By Dr Ndiviwe Mphothulo
We need to amend the National Health Act (No. 61 of 2003) so as to give the Minister of Health greater powers to intervene in provinces and avert disasters in provinces. If we do not, the Minister’s hands will remain tied when it comes to the next Life Esidimeni, the ongoing oncology crisis, and the non-placement of medical interns, argues Dr Ndiviwe Mphothulo.
In 1994 a democratic government was finally elected in South Africa. Soon after, section 27 of the Bill of Rights in the Constitution of South Africa placed an obligation on the this democratically elected government to develop legislation and implement measures to ensure that the rights (including the right to access healthcare services) enshrined in the constitution are realised.
The first task of this democratic government was to do away with the historical injustices of the past. The fragmented, apartheid South African healthcare system that had 14 health departments serving four different races was abolished by the new government in 1994.
The South African public healthcare system has made a number of major advances since 1994. These include, but are not limited to;
- free primary health care,
- greater parity in district expenditure,
- the essential drugs programme,
- choice on termination of pregnancy,
- the hospital revitalisation programme,
- anti‐tobacco legislation,
- an improved immunisation programme,
- community service for graduating healthcare professionals,
- training of Clinical associates,
- improved malaria control, and
- the biggest ARV treatment program in the world.
With all these commendable gains, our health system still faces major challenges. These include:
- the quadruple disease burden of explosive HIV and TB epidemics, a high burden of chronic illness, injury and violence, and the epidemic of maternal, neonatal and child mortality,
- Severe shortages of doctors and other healthcare professionals in the public sector, and in rural areas,
- the current funding model which sees South Africa having a two-tier healthcare system: the private sector providing for 16% of the population but utilising a greater proportion of health GDP compared to the public sector that provides for 84% of the population.
- Poor leadership and governance in provinces.
According to the World Health Organisation (WHO) the functions and objectives of a healthcare system are to impact positively on the health status of its community. To achieve the objectives of responsiveness, fair contribution and distribution, new financing mechanisms will be required to provide the much-needed funds to health systems across the world – but critically, it will also require leadership and stewardship.
The crisis in the North West Province, where the department of health was facing near collapse (due to poor procurement procedures), interns and community service doctors and pharmacists not getting placed due to lack of budget for their posts in different provinces, the near collapse of oncology services in KwaZulu Natal, the Life Esidimeni saga in Gauteng, doctors not receiving salaries in other provinces, all point to poor leadership, collapsed governance and lack of stewardship in provinces.
Some parts of the National Health Act (No. 61 of 2003) make it impossible for the National Department of Health (NDoH) to intervene in provinces. According to the act, one of the responsibilities of the health minister is to “endeavour to protect, promote, improve and maintain the health of the population (within the limits of available resources).
But the people who drafted this act never envisaged the potential negative consequences of giving powers to provinces. As pointed out by Minister of Health Dr Aaron Motsoaledi on various occasions, the Minister of health is unable to deal with the following issues:
- The Human resource system,
- financial management and budgeting,
- procurement procedures, and
- maintenance of infrastructure.
This means that legally speaking the Minister can do little more than watch as tragedies like Life Esidimeni unfold, as Interns are not placed at various hospitals, as oncology services in provinces collapse, and as crises in provincial health systems deepen. The Minister has no legal powers to intervene except for asking cabinet to place provincial departments under administration or holding provinces to account through the office of the health ombudsman. This situation is clearly untenable.
We urgently need to amend the National Health Act (No. 61 of 2003) so as to give the minister more powers to intervene in provinces and avert disasters in provinces.
Note: Mphothulo is writing in his personal capacity. He is the North West Representative of the Rural Doctors Association of South Africa, a board Member of the Southern African HIV Clinicians Society, and South Africa’s 2015 rural doctor of the year.