by Chris Bateman
Even with the best possible value for money from both the public and private healthcare sectors, there is not enough money in the system to give all South Africans the care the country aspires to. This sobering assertion comes from Professor Eric Buch, Deputy Chairperson of the Inter-ministerial Task Team on Human Resources for Healthcare, during a wide-ranging panel discussion on the country’s healthcare worker crisis on the final day of the Hospital Association of South Africa (HASA) annual conference on Cape Town’s Foreshore on Wednesday, 28 August. The discussion, moderated by Dr Paul Soko, Head of Life Healthcare’s Clinical Directorate, centred on the country’s healthcare human resource challenges and the opportunities an incoming NHI might provide to turn things around.
Professor Buch, the head of Health Policy and Management at the University of Pretoria and Chairperson of the National Health Laboratory Services, (NHLS), says a comprehensive human resources report involving a number of key workstreams will be tabled at a national stakeholder meeting on September 9th. He says what struck him forcibly in numerous interactions with Health Minister, Dr Zweli Mkhize was his willingness to take the best advice available.
“We asked him a number of really tricky questions and put various dilemmas to him and his response was to ask us put together what we thought was the best strategy, no matter how unpalatable it might be. He wants to get things out there, like the NHI, and then engage over it,” he said.
Determined to get it right
Professor Buch said his task team was determined not to produce, “yet another tired strategy that says the same things and sits on the shelves. We’re looking to tackle areas where strategies haven’t worked before in a new approach. We want to drive implementation this time around. Out situational analysis and view are that a lot of what was supposed to have been done wasn’t.” A core area his team tackled was the lack of available clinical posts in the public sector while addressing anomalies like private sector over-servicing and the inverse proportion of C-sections performed in the private sector versus the public sector (80%-20% split) – and preventing public sector looting, thus freeing up more funds.
“There are huge problems in the public sector, but maternal mortality, the single most important indicator of health system performance is dropping. The key will be using the money better. Nobody’s saying we can deliver on all the NHI promises, but huge change is possible and potential is going to be unlocked, for example in access to cataract surgery.”
Professor Buch cited Section 27 of the Constitution to contextualize his lack of funds assertion, (given the economic realities), saying the NHI was a courageous attempt to provide people with the required progressive realisation of access to healthcare.
Dr Soko said something was drastically wrong when, of 32 000 doctors registered with the Health Professions Council of SA, (HPCSA), 12 000 of them were specialists, of whom 8000 worked in the private sector with 4000 in the overburdened public sector. He said the disparity of income for doctors and allied healthcare professionals was far greater between the two sectors than it was for nurses, although similar critical shortages existed. This partly explained the specialist ratio imbalance, though private hospitals were being forced to hire nurses through agencies, with many nurses moonlighting between sectors.
Professor Lungile Pepeta, Executive Dean of the Faculty of Health Sciences at Nelson Mandela University, said a quarter of his specialists at the Port Elizabeth Academic Hospital Complex were going abroad with no available posts or a State strategy to stop them. The only HR report I know of dates back to 2011 (the Pick Report). Now a second one is being drafted and I’ve not even seen the first! he complained.
“There’s no approved organogram for our hospital complex. In SA we make lots of plans, but don’t implement them,” he added. He amused the audience with an anecdote of encountering the same senior nurse he’d just seen remonstrating rudely with a State patient in a public hospital during the day, behaving impeccably towards a patient in a private hospital that evening.
“A mother in a state hospital is no less deserving of respect than one in a private hospital,” he said. Professor Buch said bolstering cadres of mid-level workers was crucial to addressing the crisis. “It’s been shown for example that appropriately-trained nurses can deliver a cataract service at a fraction of the price of an ophthalmologist. Instead of a fully-qualified physiotherapist working three to five times a day with a severely burnt child to avoid post-operative deformity, this could be done by a physiotherapy assistant with two year’s training. We have to shift out skills mix in a dramatic way to make healthcare more affordable,” he said.
Dr Soko said South Africa was at a healthcare crossroads. “The NHI now is to healthcare what Codesa was to us in 1994. There’s a lot of anxiety and uncertainty, but we all agree that we have to engage positively and constructively to sharpen the discourse as we move forward,” he added.