11 February 2016

South Africa: Strategic Direction Around South Africa's Health Policy Has Deteriorated to Almost Nothing


Health did not get significant attention in South African President Jacob Zuma's State of the Nation address. The main points he mentioned included the fact that life expectancy had significantly improved to 62 years across all genders; that the HIV policy introduced in 2009 had led to massive increases in testing and treatment for the 3.2 million people who are on ARVs and that a white paper on National Health Insurance had been released in December 2015 to improve health care for everyone.

Health and Medicine editor Candice Bailey spoke to Professor Alex van den Heever to probe the health issues facing South Africa. You can listen to the interview and read our transcript below.

Did the president say anything significant about health?

The president has provided information that you can get on a website and has not been able to appropriately outline a strategic policy direction going forward. It shows that the strategic direction around health policy has deteriorated to almost nothing.

There was a loose mention of the white paper, which is something that will only be implemented in 25 years from now. There will be five government terms before the promises can be tested. What we need are plans for the next five years and not plans that are so far in the future that they are meaningless.

The country cannot afford to have a failing health system, whether it is in the public or private sector. The issues the president mentioned are peripheral initiatives and do not address many of the systemic problems that are the major concerns facing the health system now.

What are some of the problems in the health sector at the moment?

We have not implemented the district health system policy recommendations, which were first introduced in 1994. These would give districts the power to make local operational decisions around the provision of health care and strengthen the performance of clinics and their related referral services.

There are structural workforce problems which result in poor management of staff. In certain provinces, specialists are spending up to 40% of their time working improperly in the private sector. There is systemic abuse by nurses, who are absent from the public sector because they are contracted to work in the private or in another area of the public sector. This has a major impact on the quality of care.

There are billions of rands in contingent liabilities that are building up as a result of poor nursing and medical staff that are not on site. This results in the medical negligence cases that now cost billions.

We have an under-performing emergency care system where many trauma patients are treated too late. And there is an inadequate information system so we cannot even manage health care problems efficiently - or even know where they are. It means that the public also can't assess what is going on.

The community is excluded from the oversight of the public service and they should be centrally involved in the delivery of health care. It entrenches accountability in the system.

If I were making strategic policy these would be some of the considerations. Zuma's approach suggests there is no strategic policy underway.

The president mentioned a massive HIV prevention campaign that will be launched soon. What do you make of this?

South Africa has had a prioritised prevention campaign between 1994 and 2002. That was all they did. After 2002 they introduced treatment as well. What we need to know is what is new that is going to be done.

Prevention is obviously an important measure but there are so many other critical issues to address. This should be part of a coherent package of reforms.

The president said the Department of Social Development and National Treasury would create a comprehensive social security reform paper. Why is this important?

This issue was first introduced in a State of the Nation address in 2007 and then in the budget speech of the same year but nothing has ever come of it. It is an important matter because it is contained in the Constitution's Bill of Rights, along with health care.

The government has taken no reasonable steps to implement these provisions, which would ensure a basic system of appropriate income protection for every South African resident. This would include protection against death, disability, illnesses, poverty and unemployment via a harmonised system of state and regulated private benefits.

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