Health-e (Cape Town)
1 July 2009
document
Health minister Dr Aaron Motsoaledi shared his priorities during his first budget speech this week. Urgently increasing the number of women receiving PMTCT and implementing NHI are just some of the issues highlighted by Motsoaledi.
There are two contemporary about healthcare around the world:
(i) the ever threatening H1N1 Influenza which has spread so widely that it has moved up to stage 6. Fortunately it is not virulent but just spreading widely. However I must state that it is under control.
In our country we are able to control it despite the fact that we were having many visitors from all over the world in recent weeks;
(ii) the second issue is the global economic meltdown. It has a great bearing on healthcare around the world, and especially in third-world countries like ours. For this reason, the United Nations Secretary-General, Mr Ban Ki-Moon convened a Secretary's General Forum on Advancing Global Health in the Face of Crisis two weeks ago at the UN Headquarters.
His rational was that the world has learnt during previous economic crises that social outcomes are the first to suffer, and the least to recover during such crises.
He went on to point that during such crises, countries are tempted to cut on social spending such as health. The results are that while rich people inside rich nations may lose their jobs and assets like mansions, luxury cars and other property, these they may recover when the economy recovers. But in poor countries, poor people may lose their life through extreme poverty and poor healthcare, and they will never ever recover this lost life after the crises.
Hence I wish to bring this message home to my own country, that this is the time the poor need protection more than ever before, to cushion them from the devastating effects of these crises. Coming back home the challenges are overwhelming.
During the State of the Nation Address, the President of the Country, his Excellency Mr Jacob Zuma said: "fellow South Africans, we are seriously concerned about the degeneration of the quality of healthcare, aggravated by the steady increase in the burden of disease, in the past decade and a half".
We have no option, but to be fired up to take the bull by the horns in tackling these state of affairs, and deal with it decisively.
Unfortunately, the present events within the public health sector does not help the situation either. Chairperson, I need to mention that we as the governing party started being concerned sometimes back. Hence the resolution at the ANC 2007 Limpopo Conference, that Health and Education be top priorities for the next 5 years and beyond.
To this end, the Government adopted a 10 point plan which is our programme for the next 5 years. The public health system is also forced to carry the ever increasing burden of diseases, obviously made worse by poverty, HIV and AIDS, and other communicable diseases. However, Hon Chairperson, let me accept and acknowledge upfront that some of the factors contributing in no small measure to the problems the health system is carrying, are the following:
· lack of managerial skills within health institutions;
· failure to cut on identified deficiencies;
· delayed response to quality improvement requirements;
· unsatisfactory maintenance and repair services;
· poor technological management;
· poor supply chain management;
· inability of individuals to take responsibility for their actions;
· poor disciplinary procedures and corruption;
· significant problems in clinical areas related to training and poor attitude of staff; and lastly
· inadequate staffing levels in all areas
We are going to be facing all these issues head on and we will do so without fear and favour. We owe it to our country that these issues be tackled head on.
Hon Chairperson, some of the issues I have mentioned as contributing factors to the problems the health system is facing are very urgent and will be dealt with urgently. For instance, Gauteng Provincial Government has already launched "Operation kuyasheshwa-la" to deal with such urgent matters.
Our Programme of Action however with its 10-point plan, has been designed to deal with the issues systematically and in a sustainable manner. Its implementation will be both decisive and incisive.
Hence Hon Chairperson, our 2009/10 - 2009/14 will allocate resources for the following ten priorities in line with the Programme of Action:
(i) provision of strategic leadership and creation of a social compact for better health outcomes
While issues of strategic leadership are very clear, I wish to add up the social compact part of this point speaks to "working together we shall achieve more"
Mooney (2008) also states that:
"The view of patients as passive receivers of health care is being replaced by one of communities as equal partners in decision making about health care priorities, contributing their opinions alongside those of bureaucrats and policy makers"
We shall follow this line very closely.
(ii) Implementation of a National Health Insurance (NHI)
Hon Chairperson, in recent weeks there has been a ranging debate in the public arena about the intended introduction of the NHI by Government. This debate was introduced prematurely by people who wanted to scuttle the NHI as an unworkable system. South Africans were urged to run for cover because the NHI is going to be a marauding monster that will destroy everything that you hold dear in the health care system of the country.
Hon Chairperson, while I am not yet presenting an official document as yet on NHI, because it is a policy that is still to come (though very soon), I wish to make the following known:
· the present system of healthcare financing can no longer be allowed to go on, because it is simply unsustainable. No way can we perpetuate a system whereby we spend 8.5% of the GDP whereas 5% caters for 14% of the population or 7 million people, on the remaining 3.5% caters for a whooping 84% of the population or 41 million people. Nowhere in the civilised world can you find that state of affairs;
· the present model of healthcare financing is just outright primitive, and we are going to abandon it. The General Secretary of the United Nations, Mr Ban Ki-Moon, on the 15 June 2009, which is just two weeks ago, had this to say: "out of pocket expenditure, is the worst form of healthcare financing". That says it all.
Critics of the NHI were hard at work to prove that we are going to overburden the rich, and the economy will not cope.
Hon Chairperson, what is NHI? - it is a system of universal healthcare coverage where every citizen is covered by healthcare insurance, rich or poor, employed or unemployed, young or old, sick or very healthy, black, white, yellow or people of whatever persuation.
It is this part about covering the poor and the unemployed that is bringing discomfort and unprecedented anger in the minds of the enemies of NHI. Let me read the following paragraph of the speech made by Dr Margaret Chan - Director-General of the World Health Organisation (WHO), at the meeting of the United Nations. Dr Chan was the Minister of Health in Hong Kong before taking over as Director-General of WHO: "Fairness, I believe, is the heart of our ambition in global health". A quest for greater fairness dominated the agenda of the UN Forum.
We see this as our concern about vulnerable populations and about health systems that exclude the poor. We see this in your support for global health initiatives and funding mechanisms that redistribute some of the world's riches towards health needs of the poor.
On the issue of fairness, let me again state the obvious. Our word is dangerously out of balance also on matters of health. Differences within and between countries, in income levels, opportunities, and health status are greater today than at any time in the recent history.
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