"The public sector has a problem, but three provinces are the most problematic – it's Gauteng, Limpopo and the Eastern Cape. We've replaced the healthcare system with the 'tender-care' system and it's the ANC that must repair that. People went out on a rampage, ordering things that had nothing to do with healthcare. It's been happening on a massive scale in Gauteng and Limpopo for some five or 10 years – and now we are paying the price," he said.
He said those who issued health tenders for things that had nothing to do with health were driven by "uncontrolled commercialism".
Motsoaledi was addressing an event held on Wednesday evening by the ANC's Rivonia Heroes Ward 106, a branch of the ruling party which encompasses affluent parts of Rivonia, Bryanston and Woodmead.
The health minister gave an abridged version of the presentation on National Health Insurance (NHI) that he gave at the ANC policy conference earlier this year.
Motsoaledi said there were instances in which hi-tech equipment was bought from reputable companies but their maintenance programmes were shunned in favour of BEE contractors who had "never repaired a machine in [their] life".
"It causes havoc in the healthcare system," he said.
The result was that some machines that broke down in public hospitals are thrown away and replaced with new ones instead of being repaired. "It costs eight times more than it does to repair," he said.
"We need to have equipment that is essential and it must be repaired by people who are hired by the state, not people who are given [a contract] because they are a BEE [company]. I'm not fighting BEE but it cannot happen at the expense of our people," he said.
Motsoaledi also complained about the tendency in private hospitals towards a "medical arms race" where expensive, nonessential equipment was purchased and the price passed on to the consumer.
Health system overhaul
During the presentation Motsoaledi outlined various projects that the health department is pursuing in order to move towards a preventative healthcare system, that will head off health problems before they becomes more serious and costly to treat.
Apart from improvements in infrastructure and management, there is a R1.2-billion plan to upgrade and expand the country's nursing colleges and a scheme to increase the number of doctors that the country produces each year from 1 200 to 3 600. This will involve increasing the number of places available at the country's medical schools, opening a ninth medical school in Limpopo, and increasing the number of rural students sent to study medicine in Cuba from 80 to 1000.
"When you train human beings it's not expenditure, it's an investment," he said.
Motsoaledi also flighted a number of regulatory measures that would help improve the functioning of the health system. These include an Office of Standards Compliance, which will set minimum health standards that all health facilities must abide by. The establishment of hospital boards – which will function similarly to school governing bodies – will ensure that there is community oversight over healthcare facilities.
A school health programme, to be run in conjunction with the department of basic education, would also ensure that every child who attends school will have hearing tests, eye tests and immunizations. They would also be taught about hygiene and, later, substance abuse and family planning.
Towards universal healthcare
Motsoaledi said that the route to NHI was a 14-year plan and that the first five years would be focused on piloting the plan in 10 districts around the country.
He defended the ruling party's push for universal healthcare, saying people who opposed the formation of the NHI in South Africa were "opposing something they don't understand".
"NHI is not a beauty contest between public and private. It means both public and private must work together for the healthcare of the population. It means public healthcare must be of good quality and it means private healthcare must be affordable," he said.
Motsoaledi said that there was a global movement towards universal healthcare and that countries poorer than South Africa had taken meaningful steps to achieve this.
However, he shied away from questions on how the state would pay for NHI.
"I must not be asked questions about how we're going to finance NHI, It's not my job. It's [the job of] the minister of finance," he quipped.
He quoted World Health Organisation director-general Margaret Chan, who earlier this year said: "Moving towards universal coverage is never easy, but every country – at any level of development, and with any level of resources – can take immediate and sustainable steps in that direction."
He also moved to quell fears that government planned to end private healthcare.
"In the ANC there's no policy that says we must abolish private healthcare. That's not what we're fighting. What we're fighting are the excessive prices [of private healthcare], which even the middle class can no longer afford," he said.