Time to see a half-full glass for health
Vie w
SOUTH Africa’s health woes cannot be ignored or sugar-coated. The latest annual health review, published by the Health Systems Trust, confirms this.
But, despite the dark clouds hanging over our public health system, some success stories bring hope to millions whose lives depend on that silver lining, however slight.
In the midst of the oncology crisis in Kwazulu-natal, it is comforting to note that all is not lost. As a province, we are continuing to make strides – significant strides, in some areas.
The annual health review notes that South Africans are continuing to live longer, to an average of 64 years – up from 54.7 years for women and 52.3 for men a mere decade ago.
In addition, infant mortality rates, mother-to-child transmission of HIV and even births from teenagers under 18 have seen a decline.
As the province with the highest burden of diseases, it’s encouraging that KZN is credited with much of the turnaround in health outcomes, which in turn affects the health outlook for the country.
Nobody could ever have imagined, 22 years ago, that we would reverse the HIV/AIDS pandemic, that it would no longer be a death sentence, that those living with the condition would be living longer, healthier lives.
The success of course, is a direct result of the scaling up of our antiretroviral (ARV) therapy since 2006, placing South Africa on target to achieving the National Development Plan goal of a 70-year life expectancy by 2030. Credit must go to the visionary leadership of National Health Minister Dr Aaron Motsoaledi, who has steered the ship through turbulent years, both politically and economically.
In addition, the improvements in certain health areas, like lower infant mortality rates, is also credited to the introduction of new child vaccines as well as other developmental interventions, such as widening coverage of child-support grants, improved water, sanitation, electricity and housing access.
Despite the success in health, South Africans are not naive enough to assume all is well and we cannot ignore the mammoth challenges that seem to overwhelm the government, particularly as the country moves towards a re-engineered National Health Insurance plan.
The reversal in HIV/AIDS deaths is cause for celebration, but the past decade has seen a sharp rise in noncommunicable diseases, prompted largely by lifestyle changes. Diseases that can be prevented – diabetes, in particular – are on the rise. It’s a ticking time bomb.
At the heart of addressing this is the issue of strengthening human resources, without which the new health system is unlikely to succeed in its mandate to be community-centred with a disease prevention approach.
Community health care workers, and nurses in particular, notes the report, need to be increased at local level to ensure the new health system is effective in its preventive approach.
The solution, it states, is the revitalisation of the profession through nursing education reform, the participation of nurses in policymaking and the work experiences of nursing managers at PHC clinics.
It also recommends that contributing challenges such as workforce concerns and moonlighting be addressed urgently.
It would be easy to continually criticise our public health sector and its leadership, and absolve the private sector of blame. The reality is the increases in health expenditure and high costs, even exceeding international standards, have come from our private sector.
The public sector accounts for only half of total expenditure on health care and is financially constrained compared to the private sector, collecting less than one percent of total public-sector expenditure.
This premium in the private sector lies in the quality of care and the notion that this sector is better managed. With 70% of doctors and specialists working in the private sector, that notion is easy to understand, but is it sustainable?
Can we continue to ignore the disparities? The government accounts for less than half of total health spending, serving more than 80% of the population who cannot afford private care. It’s not ideal.
Without addressing the gaps in human resources, strengthening skills, retaining specialists, training more nurses and community health workers and encouraging more ruralbased training of doctors, the poor will continue to be marginalised.