with.
For example, in 2004 Ghana became one of the first African countries to introduce a universal health insurance scheme, the National Health Insurance Scheme (NHIS). But it had to undergo multiple reforms because, as a result of the rising costs of providing healthcare and shrinking financial resources, it could not be sustained.
A subsequent review of the scheme has recommended that the focus of the NHIS should be on universal access to primary care, so that limited resources are not spread too thin. It’s not perfect. Long waiting times and registration difficulties remain. But it has dramatically improved access to healthcare. Prior to 2004 it would have been out of Ghana’s reach.
The healthcare system in South Africa is reaching its breaking point. Healthcare workers know this better than most, which is why they have been calling for change in the system. We cannot afford any delays.
We cannot continue to allow the poorest in society to be left without healthcare. We must not resign ourselves to the fact that lives will needlessly be lost simply because of an accident of birth or lack of economic opportunity. If the measure of a functional democracy is its treatment of the most vulnerable, South Africa is falling short.