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Healing South Africa’s public health headache

- Lem Chetty

Academia binds the public and private healthcare sectors in the move towards universal healthcare .

Health and medicine © Curiosity

It is ironic that the Covid-19 pandemic delayed the passing of the National Health Insurance (NHI) Bill in South Africa, because the pandemic was a reminder that access to healthcare is indeed a universal collaboration. 

There are parallels, too, between the universal healthcare offering the NHI proposes, and the roll-out of the country’s vaccination programme. Perhaps the latter is a microcosm of how this mammoth task will materialise. What is evident is that both scenarios will come to fruition – because they have to.

In a true democracy, the management of and access to the Covid-19 vaccination and treatment should play out exactly as the NHI should – equitably, and made possible through omni-channels. In other words, the NHI can only work if the private and public sector come together – and academia might be the tie that binds the two.

Academia binds public-private healthcare collaboration

Universities continue to be an integral part of the fight against Covid-19, and they also have a critical role to play in the NHI. Professor Emeritus Martin Veller, former Dean of the Faculty of Health Sciences at Wits, says: “Firstly, universal healthcare in South Africa is absolutely needed. From the Covid-19 pandemic, what we have seen is that the academic health sector is poised to become a significant facilitator – if not the facilitator – of the healthcare delivery system. Particularly, to implement the necessary changes in healthcare, to then make universal healthcare possible in this country.” 

Veller says that the Faculty was deeply involved in drafting seminal work on NHI, the Presidential Health Compact. Titled South African Government: Strengthening the South African health system towards an integrated and unified health system, the Presidential Health Compact was published on 25 July 2019.

The document stemmed from the Presidential Health Summit in October 2018, which, President Cyril Ramaphosa writes, set out to “diagnose and propose solutions to end the identified crises in the health system that are hampering our progress towards creating a unified, people-centred and responsive health system that leaves no one behind”. 

The Compact that followed is an agreement consented to by government and key stakeholders – academics and researchers, health and allied health professionals, labour, business, community, statutory councils, traditional health practitioners, and public health entities.

Veller, representing not only Wits and the Faculty, but also as Chair of the Committee of Medical Deans in the country, says the team delved into a study to highlight the problems in the public health sector. This participation showed that “we are committed to universal healthcare and recognise that very significant numbers of patients in our country do not have access to a strong healthcare system”.

Faculty takes the lead

Many academics within the Faculty are advising government and partners on the development, management and monitoring of the NHI, “with the ultimate aim of getting the country’s health system out of the doldrums. But there are also other faculties at Wits doing the same, for example, in commerce, law and management, definitely in science, in one way or another”, says Veller.

“Much of what we do is in the research and knowledge-generation space, especially around the issues in the health system and later, in implementation. The Faculty also addresses gaps in the system. Finally, being the largest health sciences faculty in the country, we have committed to increasing training numbers, so that our graduates will assist in the universal access to healthcare.” 

People solve people problems

The management of human resources – people – in the healthcare system is paramount to the NHI succeeding and operating well. The combination of unemployed graduates and a shortage of healthcare workers, makes the answers seem simple, but often they are not. Wits has come up with a working solution. 

Dan Mosia, Chief Commercial Officer at the Wits Health Consortium (WHC), says the Wits team, in partnership with other universities, created a pipeline of doctors to fill staffing gaps, including in KwaZulu-Natal where oncology care was a challenge because of a shortage of trained healthcare workers.

“The Wits Health Consortium is a wholly-owned entity of Wits University, with strategic objectives around the Faculty of Health Sciences. We are deliberate about how best we can assist the Faculty to unlock business opportunities and increase income streams for the University,” he says.

Unlocking opportunities for Wits which also help the NHI work well is part of its mandate. The consortium aligned with six other universities with medical schools to come up with a response to what the National Department of Health needed as a test case in the placement of unemployed healthcare professionals where they were needed.

“It worked,” says Mosia. “There was a backlog in the department of placing healthcare professionals in a number of provinces. We were able to assist. For instance, in KZN [where we were able] to attract oncologists and regain the confidence of both patients and doctors that the public service can work. It was imperative that we paid healthcare workers timeously, so that they could come back and do the work, and in turn, patients who attend public hospitals were treated by private oncologists.”

This is the basis of the NHI – the use of private care skills in the public sector by professionals trained in public institutions.

“The mechanism to get the skills right has worked, even in rural areas. In Mpumalanga, people in some rural areas could access specialist healthcare for the very first time,” he says. 

“Our country needs a solution and the solution has been identified as NHI. Universal healthcare is a fundamental need, a matter of life and death, so the NHI has to work – but in a sustainable manner. Academic institutions are well-placed to work with both the public and private sectors. Our role is to continue to bring the two sectors together, and to find models that can be implemented without compromising either of the sectors.”

  • Lem Chetty is a freelance writer.
  • This article first appeared in Curiositya research magazine produced byWits Communications and the Research Office.
  • Read more in the 12th issue, themed: #Solutions. We explore #WitsForGood solutions to the structural, political and socioeconomic challenges that persist in South Africa, and we are encouraged by astounding ‘moonshot moments’ where Witsies are advancing science, health, engineering, technology and innovation.