HOW TO FIX OUR BROKEN HEALTHCARE SYSTEM
THE provision of health care in South Africa is a deeply emotional subject. Speak to anyone – whether they use public or private health care – and you are likely to hear less than rosy comments.
There have been many in-depth studies of the troubles that ail the South African health care system.
Many of the root causes are well documented: a disparate distribution of health resources; a public sector that is starved of health care professionals; a dysfunctional district and primary healthcare system; gross mismanagement of hospitals; a shortage of drugs and supplies; and a poor organisational culture that leads to low staff morale and poor patient care.
There is general agreement that South Africa is still failing on many health indicators. Although the Department of Health under Dr Aaron Motsoaledi has made some progress in tackling public health care challenges, the government is still failing the majority of our people.
What can be done to fix this broken system? Undoubtedly, any immediate action must focus on improving a weak public sector system through: better administrative management; arresting the decline in staff morale; improving decision-making, accountability and authority and improving performance management systems.
In the long-term, the following improvements can be made, through legislation and collaborative engagement that can result in a better healthcare sys- tem in the future:
Increase the number of health professionals: reopen nursing colleges; recruit and accredit qualified foreign professionals; develop training sites and enable the private sector to train doctors in a similar manner to that in which nurses are trained by private nursing schools.
Expand local control: stop central government bureaucracy from handcuffing the system and allow provincial and local institutions more authority as they show themselves capable.
Give public hospitals more autonomy and allow them to raise funds.
Allow them to source expertise and enter into service contracts so that they do not rely on government for basic mainte- nance and order processing; allow them to create flexible posts within their budgets to attract more professionals.
Using private expertise to run our supply chains could reduce corruption and ensure that drugs and supplies are available in our clinics and hospitals.
Make performance transparent: define a comprehensive performance management framework and publish performance down to institutions so the public can hold all levels of government accountable.
The current performance systems in the public health sector clearly do not work and need to be reconsidered.
Performance management also needs to be made transparent by including communities in
Healthcare provision a deeply emotional subject
measuring hospital and staff outputs so citizens can more closely hold their health care institutions accountable.
Turnaround health outcomes: at central government level, the focus should be on specifically turning around national health outcomes by focusing on the war against HIV, tuberculosis, chronic diseases and maternal and child mortality.
Build a functioning primary care system: support the integration and capacitation of public, private and civil society actors.
Effectively integrate private actors into district health systems through, for instance, the creation of independent health teams run by private medical practitioners and funded through health insurance.
These health teams can be incentivised to follow up with patients through teams of community health workers (CHW). For their part, CHW should be trained and regulated.
Improve rural health care: incentivise rural private practitioners through higher capitation amounts and clinical outcome measures for performance bonuses that take the complexities of rural health care into account.
These proposed measures do not represent an all-cure for our ailing health system. The problems faced by patients and healthcare professionals will likely require far more complex solutions.
But it is through constructive conversations, partnerships and respect for communities and healthcare professionals that we can build a healthcare system we can all be proud of.
Dr Hugo is convener of AgangSA s health policy working group