Will the President cure the health system?
The corridors and floors of Tuynhuys are so shiny you almost want to wear sunglasses. Smiling workers bustle around in the fancy mansion, presumably making sure the engine of government’s highest office is purring along. Almost 800 kilometres away the corridors and floors of Keimoes Hospital in the Northern Cape are so dirty and grimy you fear contracting a disease. There are almost no staff in this sad, hot building, an ill patient moans alone in his bare room, two nurses (the hospital’s only health workers) valiantly trying to get through the waiting patients with few drugs and less medical supplies.
One country, two worlds.
Last week a motley crew of government officials, health lobbyists and others working in the health sector gathered at the President’s Cape Town office, assumingly to hear how we will address problems in Keimoes, the Northern Cape and every other corner of South Africa where healthcare is in code Red.
The invitation to Tuynhuys offered a hint that the outcome of this briefing would be some concrete plans, some detail on next steps: “The President will report on the proposed solutions that the nine Summit commissions developed to enhance healthcare efficiency”.
But first a few steps back to October 19 and 20 last year when most of the who’s who in South Africa’s health sector, past and present, descended on a monster-sized conference venue adjacent to OR Tambo International Airport.
Bureaucrats, activists, politicians, doctors, nurses, health workers, researchers, scientists and academics poured over the sick health system and spoke and spoke for two days in what many believed was a genuine effort to save South Africa’s terminally ill health system.
Christmas came, there was a lot of backroom lobbying, but no real signs that there was agreement that a medicine had been found for the ill patient.
The much-awaited Presidential Health Summit compact – based on the outcomes – that was supposed to be released by December 10, was delayed. It remains delayed.
Fast forward to last week where the President was due to perform the launch of the Presidential Health Summit report at a media briefing at Tuynhuys in Cape Town.
A few journalists gathered in the media room, but were soon outnumbered by men and women in business suits, some good people but with an unhealthy sprinkling of individuals who have been freeloading off the health system’s challenges by selling themselves as consultants or representatives of one or other stakeholder.
The first hiccup was the none arrival of the President. In October last year Ramaphosa also failed to arrive at his own summit, but he had done so on doctor’s order as he battled a nasty respiratory infection.
This time we were told the President had landed at 4am from the African Union meeting in Addis Ababa (the true story was possibly more linked to Eskom which turned the Monday blue with Stage 4 load shedding).
Enter Health Minister Dr Aaron Motsoaledi who read the President’s speech, joined on his right by a group of people seated on gold-coloured chairs and who were introduced as those representing various key stakeholders in the crafting of the President-led plan, the leaders of the various commissions.
Sadly the report and the various speakers did very little to deliver on the promise of “proposed solutions that the nine Summit commissions developed to enhance healthcare efficiency”. The report reads like minutes of the two-day meeting with the “Way Forward” chapter already outdated as the compact is yet to be signed.
Some speakers rambled on about rather being on the train than being left at the station, others rambled on about first having to meet before being able to say how they would contribute meaningfully while others just blew hot air.
The President’s statement released after the launch offered some glimmers of hope: “The Presidential Health Summit 2018 gave us an opportunity to examine our national health system as a patient in its own right and to arrive at a diagnosis that would allow us to intervene and return this system to good health.” Okay, so at least an admission that we had a sick patient.
The President’s speech spoke about the need to prioritise the filling of critical vacant posts so that staff shortages in key areas of the health system can be stabilized, the need for provinces to prioritise their financial resource allocations in a manner that will ensure that the delivery of quality health care, the need to review and develop sustainable financing model to address urgent financial resource requirements and the need to look at a centralised procurement system with standardised procurement systems and a processes to deal with corruption, economy of skills and scale. Imagine what would happen in Keimoes if this was operationalised.
Was there enough in the President’s statement to offer us a way forward, to hold those in power accountable? Do we have a plan that will help us to hold them accountable, to nudge and push and make sure they deliver and work faster and with more urgency?.
Not yet, but time will tell. South Africa is notorious for saying the right things on paper, writing policies that hit all the right notes, but our Achilles heel has always been implementation and even if there is an attempt at some implementation, holding those with the power to account will be the challenge.
The Presidential Health Summit report released last week is not the desperately needed road map, it is not the plan that will take us forward. It is one of many, many building blocks, a part-recording of an important meeting that took place.
And then there is of course National Health Insurance which is already a pre-election playball, but is not moving forwards, backwards or sideways. If those in the driving seats do not tread carefully, we will one day look back and know we missed a crucial opportunity to truly create a health system for all and not one that simply suited the short-term political objectives at the time.
Asked for an update on the progress of the NHI Bill (which was discussed at the cabinet meeting on January 30) Motsoaledi said, “When everything is done and dusted, and the bill is going to parliament we will make an announcement. You just have to be very, very patient.”
So, in short, last week’s “launch” felt like nothing more than ticking a box, releasing a “report” that does not offer the urgent way forward or a road map. It had the feel of a pseudo-consultation with well-selected yes-persons to nod through what has already been decided behind closed doors along gleaming corridors. It appears that for now those in Keimoes and the rest of the country will have to be very, very patient.
This is an illness we have as a country, we convene summits, we appoint task teams, we create war rooms, we write and launch glossy reports and hold press conferences saying all kinds of things, but very rarely does it make a difference.
For now, the reality for Keimoes will remain critical nurse and doctor shortages, drug stockouts, almost no ambulances, dirty floors, long queues, stockouts of basic medical supplies and rampant corruption. For now we have to wait and hope the good people, who have the best interests of our country at heart will find the solutions, the medicine to heal this sick patient.
For an hour and a bit Tuynhuys felt a little like a time warp amid clinking glasses and fresh sandwiches while at the coal face the picture is the polar opposite. The time for window dressing is over, it is time to revive this patient, apply the plasters, administer the drugs and bring in the “doctors” who know how to save this very sick patient. This means having actual consultations with a variety of experts where you actually listen, rather than simply trying to get agreement on what you have already decided is the way forward. Our economy, our well-being, the lives of millions depend on this.