Time for our health minister to bridge the trust deficit

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.