Government is raising health funding by 10,6% to R75,5bn in 2008/2009. In particular we welcome the additional allocations to the state hospital revitalisation programme. This should be linked with public-private partnerships so that public hospitals can target medical scheme beneficiaries and become self-sufficient.
Though government has hiked health-care worker salaries significantly, increased posts by 39 600 in the past four years and plans to fill a further 25 000 posts by 2010, we would like to see more clarity on this, given the country's skills shortages.
We would have liked to see hospitals being given incentives to manage their own budgets, by allowing them to plough profits back into their own facilities instead of into provincial health budget pools.
Government needs to widen and integrate its HIV/Aids and sexually transmitted infection programmes for education, awareness and treatment to embrace communities at work, home, school, church and play. Blaming private health-care providers or funders without urging critically important corporate employers to pull their weight on HIV/Aids is unproductive.
The biggest purchaser of private health care is the employer. Government should give corporates tax breaks for driving HIV prevention.
It is widely accepted that we have significant resource constraints in health care. Government can smooth the way by referring long-suffering patients to the non governmental, community-based and private sectors while concurrently opening up its hospitals to private-sector fee-paying patients.
By creatively sourcing ARV drugs and re agents at rock-bottom prices, it can also pass these discounts on to patients in the private and NGO sector. People then won't have to wait until they are too sick before they get treated.
Increasing the revenue base of public health funding is necessary, but the focus must shift to improving outcomes and our ratings when compared internationally. Significant opportunities exist, as I still believe that public-sector facilities are under utilised.
What's needed are common goals on access to health care, affordability and participation across private and public sectors.
By documenting the realistic, basic primary health and hospital cover an individual requires, determining whether the person has a right to cover for all lifestyle conditions, and reinforcing that the responsibility for health belongs with the individual, progress can be made.
However, this will require a critical review of what worked and what failed over the past decade. Only a simple, clear, low-bureaucracy system with consolidated legislation will achieve the desired objectives.
Current health legislation remains fragmented and though aimed at the same goals, allows varied implementation and inconsistent interpretation across the delivery chain.
SA has reached a point in the development of health care where the failure to flesh out the much-vaunted national health insurance plan in the budget is becoming an increasingly noticeable gap.
It needs to be spelt out or people will think the wheels are turning as slowly as in the implementation of the risk equalisation fund. The subsidisation of government employees though the Government Employees Medical Scheme is a first step, but spelling out the national health insurance and its funding structure is long overdue.
Khan is CEO of Metropolitan Health Group
