The crisis in South Africa’s public healthcare system seems to deepen by the day, despite new Health Minister Aaron Motsoaledi’s claims to the contrary. In fairness to Motsoaledi, he has to wrestle with the legacy of policy incoherence and official miserliness left by Thabo Mbeki.
As we report today, the ANC has consistently underfunded state hospitals and shifted resources away from them amid of a burgeoning Aids epidemic. State health spending per citizen declined after 1996, returning to the same levels almost a decade later.
A further toxic inheritance of the Mbeki era is the greatly increased cost burden of treating the millions of South Africans infected with HIV. If he and his deluded former health minister, Manto Tshabalala-Msimang, had faced the facts and acted promptly, many sick people might have avoided infection.
One consequence of systematic underfunding is the absurdly low pay of state healthcare workers and their often inhumanly long hours. It is a national scandal that interns in state hospitals, who have completed a demanding medical degree, earn R9 000 a month and sometimes work 180-hour weeks.
An independent study commissioned by the South African Medical Association (Sama) has revealed that junior doctors earn less than half the salaries of similarly ranked public sector accountants and specialist doctors a fraction of what engineering managers take home. Compounding the pay complaints are widespread shortages of vital medical equipment and staff shortages, including 11 000 vacant doctors’ posts and a 50% shortfall in nursing staff at the country’s 386 public hospitals.
The warning signs were there two years ago, when nurses, not noted for their labour militancy, launched an acrimonious national strike. Their plight was partly addressed in subsequent negotiations on an ”occupational-specific dispensation”, but doctors, also promised pay adjustments, are still out in the cold. Their anger is approaching boiling point.
It is in this context of system failure that the government is seeking, hastily and without public debate and scrutiny, to introduce a national health insurance (NHI) scheme.
There can be no objections on principle to national insurance, which aims to make decent healthcare available to all South Africans, regardless of socio-economic status. It makes sense for those who can afford expensive private healthcare to subsidise those who cannot.
Social democratic Europe pioneered socialised medicine and it has worked well in those countries. But Britain and Scandinavia had functioning hospitals, efficient state bureaucracies and buy-in across the social spectrum when they introduced NHI.
Health insurance will not fix South Africa’s chronic failures of financial and human resource management, low staff morale and equipment shortages. Public hospitals must be rehabilitated into service providers the public trusts and wants to use.
Trust — the belief that government planners know what they are doing and have laid the infrastructural and actuarial foundations for what will be a very complex exercise — has not been served by the secrecy in which planning has been shrouded.
Everything is happening behind closed doors; this week the official driving the process, former director general of health Olive Shisana, refused to discuss the NHI with the Mail & Guardian.
Too many large state projects — from Coega to outcomes-based education — have run aground because ideological zeal has trumped careful planning and implementation. The risk is that an ill-planned and ill-constructed NHI scheme will put intolerable strain on services that are already close to collapse.
The little box in your lounge
SABC boss Gabs Mampone gatecrashed the Redi Direko Show on Talk Radio 702 last Thursday where discussion about the poor state of the corporation’s finances in general turned to the specific issue of stalled payments to the local production sector.
As the industry tries to make sense of Mampone’s projection that 40% of local production could be done by the SABC in-house in the future, it’s worth pausing for a moment to consider the little box in your lounge. While the soap continues to flow from it unabated today, there are dramas behind the scenes that are beginning to shape the content of tomorrow.
The idea of free and open public broadcasting implies that the public should choose what it wants to watch. The huge traffic the M&G Online site experienced this week once it put up the Special Assignment report on satire that the SABC had pulled testifies to the public’s desire to exercise that choice.
For television producers today, it is clear that if a broadcaster does not want to show their work there are other ways of getting it seen. We expect our public broadcaster to be responsive to what the public wants. We expect it, for our licence fees and our taxes, to keep the party bubbling. And not just for its own executives, who have been partying in Cannes, but for the nation at large.