THE announcement by Health Minister Aaron Motsoaledi on Friday that the Department of Health is to embark on a joint venture to invest R1bn in the construction of a factory to produce antiretroviral ingredients is another example of the minister’s obvious commitment to improving the South African public health system.
The purpose of the joint venture with Swiss pharmaceutical manufacturer Lonza is to reduce SA’s dependence on imported drugs used to treat HIV/AIDS, while at the same time promoting domestic manufacturing. This is a prime example of state intervention in the economy as not only justified but necessary.
Dr Motsoaledi also revealed at the weekend that the government is planning to spend billions of rand over the next 5-10 years to improve state health infrastructure and revitalise the primary healthcare system. This includes repairing and building new clinics, district and provincial hospitals, as well as revamping 122 nursing colleges throughout the country to address the dire shortage of skilled medical personnel. The minister has also set his sights on reducing the burden of noncommunicable diseases caused by smoking, alcohol consumption, poor diet and a lack of exercise.
These are the kinds of initiative we would expect from a competent and committed health minister; they are notable only by comparison with the misguided approach of his predecessor but one. However, despite Dr Motsoaledi’s best efforts, it will take considerable time for his actions to bear fruit.
At present the benefits from sound leadership and policy decisions are being constrained by a public health system plagued by a critical shortages of doctors and nurses, rapidly ageing infrastructure that requires urgent refurbishing, administrative chaos in some provinces, and a heavy burden of disease. Despite these problems, there is considerable political pressure on the health department to implement a national health insurance (NHI) system immediately.
In last year’s medium-term budget policy statement, Finance Minister Pravin Gordhan indicated that the government expected to spend R500m on the NHI this year, and details are expected to be included in the budget announcement later this month. Mr Gordhan has been careful to emphasise that funding the NHI will require the development of a long-term fiscal framework, agreed between the Treasury and Department of Health, and that the quality of health services and infrastructure will have to be improved considerably before the policy can be formally adopted.
Reading between the lines, it is clear that Mr Gordhan and Dr Motsoaledi are well aware that the NHI cannot be implemented until the fundamental flaws in the existing state health system have been addressed. The collapse of the Gauteng and Eastern Cape health departments has spurred calls for the constitution to be amended to centralise control of the nation’s public hospitals under the national health department. However, if the primary problem is a lack of skills, centralisation is not going to fix things, and if the failure is due to underfunding and administrative inefficiencies, the solution is surely to tackle these head-on — as Dr Motsoaledi is already doing.
This may, however, be an ideal opportunity to determine the feasibility of public-private partnerships in the running of state hospitals by establishing a pilot project at, for example, Chris Hani Baragwanath Hospital in Gauteng. The NHI will only succeed if the private sector can be brought on board. This is a way of testing the waters.
The amount of money allocated to the NHI in the 2012 budget, and the type of projects that are specified, will be a good indicator of how quickly the government plans to implement its policy. Any thought of imposing the proposed payroll taxes that will be needed to fund the NHI, before the basic state health infrastructure has been improved, must be dispelled if SA’s medium-term budgetary process is to retain any credibility.