24 February 2015

Why health care needs a shot in the arm

A fair chunk of our budget should be injected into the state health care system because health is in an absolute crisis in this country, says Mandi Smallhorne.


What will South Africans really be paying attention to when they listen to the National Budget speech? In SONA 2015, apart from a few cursory words about treatment of HIV/Aids and TB (and of course we will hope for adequate funding for treatment of both these diseases – we cannot afford to let our gains slide backwards, as is feared every time stock-outs of essential drugs occur), this was basically all our president had to say about health: “We will continue to promote healthy lifestyles and to urge citizens to refrain from smoking and the abuse of alcohol and drugs.”

Is that strong enough? Hardly. Health is in absolute crisis in this country. And that’s not hyperbole.

Take the National Health Laboratory Services (NHLS): it has been slowly sliding into a financial crisis which has seen senior, highly skilled staff leave, with hard-to-replace pathologists and technologists heading for the private sector or overseas. The NHLS provides laboratory services – among them tests for HIV and TB – to some 80% of the population; should it implode, the impact will be incalculable. That’s a failure of management – the crisis is due to unpaid bills, apparently. So who is tasked with ensuring the bills get paid and raising red flags long before the problem reaches crisis proportions?

That’s just one example of a tottering system. Human resources in the public sector (which services over 80% of the population) are stretched to their limits. In December, reports Mark Heywood (in a 5 February article for the Daily Maverick), a Bloemfontein doctor working in a state hospital, said he and his colleagues have been told to operate at 70% capacity till the end of the financial year. He added that in his ward (not ICU but a medical ward), 25% of admissions die. One in four patients will leave the hospital via the mortuary van! And “staff morale is somewhere between burned-out complacency and intimidated silence”.

Read: Blood running into streets from mortuary

That’s a familiar tale. The South African Society of Physiotherapy, says president Linda Steyn, receives many reports of posts being frozen. This means staff numbers are down and existing staff are stretched too thin. It is also bad for patients, of course, and the economy. Physiotherapy is an essential component of “rehabilitation to a pre-morbid state”, she says – in other words, getting a heart patient, an accident victim, and patients who’ve suffered a vast range of other conditions, back to decent daily function. This ends up being a cost to the economy, as it means that otherwise productive individuals who are inadequately rehabbed are unable to work, posing a burden to the state and families.

It can have dire human consequences – a physiotherapist at Natalspruit Hospital once memorably noted that spinal injury patients who could have otherwise worked and lived for many years end up dying at around two years, simply because of lack of rehab and the necessary education and follow-up.

So a fair chunk of our budget should be intravenously injected into human resources in the state health care system. State-of-the-art equipment is worth nothing without skilled, trained, resourced and incentivised staff to use it.

Read: South African universities get R37 million in funding to fight cancer

We also desperately need to be smarter and more strategic about the way we spend funding for healthcare. Lauren Pretorius of Campaigning for Cancer would like to see ring-fenced funding to create and efficient and speedy referral pathway for cancer patients from the point of detection to ‘ideal’ clinics for treatment. Bells-and-whistles early detection campaigns are no good if we haven’t injected funds into the follow-through, if we haven’t thought through the impact of our spend.

And by the way, let’s see Minister Aaron Motsoaledi get the respect and co-operation he deserves from his colleagues in government. Turning the behemoth of public health around is a thankless and incredibly slow-moving task which could do with another few high-powered shoulders to the wheel and urgently expressed leadership from the highest echelons – which means far more than support for lifestyle changes.

Not that those don’t matter – a lot. “We’d like to see serious funds to support prevention of non-communicable diseases,” says Dr Steyn. Exercise is a physiotherapist’s tool which crucially targets diseases and conditions like high blood pressure, cardiovascular disease and diabetes.

This is not just a nice-to-have, it’s essential to our country’s future growth – and that doesn’t mean growth in size, it refers to prosperity.

Read: We have an absolute epidemic of obesity in SA

South Africa is the fattest nation in Africa and the third fattest in the world, after Mexico and the USA. We have one of the fastest-growing epidemics of diabetes (very often a consequence of obesity) in the world – diabetes is characterised by a higher risk of cardiovascular disease, among other things. We’re also shooting to the top of the log in hypertension (high blood pressure).

Worldwide, health economists express dismay at the rapid march of diabetes alone. Phrases like “subvert the gains of development” and “overwhelm healthcare systems” are frequently used – one expert reckons that within less than two decades, the healthcare budgets of entire countries will be devoted almost exclusively to treat this chronic disease. What are we doing about this and the constellation of chronic disease that marches with it, including obesity, hypertension and cardiovascular disease? Continuing to promote healthy lifestyles and “urge citizens to refrain from smoking and the abuse of alcohol and drugs” doesn’t really cut it. We have to take urgent action – to put the nation on something resembling a war footing – and the budget should reflect this strategy in how the financial pie is cut. An unhealthy nation is a massive drag on productivity and growth potential.

Read: Private health care must become cheaper

Two other things should be given attention in this budget: what is the progress on National Health Insurance? Contrary to what you may think, many health professionals would welcome this being implemented and implemented well (it broadens their base of paying customers, after all), but it simply has to be done well. Will there be money for this, and how much? Or is the plan simply to stagger on with what we’ve got, patching and mending as we go?

And finally, the crisis is not all about state care. We await the results of the Competition Commission’s Market Inquiry into the private health care sector; but there must have been some strategic thinking about the possible outcome. The budget should give some indication of funding for mechanisms to address this aspect.

Decent healthcare is one of the four pillars of a flourishing society; let’s hope the budget addresses it soberly and effectively.

Also read:

Carbs don't only make you fat, they make you sick

Surgeon walks out on patient, not once but twice

Cost of diabetes doubles in 20 years


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2013-02-09 07:27



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