Time for our health min­is­ter to bridge the trust deficit

Sunday Times - - Business | Opinion & Bits - By Ron Derby

Achild at any one of Jo­han­nes­burg’s big­gest pub­lic hos­pi­tals can wait for as long as 10 months to un­dergo a sim­ple scan, a pro­ce­dure that can take as lit­tle as 10 min­utes. It’s just one ex­am­ple of what a health­care pro­fes­sional calls the “in­vis­i­ble line” out­side the coun­try’s stressed hos­pi­tals. To book an ap­point­ment for an MRI-scan of my crock knee, which prob­a­bly spells an end to my foot­ball ca­reer, all it took was a phone call and a cou­ple of days later I was on my back in one of the city’s many pri­vate hos­pi­tals. The only dif­fer­ence be­tween peo­ple is ac­cess to med­i­cal aid. I am just one of the 20% of South Africans with some sort of med­i­cal aid. The rest of the coun­try re­lies on a strained pub­lic sec­tor for its health needs. And for a coun­try with the high­est lev­els of obe­sity on the con­ti­nent, ri­valling coun­tries such as the US, there’s quite clearly a need for re­form. Never mind our ever-ex­pand­ing waists, there’s still the cri­sis of HIV, high rates of vi­o­lence and car ac­ci­dents that make the coun­try com­pa­ra­ble to a war zone.

So the pur­suit of uni­ver­sal health­care that na­tions like the UK, Ja­pan and Nor­way en­joy fits into that over­all goal of at­tain­ing so­cial jus­tice for all. It’s an ar­gu­ment that, given our his­tory, the health min­is­ter Aaron Motsoaledi doesn’t have to do much to jus­tify. Rat­ings agen­cies will not raise questions about fund­ing uni­ver­sal care as there’s com­pet­i­tive ad­van­tage in hav­ing a young pop­u­la­tion with ac­cess to good health­care.

But to get the coun­try mov­ing in that di­rec­tion, the min­is­ter has to start with cur­rent prob­lems in his port­fo­lio. That means sort­ing out gov­er­nance is­sues that face ev­ery hospi­tal and clinic un­der his am­bit.

The sys­tems in place don’t talk to the de­mands of the health­care sys­tem. His­tor­i­cally, we have pro­duced some of the best train­ing sys­tems for both doctors and nurses in the world, but in the past few decades, sup­port from med­i­cal schools for the health­care pro­fes­sion has dwin­dled. Highly skilled and knowl­edge­able peo­ple have drifted to the pri­vate sec­tor and over­seas mar­kets, and pro­fes­sion­al­ism has taken a dive.

In­fra­struc­ture has aged, with poor main­te­nance. Barag­wanath Hospi­tal, which went through a heavy re­fur­bish­ment some years ago, al­ready faces a sig­nif­i­cant main­te­nance back­log. It’s all a ques­tion of gov­er­nance, a con­se­quence of which has been an in­abil­ity to at­tract or re­tain tal­ent.

The ex­am­ples of this de­cay are gen­er­ally in the ur­ban nodes, of which we’ve seen the worst fruits such as the Life Esidi­meni tragedy in which 143 peo­ple per­ished. One shud­ders at the tales one is likely to hear in the hin­ter­lands.

Another ob­sta­cle to over­come is a bit of a per­sonal chal­lenge to the min­is­ter, es­pe­cially if he is to re­main in his min­istry af­ter next year’s elec­tion. He must get over his dis­trust of the pri­vate sec­tor. Of­ten de­scribed as the most anti-busi­ness min­is­ter in cabi­net, it’s for him to over­come this trust deficit, if the state, given its des­per­ate fis­cal po­si­tion, is to make a sus­tain­able play at im­prov­ing lives.

This ten­sion be­tween pri­vate and pub­lic health­care is unnecessary, as these are the re­sources of the coun­try. There’s ab­so­lutely no rea­son for par­ties not to prop­erly en­gage. In pur­su­ing uni­ver­sal health­care, there’s no doubt­ing that some large pri­vate-sec­tor play­ers can of­fer some so­lu­tions to a strug­gling pub­lic health­care sec­tor. One that we will hope­fully all be us­ing.

In build­ing a bank­ing op­er­a­tion, Dis­cov­ery may very well be pre­par­ing for a fu­ture where its med­i­cal aid unit is a shrink­ing em­pire. Al­ready its in­sur­ance is big­ger.

While Dis­cov­ery and hospi­tal groups such as Net­care re­align their busi­ness mod­els, Motsoaledi or who­ever re­places him in years to come shouldn’t un­der­take a na­tional health in­sur­ance plan that doesn’t in­clude the skills they house. Room must be made for co-op­er­a­tion. There is ex­per­tise in the pri­vate sec­tor that, as things stand now, isn’t fully utilised.

I am just one of 20% with med­i­cal aid. The rest go to pub­lic clin­ics.

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