Public health system in dire straits
THE SA Committee of Medical Deans (SACoMD) is deeply concerned about the state of South Africa’s public health system
The association was formed to facilitate the collective interaction of medical deans with other stakeholders in the country on academic matters related to health sciences education, research and health services. SACoMD operates from the offices of Universities South Africa, formerly known as Higher Education SA (Hesa).
The recent health workers’ strike in the North West province and the Mail & Guardian article (“Health Care under Fire”) has brought into sharp focus the challenges facing the country’s health system.
The deans are deeply concerned that industrial action by organised labour has actively prevented the access to health care for the most vulnerable members of society and patients have died as a result.
These events follow several significant events in the national health system, including the Life Esidimeni tragedy, the ongoing oncology service crisis and the ever-increasing burden of diseases, which all demand some introspection among those managing health services. These do not support an environment for the eventual realisation of a health system based on the concept of universal health coverage.
The deans of the medical schools are committed to partnering with the National Ministry of Health, the provincial departments of health, the National Department of Higher Education and Training, and engaging civil society organisations and other stakeholders to ensure that our health system delivers accessible and good-quality care to all citizens. Graduating high-quality health professionals and ensuring that all South African health-care graduates are absorbed into the country’s health system will significantly contribute to the quality of care provided.
The aforementioned Mail & Guardian article sketched the dire state within six provincial health departments. The impact of the systemic failures in these health departments are on patients where the quality of care is compromised and on the training platform available for the training of medical students and specialist medical doctors, and other health professionals.
The deans have grave concerns about the future of academic medicine because of the chronic underfunding of health professional education and training. The absence of a national, integrated and comprehensive health system plan, poor human resource planning, and poor governance and management of the health system continue to destabilise academic health services. Despite multiple interventions on the part of the minister of health and the national Department of Health, the deans feel the health system remains in crisis.
The cabinet’s recent decision to place the North West health department under national government administration in the wake of the health worker protests and the appointment of the Intervention Task Team in the Gauteng Health Department to advise on a turnaround strategy are indicative of a limping, and indeed failing, health system.
The deans are calling on the government to take drastic steps to address the systemic failures in the provincial health departments as a matter of priority. An optimal health system in South Africa is a prerequisite for a well-functioning academic health complex to train and graduate quality health professionals at undergraduate and postgraduate level (including at specialist and sub-specialist levels).
The constant failure to fund internship and community service placements for graduating health professionals represents a serious human resources challenge as well as ethical disquiet.
The deans believe that the state has a duty to ensure that all South African students and those with permanent residency should be placed in funded posts, as this is a legal requirement for practice in the country. A concern is that permanent residency is being treated differently to citizens in the allocation of internship positions. It is the committee’s view that the government must make funding available consistently so that all eligible graduating students are guaranteed funded placements.
The government must also similarly commit to find the funding to place all South African students who graduate from the Mandela-Castro Medical Collaboration from 2019 onwards in internship and community service posts. The deans are deeply concerned that the additional training sites required to complete the training of the medical students from the Mandela-Castro Medical Collaboration Programme are still not fully prepared, with only 60 days left before the first group of 720 students arrive in South Africa from Cuba.
The deans call on the minister of health, in consultation with the minister of higher education and training and the National Treasury, to urgently:
Ensure that all the training sites have been assessed and are ready to host the medical students returning from Cuba by June 30.
Engage with organised labour to ensure that industrial action does not limit access to health care for patients.
Initiate a policy development process in conjunction with the universities that will result in the publication of the regulations governing academic health complexes as provided for in the National Health Act of 2003, chapter 7, section 51(a) and (b).
The deans believe that this process must resolve the issues related to policy, governance, organisation and management, and the financing of academic health complexes.
Establish the National Tertiary Health Services Committee and National Governing Body for Human Resources for Health (incorporating training and development) by the end of July 2018.
These National Health Insurance Implementation Structures will enable the health and higher education and training sector to jointly plan the short-, medium- and long-term future of health services and health professions education and training. The establishment of a joint workforce planning process will also ensure that funding can be made available for guaranteed allocation in internship and community service posts.
Facilitate engagements with the parliamentary portfolio committee on health to host open and public hearings during June and July 2018 on the crises in provincial health departments. The outcome of these hearings should be addressed by the government and, where necessary and appropriate, constitutional provisions in Section 100 of the constitution should be used to address the systemic failures in service delivery in these departments.
We call on civil society to play their role to ensure that all South Africans have access to quality health care.
The medical deans are fully committed to the realisation of an effective health system based on the concept of universal health coverage, providing high-quality care to all South Africans.
Veller is chairperson of the SA Committee of Medical Deans