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Public Health under pressure

With South Africa’s health care system viewed, amongst others, as a reflection of the social issues the country is facing, on World Health Day (7 April), Prof Renata Schoeman, Head of Healthcare Leadership at Stellenbosch Business School says there is not only one solution to addressing access to healthcare.

“Although efforts over the past almost three decades have to some degree improved the quality of care, failure in providing a basic standard of care to the more than 84% of our population reliant on public health is intensifying. The deterioration of the health care system is especially evident in certain provinces such as the Free State and Limpopo, where lack of resources, mismanagement of funds and declining infrastructure, affects the poorer communities.”

She says that the healthcare system in the country needs to be seen against the backdrop of rising poverty, unemployment and inequality, where the overburdened public health system struggles to accommodate the major challenges of meeting the increased demand for burden of diseases – communicable diseases such as HIV and AIDS, TB and non-communicable diseases such as diabetes, obesity, violence, injuries and maternal, perinatal and nutritional conditions.

“South Africa’s health care is chronically understaffed and even though there is a worrying vacancy rate, the posts are not filled. Medical personnel and students are struggling to find employment due to posts not being made available to apply for or frozen. We are losing a worrying number of medical professionals moving overseas to find employment due to the lack of positions and the uncertainty of what the future would hold for the private sector under the proposed NHI.”

“The statistics of around 70% of doctors working in the private sector versus only 30% available to service the public sector also do not provide a clear-cut picture. The trained professionals are there, however, there is a lack of positions to apply for, and this clearly points to healthcare in the country not having the budget, efficiency, or ability to fill these posts.”

Prof Schoeman says the unequal allocation of resources amongst the provinces is a worrying concern in that the regions with the greatest health needs receive fewer resources.

“The Western Cape and Gauteng administrations are the two provinces that spend slightly more on healthcare than on education. This is in contrast to the other seven provinces where education is the biggest expenditure item.”

“In the 2019/2020 budget year the Free State’s budget spend was R10.8 billion compared to Gauteng’s R49 billion and the Western Cape’s R24 billion. The higher healthcare spending in these provinces is a result of new infrastructure and expanding services, creating an infrastructure deficit in poorer-resourced provinces such as the Free State and Limpopo. The provinces that manage their money efficiently and allocate funds to infrastructure and resource development are strengthened with a larger portion of the national budget, leaving the rural areas and their people in poorer health.”

Even though the healthcare system is not one dimensional with various other factors of social-economical inequalities playing a role, Prof Schoeman suggests the following:

  • Efficiency of budget allocation per province

  • Stronger, qualified and ethical leadership to fight corruption and to manage budgets efficiently

  • Attract and retain medical professionals

  • Unfreezing posts to fill the shortage of medical professionals

  • Although the NHI is proposed as a solution to address the healthcare needs of the country, the implementation thereof in the foreseeable future is not likely and should not be seen as the answer to the lack of care

  • Empowering healthcare users with lifestyle changes and the responsibility of caring for their own health to lower the increased burden of diseases such as diabetes. The focus should be on keeping the nation healthy to alleviate the pressure on medical care for uncommunicable diseases.



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