WeeklySA_AdminDISPARITIES: Unequal distribution of resources and increasing disease burden some of the issues that have led to a dysfunctional health system in the country…
By Yoliswa Sobuwa
The South African Medical Research Council (SAMRC) president Ntobeko Ntusi has called for urgent reforms to get the country’s dire state of South Africa’s health sector on the right track…
The SAMRC president and CEO’s call follows a recent presentation she made on the state of health in South Africa, in which she highlighted the complex legacy of apartheid weighing down on the public health system, including the unequal distribution of resources between the public and private sectors. Ntusi said the increasing disease burden was one of the issues that had led to a dysfunctional health system in the country.
“The health and well-being of most South Africans remain plagued by a relentless burden of infectious and non-communicable diseases, persisting social disparities, and inadequate human resources to provide care for a growing population, and a crisis of governance in health,” he said.
Ntusi added that the skewed allocation of resources between the public and private sector had led to insufficient health professionals in the public sector. South Africa had the lowest doctor-patient ratio of 0,9 per 1,000 compared to other BRICS countries. BRICS member countries are Brazil, Russia, India, China and South Africa.
“The health system is grappling with poor health management. There is poor quality of care in key programmes, and health workers’ morale is very low. The public sector is experiencing increased litigation because of avoidable errors,” he says. “Even though the country’s poorest people have access to free treatment at 3,800 public clinics and hospitals, this is plagued by broken equipment and shortage of medicines,” he said.
He said only five of the 696 health facilities covered by the Office of the Health Standard Compliance (OHSC) in the recent report met 80% of their required performance criteria in areas such as drug availability and proper infection control.
The situation was made worse by the growing burden of disease. Health experts had been warning about the non-communicable disease epidemic which was driving morbidity and mortality. According to Stats SA, deaths due to non-communicable diseases such as cardiovascular disease, cancer, diabetes and chronic lower respiratory disease increased by 58.7% over 20 years.
In the same breath, South Africa still had not a handle on infectious diseases like TB – a leading cause of death claiming 54 000 lives in 2022.
“Despite the huge burden of TB infections we don’t do well with notifications, these are always far lower than the number of people diagnosed with TB. As it can be noted, still driven by the HIV epidemic, there is a high rate of mortality from TB in this country,” he said.
Ntusi said substantial advances have been made in treatment of HIV and TB which saw improved clinical services and robust programmatic care. But the treatment cascade for HIV and TB remain suboptimal.
“The ideal situation would be to have 100% of people with HIV and TB diagnosed; 100% of those on treatment; and 100% of those treated to either achieve a durable cure for TB or sustained virological suppression for HIV”.
In the global efforts to end HIV as a public health threat, the UNAIDS set the 95-95-95 target that by 2025: 95% of people living with HIV know their status; 95% of people with HIV are on treatment; and that 95% of those on treatment have viral load suppression. Currently South Africa’s numbers are: 94.2-78-89.
“Also the intersection of infections and non-communicable diseases warrants serious attention”.
Studies suggested that several infections might influence the development of many non-communicable diseases. According to research the presence of infectious diseases such as HIV and TB coexist with elevated blood glucose and blood pressure.
Poverty and socio-economic disparity were among the greatest obstacles facing South Africans impacting heavily on healthcare. This led to a hostile environment characterised by worsening social disparities and social determinants of health.
To address these issues, Ntusi highlighted the need for strong, ethical leadership, adding there was a need to measure, monitor and evaluate health services to ensure a high quality of care in the health system.
While bodies such as the Office of Health Standards Compliance exist, Ntusi said, to make it more impactful, there was a need to strengthen the health system ensuring that there is sufficient staffing, functional equipment and infrastructure, no corruption and appropriate funding of healthcare.
Meanwhile, Ntusi’s critical assessments align with the recent findings by a panel appointed by the Academy of Science of South Africa. The seven-member panel was made up of a multidisciplinary group of South African public health and health systems researchers, academics and practitioners
The panel found that South Africa’s healthcare system suffered from widespread problems in its governance. A number of indicators pointed to this dysfunction, it said.
“These include the large number of managers in acting positions, frequent changes in senior leadership, worse health outcomes than similarly resourced countries, and overall deterioration of morale and trust in the public health system,” the panel said.These indicators confirmed that there were system-wide failures, and that much needed to be done to improve governance of the South African health system.
The findings underlined that poor governance results from many interrelated factors, highlighting the fact that the country’s complex health system was still influenced by its historical context of colonisation, exclusion, fragmentation and inequity.
Pockets of excellence
However, it was not all doom and gloom, as the panel pointed out that there were examples of good service and health workers committed to their jobs and to providing good, even excellent care. These “pockets of excellence” could be found across the country and at all levels in the health system. Drawing from these pockets of excellence, the panel was able to make recommendations about how to improve South Africa’s health system.
The panel made eight key recommendations to get the public sector on track, including:
· Define and communicate a clear public value mission and the mandate for each level of the health service and each governance actor;
· Get the right people – ethical people with the appropriate competencies – into leadership and management positions within the health system;
· Delegate authority appropriately to each level and within levels of the health system;
· Update legislation and governance structures to insulate them from vested interests and give them executive rather than merely advisory functions;
· Support managers at every level with the resources, understanding and ability to build teams and attend to the relationships that make complex systems work;
· Harness the potential of community participation in an authentic way to ensure appropriate, respectful and responsive health services and to monitor health service outcomes and processes; and
· Act on dereliction of duty and acts of corruption and protect whistle-blowers.
South Africa has a two-tiered, and highly unequal, healthcare system. The public sector is state-funded and caters to the majority – 71% – of the population. The private sector is largely funded through individual contributions to medical aid schemes or health insurance, and serves around 27% of the population. South Africa ranked 50th out of 94 countries on the 2024 Global Healthcare Index. – Health-e News. Additional information from The Conversations
