SA has two parallel health systems, public and private, “neither of which are functioning well”, says Dr Nicholas Crisp, deputy director-general in the health department.
“Both spaces don't do well. The one just looks prettier than the other,” he said in a candid interview this week with the Sunday Times. “So we are on a hiding to nowhere with these current systems.”
Crisp is on a mission to change that and says the National Health Insurance (NHI), under construction, “is a massive multiyear reform programme for the health system going forward”.
“It is called NHI because it is driven by a change in the way we finance health. In doing so it will change how we deliver it into a different format.”
SA spends 8.5% of its GDP on health and “given the size of this resource”, it is even worse that the two health systems, divided along socioeconomic lines, are not as functional and free of theft as they should be.
Crisp said if one considered that SA has the 35th-biggest economy in the world, “we perform very badly on health outcomes”.
He described the health system as hugely fragmented and said in the case of the public system, that is due to nine provinces managing their own departments.
In the private sector “it’s even more complicated as there are 76 schemes and the complexity of the administration makes it very expensive to run.”
He said people only hear about the pitfalls in public health because “it’s compulsory to report back in parliament”.
He added: “In private, nothing is reported because it is not compulsory to report to anyone.”
He said committees must be appointed and adverts for positions working towards the NHI will soon be published. However, “it could be a dog’s breakfast if parliamentarians who are not medical people get involved”.
A crucial part of the NHI is the digital system backing it up, which is being built, said Crisp, and it’s all about the patient.
“Everyone needs one portable health record that follows you for life. That becomes your file number. It will be a digital record in cyberspace with tight security and data that belongs to the patient.
“In Japan it took 34 years, but 34 years is a journey that starts on day one. We are putting digital systems in place. In the next 10 days adverts are going out. Our data centre is already in place, as is our coding system.”
Experts agree the existing system is a mess.
Everyone needs one portable health record that follows you for life. That becomes your file number. It will be a digital record in cyberspace with tight security and data that belongs to the patient
— Dr Nicholas Crisp
Mande Toubkin, a general manager at Netcare, said: “Health personnel have to put up with aggression from patients. There is conflict between public and private, and there is emotional pressure. We need to recognise that we all have a part to play. We do not need political antagonism. We need a functional health system that works for everyone.”
Human rights activist Mark Heywood added: “I think the biggest problem we have in the health system is governance and management of the healthcare system. If you look at the health system in South Africa, you see there is a substantial physical infrastructure — the best on the continent and better than many in the world.
“Our human resources are insufficient, but still very substantial. We have financial problems, but we spend 8.5% of our GDP on health, but allocation and theft are a problem. We have some of the best clinicians in many disciplines. So why is it that we have all of this, but we’re in such a mess? And a mess that gets worse and is costing lives. There are disasters waiting to happen.”
Cas Coovadia, head of Business Unity SA, said: “We are going to need to collaborate on the whole NHI debate and have a common focus, just as we did with Covid. During the pandemic we focused on common goals like getting people vaccinated. All social partners knew that if we didn’t get our act together and manage effectively people were going to die.
“The NHI focus has to be on universal healthcare, but we have to be pragmatic about how we get there and utilise all the resources in the country to do so. Let’s not break what’s working. The private system is working and should not be put at risk.”
Crisp said many using private healthcare are nervous of the new system because they don’t understand it.
“I have family members who can’t meet my eye,” he laughed, “because they think I am a crazy communist. You also get the people in Diepsloot who’ll be the first to realise they don’t have to go all the way to Charlotte Maxeke to get help when there is a hospital much nearer which they can’t use under the current system. Then you’ll get the lady in Dainfern who can’t handle the fact that she may end up in the same ward as her gardener from Diepsloot.”
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