The Presidential Health Summit held on Thursday and Friday last week set out ten key areas targeted for intervention to meet the South African government's objective of advancing the introduction of National Health Insurance (NHI).
It's the second iteration of the Summit, but at the start of this second five-year cycle, the backdrop remains one of multiple systemic crises in healthcare. There also remain unanswered questions about the overall inaction or slow progress from the first summit in 2018.
Some long-standing health sector challenges have included failing infrastructure and maintenance of hospitals and clinics, staffing shortages at crisis levels, widespread corruption that goes unpunished, political interference and poor governance, mounting medico-legal claims and costs arising from sub-standard treatment and care, and patient experience of clinics and hospitals marked by high levels of dissatisfaction and distrust.
There is also the question of the impact of government not having in place a stronger strategy to end the rolling blackouts that have worsened to higher stages of loadshedding at greater frequencies with each passing year. Knock-on effects from blackouts are causing disruptions of service delivery in the healthcare sector, putting patients and lives at risk.
'Health revolution'
In his speech on Friday, President Cyril Ramaphosa said the groundwork of the 2023 Summit would lead to a "health revolution" in the country in realising universal health coverage - the aim for more equitable healthcare access for all. The NHI Bill that was presented to Parliament in 2019 will be debated in the National Assembly next month, Ramaphosa said, thereafter the National Council of Provinces will consider the bill. (You can read the written version of his speech here. It differs slightly from the speech he delivered in person.)
"We were fortunate in that we put the legislative wheels for NHI in motion before the pandemic," Ramaphosa said. "We need to implement the pillars of the compact if our country's health system is to be prepared for NHI; so what we are doing here is really preparing work for the health revolution to take place."
The ten pillars of the 2023 Summit are:
human resources
access to medicines, vaccines, and health products
infrastructure planning
private sector engagement
quality, safety, and primary healthcare
public sector financial management
leadership and governance
community engagement
health information systems, and
pandemic preparedness.
Pandemic preparedness is the newly added tenth pillar in the 2023 Health Summit agenda. It aligns with African Union healthcare goals. Ramaphosa said, "Having been appointed COVID-19 champion by the continent has put us right at the centre of what we need to do - not only to have responded to COVID-19 but also how we need to prepare for future pandemics.
"The African Union's public health order ... is a continental health security policy that is anchored on five pillars. These [include] strengthening public health institutions; financing of health, which should really underpin the continent's ability to have a robust health system, attaining biotech sovereignty through local pharmaceutical manufacturing ... and also action-oriented partnerships as we forge partnerships with a variety of partners across our continent and across the world," Ramaphosa said.
While he said COVID-19 and the subsequent lockdowns were major disruptions it should be a time now for a "stock take" and what he called a "launch pad" to build on the wins of the public-private partnerships and building resilience in the sector. During the pandemic response the two sectors collaborated strongly on the vaccination programmes and the creation of the electronic verification data system. The healthcare sector though severely pummelled by the pandemic did withstand total collapse.
Spotlight on corruption
Ramaphosa was scathing of corruption in the healthcare sector. At the height of the COVID-19 crisis, the then health minister Zweli Mkhize - who was also Ramphosa's key rival for ANC leadership in December last year - was implicated in corruption scandals that saw him being forced to exit the post.
Ramaphosa said, "All the crooks and the thieves conspire; it is in healthcare where they are waiting to plunder and where they're going to siphon money ... So making funding available should mean that we need to use money properly. We need to watch the money that is given [to] the health sector with a hawk's eye and make sure that it is properly used - no overcharging, no overspending, or incidents of non-spending because sometimes money is not spent because people are trying to find ways of siphoning the money."
He lauded investigations by the Special Investigating Unit (SIU) and said stronger partnerships with civil society and the protection of whistle-blowers were essential as ways to improve oversight and accountability.
Daily Maverick last week reported that of around R8 billion in COVID-19-related irregular expenditure identified by the SIU, only R36 million have been recovered so far.
The President also called out healthcare workers who are moonlighting and defrauding government and taxpayers in illegal payments for hours worked in the public sector and those who are mistreating patients with bad attitudes and unprofessional conduct.
"To develop a motivated, capable, compassionate workforce, we are working with medical schools, nursing colleges, and other healthcare training institutions; so that those who are at the frontline, the front desk of treating people, should demonstrate their compassion. They must demonstrate their care. The arrogance that sometimes seeps through ... should be something of the past. Our people must be taken care of with delicacy, with real love, and compassion. Government must invest more in training programmes for healthcare professionals and increase staffing levels to meet the population's needs... And community healthcare workers should be integrated into the national health issue; I agree fully with that," he said.
'Teething problems'
Ramaphosa added that there is a need to expand public awareness of NHI. He also said that NHI is having "teething problems" but added, "Working together [to find solutions] includes implementing policies - policies that address poverty, that address education, housing, transportation, and environmental factors that impact health outcomes by addressing social determinants of health across sectors."
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Recommendations
The Summit closed with a set of recommendations that came from the 750 in-person delegates and about 700 online participants over the two days. These were highlighted by Dr Olive Shisana, special adviser to the President.
Among the recommendations were new nursing qualifications being "ramped up" through greater collaboration between the private and public sectors; recommendations for alternate resolution mechanisms for medico-legal claims to curb rising bills from maltreatment and malpractice cases against government; better assessment and monitoring tools to measure the functionality of clinics and hospitals; and better reporting systems to regulate and account for remunerative work outside of the public service. This Shisana called "a problem that we have had for a very long time".
Other recommendations included incentivisation schemes for provinces that manage their health budgets efficiently and a no bail-out policy for those provinces that fail. There was also a call for better use of technology, including speedier action to create digital patient records that will be implemented with the necessary back-up support. This would have to include the necessary equipment, connectivity, trained staff, and power supply at all facilities across the country.
Note: Most sessions at the summit were not open to the media and we could thus not report on these sessions directly.
