"If there's one thing that needs healing in this country, it's our health care system. It's so sick," Dr Kgosi Letlape told healthcare professionals, politicians and private sector representatives at a function at Chris Hani Baragwanath Hospital.
The chairman of the SA Medical Association, who is often derided as a "loose cannon", couldn't have chosen a more relevant audience and venue to highlight the plight of SA's health system.
Standards at the hospital are deteriorating due to an overstretched workforce, a shoestring budget and an increasing burden of disease, among other issues. In addition,, there have been reports that some staff members steal drugs and other resources and sell them to private practitioners.
WHAT IT MEANS
 Standards at public hospitals worsening
Government out of touch with reality
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The 2 900-bed Soweto hospital gets R1,1bn from the state, compared with R900m for the 1 200-bed Johannesburg General Hospital. Though the R1,1bn might sound huge, a visit to Africa's biggest hospital shows that the amount is barely enough to tinker at the edges.
The CE of SPNet, a GP network, Dr Elijah Nkosi, decries the lack of progress in curing the public health system. Like other players, Nkosi blames Pretoria for the ailment and calls for a change in political thinking. Baragwanath mirrors many other examples across the country, he says.
The state should consider amending parts of the Medical Schemes Act "that underpin health care apartheid", says Letlape. "Government can't speak of health care for all and yet endorse an apartheid-era divisive act. The act is a key driver of the two-care system and my worry is we aren't even debating this," Letlape says.
But given the health department's poor record, a paradigm shift is overly ambitious. For one, the department is not looking after its own workforce, leading to what Western Cape finance MEC Lynne Brown has called an "exodus" to the private sector and foreign destinations.
For now, the department could consider these steps:
- Acknowledge that the system needs urgent resuscitation;
- Accelerate the health care charter process;
- Engage with the private sector in a more constructive way;
- Deal with medical aid nonhealthcare costs, not least the dubious broker fees (that, for instance, now match Chris Hani Baragwanath's annual budget); and
- Lift budget allocation for provision in previously disadvantaged communities.
That it took a Daily Dispatch article to expose the shocking conditions at Frere Hospital in East London confirms Nkosi's theory that the state is out of touch. But, as the case of Nokuzola Ntshona illustrates, Pretoria shuns reality. The Eastern Cape doctor was suspended after expressing concerns over conditions at Frere Hospital.
Some experts say officials often deflect attention from issues of inadequacies by focusing on grand plans like the R2bn capex to revitalise hospital infrastructure and the human resources plan. Despite the plan, "nurses are underpaid and service delivery at provincial hospitals needs re-working but I think (the authorities) don't see the urgency because they are out of touch," says Nkosi.
However, health department chief director of hospital services Thabo Sibeko insists they are in touch.
On synergy between the public and private sectors, Nkosi says there is some spare capacity in private care. But private practitioners' bids to co-operate in service delivery initiatives are sometimes frustrated by bureaucracy.
However, Sibeko cites Uitenhage in the Eastern Cape as a shining example of what partnerships can achieve.
"In Uitenhage, we formed a partnership through which 60 private doctors go to public clinics once or twice a week," he says.
Another success is the national drug policy, which has decreased medicine prices. Despite initial resistance from manufacturers and pharmacists, the policy has improved access.
"The next step is international benchmarking, which should lower prices further within a few months," says the health department's Anban Pillay, adding that substituting R&D drugs with generics has also helped increase affordability.
The switch to generics, however, hasn't come without resistance. Recently, global pharmaceutical giant Pfizer said switching from its cholesterol drug Lipitor to the generic, Simvastatin, could increase the risk of death.
But Discovery Health and government dispute that. The jury is out on whether Pfizer misrepresented the research data to lift Lipitor sales amid a rise in the use of low-priced generic drugs.
Access to health care is also about bringing private health care to ordinary people.
That's why there are thousands of pharmacists and private doctors operating in townships and rural areas. Conspicuous by its absence in densely populated areas like Mitchells Plein, Mdantsane and KwaMashu is the highly priced private hospitals sector, notably the big three: Life Healthcare, Medi-Clinic and Netcare.
