A healthcare system in crisis: The long road ahead
A Speech by Sibongile Tshabalala, TAC National Chairperson, 11 June 2019, SA AIDS Conference Opening Plenary, Durban
I would like to take this moment to acknowledge the Deputy President, DD Mabuza; the Health Minister, Dr. Zweli Mkhize; the Premier of KwaZulu Natal, Sihle Zikalala; MECs for health; the organisers of the SA AIDS Conference; the media; delegates; and importantly, people living with HIV who managed to make it to the conference. We also acknowledge those who could not make it as a result of many factors such as the high cost of conference fees and the need to work in order to feed their families, amongst others.
Comrades, the ninth SA AIDS Conference occurs during a critical juncture in South Africa’s history.
We meet at a time when AIDS denialism is beginning to recede in the nation’s collective psyche.
A time where South Africa has the world’s largest HIV treatment programme.
And let me pause here to acknowledge the tremendous work of former Minister of Health Dr. Aaron Motsoaledi in building the HIV treatment programme.
But we also meet at a time where corruption is rampant.
While the disgraceful details of state capture are being exposed in commissions of inquiry – much corruption in our provincial departments of health goes unreported and unprosecuted.
Comrades, we are being trampled down into the dirt by the co-epidemics of corruption and mismanagement.
These are the co-epidemics behind the Life Esidimeni tragedy, behind the disgraceful cancer crisis here in KZN, and the looting of the HIV Conditional Grant to pay Buthelezi EMS in the NorthWest.
Honourable Deputy President and Minister of Health, if you have any doubts of the scale of the crisis, I urge you to study the reports of the Office of Health Standards Compliance.
Let me focus on one symptom of these co-epidemics. Stockouts.
Comrades and friends, as some of you know, the Treatment Action Campaign turned 20 in December last year. As one of the foremost social movements in the country, we have been monitoring drug availability in health facilities for much of those two decades.
According to PEPFAR data, in 2018, around 750 thousand people were initiated on treatment but only around 400 thousand additional patients were retained by the last quarter of the year.
What happened to the other 350 thousand people?
Through our ongoing monitoring campaign, which recently focused on the Free State and Gauteng provinces, PLHIV sector members found that many facilities still undergo drug shortages, or worse, stockouts.
As part of the Stop Stockouts Project, 673 facilities were monitored by members of the PLHIV sector and other comrades within the past two months. We found that of the health care facilities monitored, 109 facilities in the two provinces had drug stockouts of Dumiva, a key antiretroviral. 106 overall did not have injectable contraceptives. When our publication Spotlight travelled to the Northern Cape, they found many facilities with no stock of basic medical supplies such as bandages, plasters and intravenous drips.
It is heartbreaking that as we stand here today in 2019, some of the same issues from a decade ago still plague us.
We cannot run away from the fact that the health system that you are inheriting, Honorable Minister, is one that is in dire need of resuscitation.
Often we have stockouts simply because our healthcare system is in such a terrible state that medicines pile up in depots while clinic shelves are empty.
When the problem is with the supplier, it takes months for the news to filter through to clinics and for the department to provide advice on alternatives – as has just been the case.
Honourable Minister, patients are being turned away. Patients are being told to go pay R900 for Dumiva at private clinics.
Stockouts is one thing. But there are also long queues, often demoralized healthcare workers, a lack of confidentiality. These are all symptoms of the mediocrity and dysfunction in our healthcare system.
We do not accept this.
We do not accept that the price we have to pay for accessing healthcare services is to give up our dignity.
So what do we ask?
We as the Treatment Action Campaign, the PLHIV sector and public health care users call for the urgent prioritization of health care through an access to healthcare ‘bailout’ starting with the during the October budget review. In real terms our health budgets have been falling while the need for healthcare services has grown. In simple terms, we need money so that we can employ more healthcare workers.
We urge government to root out corruption in our provincial healthcare systems and to ensure only appropriately qualified persons are appointed in these departments. We will hold you responsible if the co-epidemics of corruption and mismanagement are not dealt with.
We urge the new national and provincial administrations to prioritise the welcome back campaign, in order to trace people who are missing and link them back to care and treatment.
Our HIV response is already beginning to unravel.
In order to get it back on track, we have to transform our healthcare system into a place that affirms human dignity rather that degrades it.
Comrades, Deputy President, Minister, Premier, MECs, we are not anti-government.
But please understand that we are a membership-based organizations andour responsibility is to our members and to the poor.
We are guided by this responsibility and by the Constitution of South Africa and the right to access healthcare and the right to dignity.
We will work with government in instances where it is in the best interest of our members and of the poor to do so.
But we will also hold you accountable to the highest standards.
Our lives, our dignity, is not negotiable.
I thank you!