The attitudes of South Africa's doctors and nurses must change drastically if the public health system is to improve, says Health Minister Aaron Motsoaledi.
In a wide-ranging interview with the Mail & Guardian at his office in Pretoria this week, Motsoaledi admitted the approach of medical professionals within public healthcare to their work was a major stumbling block to transforming the sector.
"It's a self-defeating prophecy to keep on saying we don't have the means. There are good services in countries with fewer facilities and staff than us," said Motsoaledi.
Motsoaledi's comments come as he plans to begin implementing the government's planned National Health Insurance (NHI) scheme, which aims to make quality healthcare available to all the country's citizens.
The system envisages a mix of both private and public healthcare, which will be accessible to all citizens. Those who can afford it will be expected to pay monthly contributions to a fund that will be used to administer the scheme.
Faced with many issues within the public health system itself -- as detailed in a 2009 report by The Lancet medical journal -- Motsoaledi has been accused of wanting to increase the capacity of the sector without improving the quality of service.
According to a report entitled: The Shortage of Public Doctors in South Africa, compiled by the department of labour in 2008, South Africa has fewer than half the required number of public doctors as prescribed by international standards for developing countries.
However, the minister argues that it is a "chicken versus the egg" debate as to which should come first.
"Many would argue that it's because there is a shortage of doctors that quality of service is so low. It's not true that you can't provide services -- attitudes must change in the way we do things," he said.
A global issue
"South Africans are obsessed with this -- as if it only happens here. At the end of the day it is a global problem we are dealing with -- not just in this country. There is a shortage of four million qualified doctors and nurses globally," said Motsoaledi.
But the minister did concede that staff shortages in sub-Saharan Africa made up 80% of that global shortfall.
"This is why we feel it so much, and South Africans believe it's only in this country," Motsoaledi said.
To arrest the situation, there were plans afoot to increase the number of doctors who qualify at the country's eight medical schools, he said, with the University of Witwatersrand set to increase its output by 40 graduates a year, a plan to which the Health department has pledged R8-million in funding.
Additionally, there will be a ninth medical school constructed at the University of Limpopo, adding to those already in the country that, combined, produce as many as 1 200 doctors every year.
Saul Kornick, the founder and the Chief Executive Officer of Africa Health Placements (AHP), says this is a step in the right direction.
"As a starting point you need more doctors. Going to most healthcare centres in South Africa, including the rural areas, you will find the infrastructure and pharmaceuticals are there -- you just need the individuals to provide the service," he said.
More caring doctors, fewer 'doctorpreneurs'
A stern critic of the spiralling costs in the private health sector, the minister criticised those in the health sector who "only think of profits", encouraging doctor's to return to the public sector and care for citizens.
"We are already experiencing this in South Africa, these 'doctorpreneurs', who study medicine just to make millions. No human being will ever convince me that something as simple as a circumcision can reasonably cost R15 000, while in a public hospital it is R1 200," he said.
With private hospitals' total capacity of approximately 27 000 beds, Motsoaledi also believes it would be foolhardy to see private healthcare as the answer to the population's health problems.
"People believe the present system is working but it can't be sustained. If everybody decided to drop public health service and go private, we would only have capacity for 16% of the population," he said.
Professor David Sanders of the University of the Western Cape's School of Public Health agreed with Motsoaledi, saying in many cases monetary incentives were trumping care incentives in the private sector.
"Medicine is primarily a vocation and not a business. The private sector professionals are coining it and private hospitals are overcharging and 'overseeing to' their patients," he said.
Nevertheless, Sanders said that if there was to be a mass migration of doctors back to public service, things need to drastically change.
"The public system needs to be something you can be proud of, and we need to greatly improve the experience of working there if we are to attract the right talent," Sanders said.
NHI is on the way
Such improvements are envisaged by Motsoaledi, in great part through the introduction of the NHI.
In the face of criticism from private healthcare industry, medical professionals and opposition parties,Motsoaledi dismissed worries that the ambitious programme would be impossible to implement.
"The reason people pay so much for private healthcare is because they think it is the only system that works -- and that's wrong. We are promising a health system that works and people have forgotten that this is possible," the minister said.
Motsoaledi called on South Africans to stay positive about the scheme.
"Many countries went through the same fears and scepticism. Once NHI is tested out will we find that it works -- and that's what is on the way," he said.