- South Africa’s healthcare system is facing myriad challenges.
- Experts have put forward a range of practical solutions to address some of the country’s pressing issues.
- Spotlight rounds up some of the proposed solutions to improve patient care, including the use of public-private partnerships.
Closing the inequality gap and making trusted healthcare services accessible to the majority will require a whole systems overhaul.
This was the underlying message of speakers at the recent Hospital Association of South Africa Conference, who tackled the question of pragmatic steps to address the divides and failings of the country’s healthcare system.
They put forward a range of solutions, models and case studies while highlighting the looming crises as more people fall through the cracks.
Around 15% of people in South Africa are members of private medical aid schemes, leaving 85% of people in the country largely reliant on a severely strained public healthcare system (though some do pay out-of-pocket to visit private sector doctors).
As reported in Business Day, an argument was made at the conference for making medical scheme membership compulsory for everyone in formal employment, a move it is estimated could triple the number of people with medical scheme coverage and result in a 25% reduction in medical scheme premiums.
Delegates at the conference also heard an integrated and coordinated whole systems approach is necessary.
Speakers stressed implementable interventions and innovations must kick in with urgency.
Some argued more political will is required, along with greater corporate commitment if effective public-private partnerships are to be established. Such partnerships were a key theme of the conference.
A kidney care example
Dr Chevon Clark, the chief executive of National Renal Care, a private renal therapy provider, outlined the stark reality of an enlarging public health crisis as more people face kidney dysfunction.
“Globally, 850 million people have chronic kidney disease, acute kidney injury or are on renal replacement therapy. This signals a significant public health issue. This is twice the number of individuals estimated to have diabetes and is 20 times higher than the number of individuals affected by HIV/Aids.
Clark said:
There has also been a 29.3% increase in reported chronic kidney disease over the last three decades. Not only is this increase deeply concerning, but so is the ability of our healthcare system to manage and treat individuals impacted by chronic kidney disease.
Last week marked Kidney Awareness week in South Africa.
Against this backdrop, Clark said South Africa fell behind other middle-income countries in having enough nephrologists and nephrology nurses for their populations.
There was a combined 147 facilities for treatment and care in the public and private sectors – a shortfall, she said.
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Clark added smarter public-private partnership initiatives were needed, saying these needed to be focused on stronger stakeholder engagement, innovative funding mechanisms, advocacy and refining weak policy frameworks.
She presented a case study of National Renal Care (a private company) partnering with the Western Cape Department of Health and Wellness to set up a dialysis clinic at the Vredenburg Provincial Hospital.
The hospital services a rural community. Before the unit was opened, patients had to travel long distances to access care in Cape Town.
The inflow of patients from outside Cape Town also added to congestion at its facilities.
A benefit of the partnership, Clark said, was they have been able to introduce newer technologies, adding they have a system that enabled the online and remote monitoring of patients.
Patients’ records can be updated continuously and are maintained digitally.
Clark said patients have also been enrolled on a mobile app making patients “active partners in their healthcare and to drive compliance for better outcomes”.
Tele-health to track diabetes patients
Dr Atiya Mosam, a public health consultant and founder of Mayibuye Health, highlighted the importance of getting the basics right.
She presented a case study of a public-private partnership in which a “tele-health doctor” called diabetes patients from the Hanover Park Clinic daily for two weeks to monitor their glucose levels, adjust their medication when needed, and offer health advice.
Mosam said 74% of the patients contacted had to have their medication adjusted, indicating the need for this kind of immediate monitoring and treatment management.
She added the intervention saw improvements in patients’ conditions and improvements in patients staying in targeted ranges for their glucose readings.
She said:
One man articulated that he had a new lease on life, attested to by his family. They said before the intervention, he was really very grumpy. Very interesting for us too was that many patients articulated that by having this contact with the ‘tele-health doctor’, they felt that the government cared for them.
Cancer care
One area where efforts at a public-private partnership appears to have failed is cancer care in Gauteng.
As widely reported, the Gauteng Department of Health set aside R784 million early in 2023 for radiation oncology services, which would have included the outsourcing of some services to the private sector.
That outsourcing has not yet happened, and the Cancer Alliance has since taken the department to court over the ongoing cancer treatment backlogs.
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Health activist Mark Heywood, speaking at the conference on behalf of The Cancer Alliance, mentioned the ongoing litigation and said a hearing has been scheduled for 21 November.
Heywood drew parallels between HIV and cancer to illustrate how the fight for cancer treatment looks set to evolve, but also where wins could be achieved.
“Cancer treatment and cancer medicines, like HIV medicines two decades ago, is inordinately expensive. It means that whilst cancer can be cured for the vast majority of people it is unaffordable and inaccessible.
“For the vast majority of people in our country, a cancer diagnosis is often a diagnosis that indicates a vastly shortened lifespan and the beginning of a journey to severe illness, very often indignity and death, and that is not how it should be.”
Heywood said the government had an obligation to follow the constitutional framework to ensure access to cancer treatment as a basic health right.
He added private healthcare providers had to do better.”
There have been complaints of discrimination by medical schemes of only partial coverage of the costs and needs of care. This leaves people unable to complete treatment. There are allegations of overcharging by hospitals and specialists. There’s also a lack of collaboration between the private and the public sector, a lack of monitoring and a lack of a determination of healthcare outcomes when it comes to cancer.
But he added the long – but ultimately successful – fight for access to treatment for HIV positive people in the country held important lessons that could be applied to cancer.
“What we learned with HIV was that with political will and with resource mobilisation, it is possible to dramatically alter the landscape of care and to tip the balance towards greater equality and social justice in healthcare.
“The question remains for the Hospital Association of South Africa and private health providers – what can you do to make cancer care more affordable, more accessible, and to build on public private partnerships to take them to scale to reach a greater number of people in a shorter period of time,” Heywood said.
*This article was first published by Spotlight – health journalism in the public interest. Sign up to the Spotlight newsletter.
