Put policy into practice
ON Thursday morning Siyabonga Jim left his Kwazakhele home for school. By 11am a teacher noticed he was not well and sent him to a nearby clinic to get help.
At the Lunga Kobese clinic, Jim was turned away.
All nurses had called in sick that day following what, we are told, was an altercation with a patient the day before.
Jim and scores of other patients were told to come back on Monday.
As he walked home, at a park not far from the clinic, the 20-year-old TB patient collapsed and died.
His was a heart-wrenching story told by this newspaper last week, highlighting the state of clinics in Nelson Mandela Bay.
First, let me be clear that as tempting as it may be, none of us can definitively say that had Jim not been turned away from the clinic, he would not have died.
There is simply no conclusive basis to back this suggestion.
However, it is reasonable to suggest that at the very least, even if Jim’s death was unavoidable, had he received help at the clinic, his last moments could have been under different and more dignified circumstances. Jim’s case is not unique. His tragedy is a symptom of a broader primary healthcare crisis endured by many in our city and the Eastern Cape.
Their stories only differ in detail and circumstances.
What is common is that they are failed by the system.
Despite various pronounced interventions from authorities over the years, it has become patently clear that many of our facilities are often unable to render the most basic services.
In fact in April, following routine inspections at 100 clinics in the province, the Office of the Health Standards Compliance (OHSC) said the majority did not meet the required health standards.
These included cleanliness, infection control and the availability of medicines.
However, to fully understand the picture, it is only fair to consider the other, equally important side of the story.
By the provincial health department’s own admission, our clinics are under-resourced and overburdened.
In her policy speech in Bhisho earlier this year, Health MEC Phumza Dyantyi said, “I must admit that although significant resources have been allocated to the department over the past years, we remain constrained.
“We are unable to fulfil our constitutional mandate of providing quality and accessible healthcare services with reduced waiting times.”
Further, the conditions under which some nurses work are, frankly, atrocious.
Intimidation and violent retaliation from angry residents as well as crime is the frightening reality of many healthcare workers in our city.
Incidentally, as I write this, a colleague has just returned from an assignment at a clinic in Kwanobuhle where at its gate, he was robbed of his cellphone at gunpoint in an unfortunate crime of opportunity. What then? Next week the ANC will sit for its national policy conference in Johannesburg.
At this gathering members are to scrutinise policies and evaluate the government’s progress in implementing them.
With regard to primary healthcare in particular, they are to examine how far South Africa is in rolling out the Ideal Clinic Model.
The model is a key part of government’s National Health Insurance (NHI) plan.
At the heart of it is, ideally, to provide community-based clinics that are well equipped to deliver efficient and comprehensive primary healthcare in line with the needs of the community.
In its policy discussion documents, the ANC says the primary healthcare sector has “prioritised and intensified the roll-out of the programme”.
Of course it must be said that the feasibility of the entire NHI plan itself is the subject of much debate in South Africa.
Regardless, what is clear is that the government is convinced that it is the future of our nation’s healthcare.
In his state of the province address this year, premier Phumulo Masualle said in this financial year his government would roll out the Ideal Clinic Model in more than 50% of the province’s facilities to improve the quality of services.
Next week’s political discussions on how to improve our healthcare system would be futile if they did not confront the gaps between formulating policy and the reality of its implementation on the ground.
It would be pointless if it did not tackle the administrative and economic difficulties as well as the political interests that often cripple the system.
In its deliberations on this matter, the ANC must answer at least three pertinent questions.
The most obvious is the pressing need to ensure that every cent budgeted is managed prudently to help resource our facilities to deliver a quality service to those who need it most.
Second, policy discussions must go beyond rhetoric to implement tangible plans to improve working conditions, and to provide adequate security for our nurses and other healthcare workers.
Third, the government must lead the process to deal with the trust deficit between clinics and communities.
Such a process will involve strengthening partnerships with communities beyond political interests to achieve a common goal. Granted, the mood is tense. Populism from all quarters may trump rational engagement.
But let us be clear, down that path are no winners.
Instead those who will suffer the most are vulnerable citizens like Jim, whose circumstances placed them firmly at the mercy of a troubled system.