The right to health is enshrined in the SA constitution. With its proud history - including the performance of the world's first heart transplant - SA's health-care industry should be well equipped to ensure that this right is realised. However, modern-day pressures - from global epidemics to the economic crisis - are placing new strains on industry players, and innovation is required to tackle these challenges.
A look at the private hospital sector, for instance, shows that there is a unique set of dynamics that must be addressed. "There are 31 500 hospital beds in the private sector, servicing about 10m people. The private hospital sector has about 2m patient admissions each year," says Hospitals Association of SA (Hasa) CEO Kurt Worrall-Clare.
He says though the moratorium placed on new private hospitals by former health minister Nkosazana Zuma in 1996 has been lifted, it has left a definite legacy. "Authorities are reticent when it comes to giving out hospital licences," he says - an unfortunate circumstance, given the uneven geographic spread of private hospitals.
"Already, we're seeing a dearth of specialists, which in a few years may escalate to a critical shortage" - KURT WORRALL-CLARE
Also distressing is the fact that, according to a Hasa study, medical admissions have increased by 35% over the past five years. Worrall-Clare says that this is a consequence of the endemic disease burden, and more disturbingly, an indication of the effects of HIV/Aids, as patients are presenting with symptoms that wouldn't require hospitalisation, were it not for compromised immune systems. During the same period, however, the number of private hospitals grew by only 1%, on average, annually - and if this trend continues, he warns, the sector will soon reach a stage where it is unable to meet patient demands.
These issues underline the need for a global study of public and private bed representation, both in terms of geography and health-care needs, Worrall-Clare says - and a similar report to obtain a precise snapshot of human resources wouldn't go amiss, either.
Human resources is, in fact, a particularly prickly area in the private sector, given the public sector's belief that its more affluent counterpart has lured away the lion's share of the industry's skills. The reality, according to Worrall-Clare, is that since the public sector has improved salary scales, particularly for scarce skills, professionals are as likely to move from the private sector to the public, and in fact, movement between the sectors is common.
Far greater threats are posed by international employers, who are able to offer more lucrative salaries; and the inability to train sufficient human resources annually.
At the core of these challenges is the fact that medicine appears to hold little career appeal among today's youth - health sciences are among the most poorly represented when it comes to university student intakes. "A study conducted by Dr Clarence Mini, focusing on the graduation of health professionals from eight medical schools, shows that the number of doctors graduating from tertiary institutions has remained unchanged at less than 1 200 for the past eight years - and we require significantly more than that," Worrall-Clare says.
Blame the lack of resources, budgetary allocation or capital at universities, but the fact remains that more can be done: "For years, we've tried to encourage partnerships between institutions and our excellent private sector, which would facilitate HR training - but our call hasn't been heeded."
This may be because of concerns that big business would push a financial agenda. But Worrall-Clare insists that this threat could be effectively contained with the implementation of a strict ethical code and sincere partnerships between the two sectors. This is an area where the distrust between the two sectors has affected policy-making decisions, he says.
"Already, we're seeing a dearth of specialists, which in a few years may escalate to a critical shortage. We also need to look exactly where those shortages lie," he says, and use this as a basis for developing national policy.
WHAT IT MEANS
 Hospital admissions have risen by 35% in the past five years
Number of private hospitals grew by 1%
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He's emphatic on the point that this national policy needs to span both sectors and specifically address common denominators. "For example, we need to look at emerging disease trends in SA and tailor our response accordingly. So, if the rising incidence of cardiac disease among women is a concern for the private sector, we need to question whether the public sector is experiencing the same phenomenon."
Linked to this, Worrall-Clare says that the country needs to start taking a more proactive approach to health issues, rather than responding to crises as they emerge, which is the current pattern.
The state also needs to reach a point where it has the resources and infrastructure to respond swiftly to unexpected developments, such as the recent outbreak of H1N1. Worrall-Clare believes that such an approach could be made possible with the establishment of a task team - comprising members of both sectors - to provide guidance.
This, however, hinges on the establishment of better relations between the two sectors.
Other steps that need to be taken include implementing a combined approach to HR training, including addressing issues related to the Health & Welfare Seta, and getting the correct qualifications on board; and most importantly, training a contingent of specialists and nurses.
Worrall-Clare says that it's unrealistic to expect significant additional resources to be allocated from the budget for these activities, especially given the strain the economic downturn has placed on the tax base. That means the resources that are available must be put to more efficient use. This, in turn, requires improved processes, better monitoring of how resources are used, improved management of facilities and increased information sharing between sectors. At the same time, Worrall-Clare says that he hopes to see the sector achieve the delicate balance between encouraging incident reporting, and appropriately dealing with players responsible for such incidents. This will help to identify areas for improvement, he says.
Ultimately, the path to a more cohesive approach to health policy lies in improved relations between both sectors, he says.
