South Africa

Maverick Citizen: Open Letter

So, about our struggling healthcare system, Mr President

President Cyril Ramaphosa (Photo: Jaco Marais)

President Cyril Ramaphosa will today deliver his third State of the Nation Address. Here are a few reminders and requests for his SONA.

Dear Mr President, 

Permit me to start by quoting you. In your State of the Nation Address in June 2019 you talked about an 80-year-old grandmother who “cannot spend an entire day in a queue waiting for her medication”. Well, she and others are still spending their days waiting.

What is worse, many like this grandmother, after a long wait, will most likely be sent home empty-handed because of medicine stock-outs at some health facilities. It used to be ARVs that ran out, these days it is antidepressants and, right now, contraceptives. 

The plight of the 80-year-old grandmother is sadly not unique, as the ongoing public hearings on the National Health Insurance (NHI) Bill have shown. I wish you could attend these hearings, Mr President and see how desperate South Africans used this platform to relay the horrors they suffer every day due to the systemic failure of the public health system. 

But you know that. 

After all, you established an entire NHI war room in the Presidency last year to address these issues in preparation for the implementation of the NHI. Besides, you don’t declare war if you have not surveyed the territory first.

Remember, you were also concerned about the “ill patient [who] “cannot be turned away because there is a shortage of doctors and nurses” and the “woman in labour [who] cannot have her unborn child’s life put in danger because the ambulance has taken too long to come”. Well, Mr President, during these hearings, many faces came to personify these concerns. 

In January, staff allegedly turned away a pregnant woman at a clinic in KwaZulu-Natal and she had to give birth in a taxi. The Health MEC in KwaZulu-Natal, Nomagugu Simelane-Zulu, has since ordered an investigation into the matter. So, these things still happen. 


In your speech at the signing of the Presidential Health Compact in July last year you said: “A healthy nation is a successful nation.” 


Yet, in your SONA last year in June you referred to health only nine times and allocated a short paragraph of 248 words littered with anecdotes on what should NOT be happening – like the 80-year-old who is kept waiting. That is 248 words out of a speech of over 6,700 words, Mr President.

The numbers, and your words and actions simply do not add up. 

In February last year, you also had an opportunity to address a nation staggering under the weight of a disease burden that the public health sector is simply not keeping up with.

In that speech, you referred to health 15 times and mainly focused on NHI – more specifically the war room in the Presidency. How is the war on a dysfunctioning public health sector going? We can really do with a comprehensive progress report rooted in the lived realities of the people dependent on our crumbling public healthcare system. 

You did mention introducing “the NHI together with a multi-pronged quality improvement programme for public health facilities” that will bring a “massive change in the healthcare experience of South Africans”. The NHI Bill is expected to be on your table by August this year. That, at least, is the aim of Parliament’s Portfolio Committee on Health. Will we by then have had a glimpse of this “massive change”? 

I know you have many very important balls in the air, Mr President. Eskom and South Africa’s persistent rage against the dying of the light – corruption, the economy, unemployment. All these issues are important, I know.

In some respects, you have made inroads – especially in the fight against corruption, and that is very encouraging. 

The Special Investigating Unit (SIU) after a series of proclamations by you, is flexing its muscles against looters. The unit is now investigating alleged corruption at, among others, the National Health Laboratory Service (NHLS), the South African Health Products Regulatory Authority (SAHPRA) and in provincial health departments. 

In January we saw some real consequences when the head of the health department in North West, Thabo Lekalakala, was fired after a disciplinary process based on payments that were made to the Gupta-linked company Mediosa. Lekalakala now also faces charges of fraud and corruption relating to his own appointment. 

According to media reports, corruption and wastage in health costs us billions every year. The Council for Medical Schemes pegs the annual cost of fraud in the private health care system at around R22-billion. The head of the SIU, Andy Mothibi, estimated fraud, waste and abuse in health care at around R39-billion a year. 

But it is more than just rands and cents, Mr President. 

As a country, we cannot afford any form or any degree of State Capture in the public health sector. Every cent looted here is a matter of life and death. Thank you for taking some promising first steps in this area. 

What I would suggest, if I may, is that arresting a few looters and even firing them, is not enough. For any real confidence in your fight against corruption, people in South Africa need to see successful high-profile prosecutions. We need every single one of them in jail, Mr President, not just as a confidence booster, but also as a clear deterrent to those eyeing the cookie jar. 

Grim statistics of 29% unemployment is another issue you are set to highlight in your SONA and rightfully so. But let us also consider the employment situation in the public health sector. The shortage of healthcare workers is well reported. We are managing a balancing act between the need to train more healthcare workers and the need to retain them. During the public hearings on the NHI many healthcare workers raised concerns over job uncertainty and threats by doctors and nurses to leave the country in the face of NHI. 

This should concern all of us and more should be done to address this uncertainty. Maybe you can say something about this when you get behind the podium for your SONA? 

Furthermore, we need a clear and implementable national plan for the training, employment, and retaining of healthcare workers, Mr President. Perhaps you can speed up the new Human Resources Strategy for Health that is in the pipeline and ensure that it actually gets implemented.

Time is of the essence and strong political leadership goes a long way. 

Mr President, at least two things of notable importance happened in February – the 30th anniversary of the release of Nelson Mandela, something you will likely highlight in your address; and what would have been the 31st birthday of Nkosi Johnson, the HIV/AIDS activist who helped shape perceptions around HIV at the height of AIDS denialism in the country. 

Remember him? 

Last year you briefly mentioned HIV in your SONA, again reiterating your “concern about rising HIV infections rates”. There are now plans for a massive roll-out of pre-exposure prophylaxis (PrEP) in every public health care facility by September. If properly implemented, it will be truly commendable, Mr President, as it will give people, especially young women, another means to keep themselves HIV-free. 

Speaking of HIV, maybe you can provide some certainty over HIV funding in the context of NHI? What steps will be taken to ensure that removing the HIV conditional grant does not harm HIV services? We can do with some clarity on that. 

Your Presidential Health Compact is a potentially important document with a finger on the pulse of much of what is wrong and needed to fix public health care. I had to read the compact again, since I haven’t heard or read anything about it since you signed it last year. I hope it isn’t going to fade into irrelevance like so many other plans and consultations in this country. 

The compact propagates for one health system, where all our hospitals and clinics are appropriately staffed and resourced, where there are adequate medicines, equipment and supplies, and infrastructure is suitable for the services to be provided. 

It almost reads like parts of the Freedom Charter, doesn’t it? 

So, maybe we should not only afford it the same reverie as that historic document but also implement it properly because getting your compact right, Mr President, might just be the start of the new dawn you have been promising South Africa – a dawn where the health of the people is made the bedrock of the country’s economic and social development. MC

 *This article was produced by Spotlight – health journalism in the public interest.



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