Health system in crisis

The South African health system is in crisis. This is according to David Sanders, Emeritus Professor at the School of Public Health at the University of the Western Cape.

Sanders, along with literary giant Zakes Mda, were awarded honorary doctorates by the University of Cape Town on 8 June.

Though he feels undeserving, Sanders is nonetheless honoured to have been recognised for his life’s work. He suspects he was selected because of his academic, advocacy and activism work in the health sector. “It is very usual to find someone who has done all three,” he says. 

Sanders pioneered a method of teaching that has since been copied by peers internationally. “It’s multidisciplinary and not only trains doctors but nurses, teachers, physiotherapists and social workers too,” Sanders says. He is also credited with starting the Global Steering Council of the People’s Health Movement in 2000.

A medical doctor by training, Sanders specialised in paediatrics and public health, and has advised several governments on public health matters.

Health system crisis

Sanders cites several reasons for his assessment of SA’s health system.

• The HIV epidemic – “We wasted many years during the Mbeki administration," Sanders says.
• High levels of poverty
• Dire living conditions
• Poor nutrition
• Lack of housing and sanitation are all contributing factors.

“Of course, the apartheid legacy is difficult to overcome,” Sanders admits, “The system was meant to serve the few and neglect the majority. However, there have been management problems in the past 20 years.”

Sanders attributes the poor management of the health system to lack of skill and an inability to translate policy into actionable programmes.

“Lack of skill is a result of poor primary and secondary education. People learn by rote and are not taught to think for themselves. Consequently, they cannot think out of the box,” he says.

Graduates’ orientation is such that if they are trained in a big urban hospital and are sent to a rural setting, they can’t cope, he adds.

How to turn it around
Sanders believes good leadership is what is required to turn the situation around. “Minister of Health Aaron Motsoaledi is a good leader but has few capable officials supporting his efforts,” Sanders says.

A bold focus on the disadvantaged is what’s needed, Sanders reckons. “We haven’t dealt with the legacy of apartheid. The majority of South Africans earn less than R2 500 a month,” he says.

However, efforts should not just concentrate on health but should take on the holistic form proposed by Trevor Manuel’s Planning Commission and include a rehaul of education, housing, sanitation and other development measures.

“We are not a poor country. We need to find a way to make our resources work better. Countries like Rwanda and Bangladesh are not as rich as us, but are doing better than us,” Sanders says.

If implemented properly, the proposed National Health Insurance (NHI) could be the key, Sanders says.

National Health Insurance
The NHI aims to pool the resources from the public and private health systems to reduce inequality. “Half of the health spend in this country is spent on 20% of the population,” Sanders says.

The idea is for anyone to be able to walk into an accredited practice and get treatment for free. But Sanders sees a potential hurdle in the rural areas, as there are few to no private health-care providers. “Who will be the accredited providers there? If the current providers are accredited but there is no improved performance, inequalities won’t be reduced.”

Sanders says the NHI will only work if rural SA is given priority and more doctors, nurses and community workers are trained specifically for those areas.

He also believes prevention should be at the core of a re-engineered primary healthcare system.