South Africa is on the brink of a momentous change in healthcare in terms of procurement, funding and reimbursement, believes Dr Mvuyisi Mzukwa, chairperson of the South African Medical Association (Sama), with the National Health Insurance (NHI) Bill having an impact on not only health professionals but the whole country.

“Sama has on various platforms made its position known that, as doctors, we swore an oath of service to those who seek healthcare from us. We do not believe this Bill will achieve what it purports to do,” he said.

Sama will hold its annual conference from 15-17 February at the Sandton Convention Centre in Johannesburg. It will focus on strengthening healthcare systems.

The association held a media briefing on Wednesday to discuss critical matters to be dealt with at the conference, including decriminalising medical negligence, the unemployment of medical doctors and the NHI Bill. 

Opposition to NHI

While Sama fully supports the principle of universal health coverage, it does not believe this will be achieved through a single-purchaser and single-payer system as stated in the NHI Bill, Mzukwa said. 

“We believe that any form of health reform must be based on a health system that is built on adequate human resources for health, access to essential drugs, medicines and vaccines, suitably utilising evidence-based policies, ethical leadership and governance, as well as built on digital and technologically integrated systems,” he said.

These are the elements of a resilient healthcare system that is capable of meeting the needs of the population it serves and weathering future pandemics, disasters and any other public health emergencies, he added.

Mzukwa said there were systemic issues that needed to be addressed before the NHI Bill was implemented.

The World Health Organization has outlined the pillars of a well-functioning healthcare system, which include: leadership and governance; health system financing; human resources for health; infrastructure; and medical products, vaccines and technologies. 

“If you are talking about reform, you have to talk about all of those things. You can’t think you are fixing a system if you are only fixing a small part. We know through the previous health ombud, Professor [Malegapuru] Makgoba, he spoke a lot about the lack of governance and leadership within our country especially when it relates to healthcare,” Mzukwa said. 

Read more in Daily Maverick: NCOP passes NHI Bill in face of widespread condemnation by health professionals, business and opposition

He said the ratio of doctors in the public sector was 0.35 doctors to 1,000 people, compared with 1.75 doctors to 1,000 citizens in the private sector. 

“If you look at those disparities, the system is not ready. You also have to consider other social determinants to health – if you don’t fix water in the municipalities, you cannot expect to have a health system that is reformed,” he said. 

“All these issues haven’t been addressed; you can’t think that just pouring in funding will be a silver bullet for the healthcare system.” 

Sama surveys indicate that the majority of doctors have no certainty about how the NHI will work, Mzukwa said.

President Cyril Ramaphosa has indicated that he will soon sign the controversial Bill into law. Delivering the 2024 State of the Nation Address (Sona), Ramaphosa joked that he was “looking for a pen” to sign the NHI Bill into law.

During the media briefing on Wednesday, Mzukwa said Sama would also be looking for a pen to contest the Bill, and Ramaphosa still had time to change his decision. 

Read more in Daily Maverick: Business organisations call on Ramaphosa to return NHI Bill to Parliament

Mzukwa said South Africa’s health professionals had achieved impressive results, even when working in the context of South Africa’s resource-constrained healthcare system. 

The Department of Health has confirmed that there are 1,500 vacant and unfunded posts in provincial departments across the country. During the Sona debate on Tuesday, 13 February, Health Minister Joe Phaahla had committed to working with Sama to find solutions for the unemployed doctors, Mzukwa said. 

Sama conference 

Sama CEO Dr Mzulungile Nodikida said the conference would look at all the weaknesses as well as the strengths of the healthcare system. 

“We saw during Covid how the public and private sector came together; so with this conference we want to see how do we leverage some of the positives from the pandemic period and plug them into an alternative blueprint for the healthcare system,” he said. 

One weakness was that different role players had been “talking across each other”.

“We want to create a platform where public and private players can engage with the state.” 

Nodikida said ways of using technological innovations and AI without undermining the fundamentals of healthcare would also be discussed during the conference. 

Professor Jacques Snyman, a Sama board member, said the conference would focus on sustainability and healthcare in South Africa, including a session on funding healthcare.  

The conference will include international and local distinguished medical professionals, including Dr Imtiaz Sooliman, the founder of the Gift of the Givers Foundation.

“There will be informative sessions spanning multiple topics. It will not be a droning on of slides that people have become accustomed to over years; it is short presentations to the point, and then interactive sessions on what really matters to a patient and the profession,” Snyman said.

Mzukwa said the conference would be more than just a meeting of minds – it would be a call to action for all stakeholders to participate in meaningful dialogue to create an optimum health system. 

“This is an invaluable chance for doctors and other health professionals to strengthen their strategic networks, reinforce sector-wide collaborations and [hold] high-level conversations about how to advance quality healthcare coverage as a fundamental human right,” he said.  

Sama will host a half-day coding conference on Thursday, 15 February. Synman described coding “as the heart of the data you will use to make decisions”.  

“Coding is to make sure there is some uniformity in data so that you can extrapolate from that data into other environments, using this data not only for funding but also for research going forward,” he said. 

Revision of Declaration of Helsinki 

Sama will host a regional meeting on the Declaration of Helsinki – an ethical guideline document that sets the standard for ethical human experimentation conducted by researchers.

The meeting will take place from 18 to 19 February in Johannesburg. Professor Ames Dhai, a Sama board member, said the association was looking forward to providing a platform for a uniquely African perspective to potentially inform revisions. 

Developed in 1964, the declaration has been revised numerous times owing to rapid advancements in science and technology that affect health research and health. 

“The Declaration of Helsinki is regarded as the cornerstone document of human research ethics globally. It is particularly relevant to Africa as a continent because of the many health challenges that we have – we have a high burden of infectious and non-communicable diseases; we are a resource-limited region; we do have infrastructure but it is also limited. Africa has been steeped in a history of colonialism and, within South Africa, a history of apartheid and exploitation,” she said. 

“Africa cannot be left behind in terms of global health research. Therefore, there is a need during the review and revision of the declaration to ensure that the current and emerging ethical issues, the best practices in human research, as well as the specific needs and context of Africa are included as well.” DM