Streamlining our health system

05 February 2014

Phumla WilliamsSouth Africans today enjoy reasonably good access to health care services. Over the past 20 years government has prioritised universal access to basic health care and has strived to improve its quality.

Prior to 1994, the country’s health system was highly fragmented and bureaucratic. There were 14 separate departments tasked with the delivery of health services and it was structured to serve a small portion of the population and not all South Africans. Public health services for the majority our people were inadequate while those living in rural areas were even worse off in terms of access to services.   

Since the democratic government was voted into power in 1994, things have changed for the better for the majority of our people. Our Constitution mandates that every South African irrespective of race, gender and background has the right to have access to health care services. In line with the Constitutional prescripts, government has over the past 20 years made a concerted effort to improve access to health care for all South Africans, including for those living in rural areas that were not previously privy to quality health care.

While progress has been made in improving the quality of services particularly in the public sector, the system still faces a number of challenges ranging from cleanliness, the availability of medicine, safety and security, staff attitude and long queues.

The majority of South Africans rely on the public health care sector, largely because the private health sector remains expensive. This has in turn led to overburdened public health care services.

The recently established Office of Health Standards Compliance (OHSC) will go a long way to improve the quality of health care services across the board. The OHSC has been established in terms of National Health Amendment Act of 2013 to regulate compliance with norms and standards by health establishments.

According to Department of Health, it is “empowered to monitor and enforce health standards in all health establishments throughout country including both private and public hospitals and clinics”.

Speaking at its launch in Pretoria last week, The Minister of Health Dr Aaron Motsoaledi said: “Today marks the end of a phase and a beginning of an era for health care in South Africa. In order to achieve universal cover in the country, two things need to be addressed - the quality of health care is the main issue.”

The Minister also introduced the new OHSC board which consists of health care professionals, academics and activists. It will be chaired by Lizo Mazwai, emeritus professor of surgery and former chairman of the South African Medical Research Council while Laetitia Rispel will be his deputy.

OHSC inspectors will pay unannounced visits to health facilities around the country to assess identified challenges such as the attitudes of staff, cleanliness and availability of medicine. Non-performance of individuals or institutions that do not meet the expectations and standards set by the office will be dealt with. “In cases of failure to comply, the office will have power to recommend disciplinary action. In very serious cases, an institution might be temporarily disabled,” Minister Motsoaledi said.

According to the Department of Health, 27 inspectors have already been employed while an additional 14 would be added in due course to monitor 4000 health facilities around the country. The OHSC will ultimately also protect and promote the interests of patients by providing them with a platform to complain about challenges they face as well as ensure that these complaints are investigated and appropriate action taken.

The Minister of Health also used the occasion to stress the need to reform the private health care system in order to bring down costs so that the services can be affordable. "There is a problem of quality of health care in our public institutions and there are exorbitant fees in private health care that are beyond the reach of citizens. This year we’re taking the bull by the horns — we’re solving both of them in one," he stated.

The Competition Commission has also begun an inquiry into the high cost of private health care in South Africa. According to the Commission, the inquiry will “probe the private health care sector holistically to determine the factors that restrict, prevent or distort competition and underlie increases in private healthcare prices and expenditure in South Africa”. This process will hopefully in future enable all South Africans to access essential health care, regardless of how much they earn.

As we head towards celebrating 20 Years of Freedom this year, we look back with pride at the building blocks we have put in place to ensure decent health care for all. These building blocks have led to increased life expectancy, the reduction in child mortality, notable victories in the fight against HIV and TB, and an overall improvement in the effectiveness of the health system.

Going forward government will continue to create a comprehensive, equitable and integrated national health system.  The success of the OHSC is dependent on the users of the hospitals and clinics coming forward with success or bad stories they experience when visiting these health facilities.

Phumla Williams is acting CEO of the Government Communication and Information System (GCIS)