WHEN we talk of transforming healthcare, we tend to think in terms of black and white. How many senior black managers are there in the bigger private hospital groups? How many small black businesses have been set up as suppliers? But transformation goes much further - it's about creating a health system that is truly equitable and provides quality services to all South Africans.
The private hospital sector can play an important role in assisting the government to ensure transformation succeeds.
For more than a decade, we have been fiddling with a system that was designed for a different country. Apartheid set us back decades in terms of democratised healthcare. Other nations, such as the UK and Switzerland, began implementing national health systems that would deliver healthcare to all their citizens after the Second World War. Meanwhile, SA was preoccupied with creating different tiers of healthcare for different races. And when we stopped discriminating on the basis of race, we started discriminating on the basis of economics.
One of the biggest challenges for the new government under President Jacob Zuma will be to implement the national health insurance (NHI) system. This system will enable every South African to access fair medical treatment at a point of service. Although the details of this plan still need to be ironed out, NHI would see healthcare providers such as hospitals being paid by the state to provide a service to each person they treated. No one would be turned away at a hospital because they couldn't pay.
A more open, consultative and inclusive relationship between the public and private sector is critical if transformation is to succeed. The appointment of Pakishe Aaron Motsoaledi as the new Minister of Health is appropriate and is welcome by those who know him. He, just like his deputy, Molefi Sefularo, has a full understanding of healthcare in the hinterlands of this country, having worked at the coal face for years under much more difficult conditions.
During the apartheid years, Motsoaledi worked in organisations intent on transforming healthcare in SA. Post-apartheid, he continued to be involved with the African National Congress (ANC) health and education committee. The private healthcare sector is encouraged by his reputation as a straight talker and a hard worker, with a passion for service delivery and a real understanding of the issues.
However, there are a number of challenges we face. Perhaps the most critical concern revolves around the chronic shortage of healthcare professionals. If NHI is to be successfully implemented, we need enough healthcare professionals to deliver the services. When the ANC came into power in 1994, there was a rationalisation in terms of human resources in the healthcare sector. Posts were frozen and a number of specialist skills were lost.
More than a decade down the line, the country faces a deficit of about 70 000 nurses, doctors, specialists, pharmacists and other healthcare workers. This shortage does not take into account the increased disease burden - such as more patients with HIV/AIDS - nor does it factor population growth into the equation. Exacerbating the healthcare skills crisis is the fact that state nursing colleges have been mothballed.
In order to ensure its own survival and meet the skills shortfall, the private hospital sector began training nurses. In 2007, private hospitals trained 1200 nurses. While some of these nurses work in the public sector, the number graduating each year is still below the estimated additional 3 500- 4 000 nurses required each year if the country is to deliver care to more people. We believe that the government should reopen all nursing colleges as a matter of urgency.
The private sector would also be willing to assist the state with training world-class doctors and specialists, but would require permission to do so. Trainee doctors and specialists could greatly benefit from exposure to the latest technologies housed in private hospitals as part of their training.
The state should engage more with the private sector in terms of public-private partnerships on a scale previously implemented at Hewu, Shiluvani, and Matikwane hospitals, where comprehensive management - including clinical management - was managed by the private sector.
The recently opened Port Alfred-Settlers public-private partnership gives much hope for the future since it allows for clinical management of patients, unlike many other public-private partnerships we have seen.
While the private sector contributes 22% of SA's hospital bed capacity, one of the best ways to improve access to healthcare for the majority of South Africans would be to open some of the mothballed beds in the public sector and allow the private sector to help manage some of these hospitals.
It also seems unfathomable that South African private hospital groups are being contracted by some European governments to help address their backlogs of patients waiting for surgical procedures, yet in SA this model has not been utilised. Our companies meet the strictest quality control standards and outperformed bidders from across the world to win these contracts.
Although the same hospital groups undertake surgical procedures as part of their corporate social responsibility programmes locally - for example, thousands of cataract operations are performed each year for free at various private hospitals - this is not a sustainable economic model. If the state were to buy these services from the private sector, the huge backlogs of surgical patients in public hospitals could be eliminated. This at little additional cost to the state because of the efficiencies extracted.
Two of the most important aspects of the healthcare system the incoming minister will need to consider are the poor leadership and structural weaknesses that currently characterise the system.
Priorities should include changing regulations to empower hospital administrators so that they are not handicapped in responding to local needs. Under the existing system, they are hamstrung while waiting for decisions from provincial heads. The end result of this arrangement is that patients suffer.
The fact that SA has failed to make much progress in meeting the Millennium Development Goals of reducing HIV/AIDS, communicable diseases and maternal deaths is an indication that the health system is performing poorly. Many of these factors are under the government's control.
It is evident that the government will have to move quickly if it is to address the healthcare catastrophe. The private hospital sector has historically contributed to programmes aimed at improving access to healthcare, both on a collective and individual level, for patients beyond those who can afford private hospitals.
We urge the government to engage the private sector to truly transform healthcare for all.
Dr Matlala is chairman of the Hospital Association of SA, and sits on the board of Medi-Clinic
Dr Nkaki Matlala: Business Day, 8 June 2009
