Opinion: A call for strengthened private and public healthcare systems in time of COVID-19

28 April 2020
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Never let a good crisis go to waste. That's what we are seeing in a time of the coronavirus crisis. Governments the world over have increased their power over citizens. There's more spending. More infringement of people's rights and freedoms. And sadly, in Africa, we are also seeing governments abusing these powers. In South Africa, it has been reported that, so far, since the lockdown started about 20 days ago, police and soldiers have killed about 9 unarmed civilians. That's the evil power of the state.

It was to be expected that we would hear more voices calling for the implementation of National Health Insurance (NHI). This is a policy where government wants to centralise healthcare and be in control of every aspect of it: what medicines patients will be able to access; what medical procedures people can do; how medical professionals will ply their trade. To control people who studied for years, sharpening their craft and worked to gain experience and expertise to become the best at what they do. Now, the state wants to have a say in how they earn an income. For a freedom-loving individual such as myself, this is preposterous and an insult to these professionals. They should have a right to earn an income as the Bill of Rights gives to all of us.

Over the last few months, I have had unpleasant experiences in a public healthcare facility in Khayelitsha. My mother lives with bipolar disorder type 1 and has done so for the last 28 years. She has had to endure treatment in public healthcare for the greater part of her adult life. It was no different from January this year when she was admitted to hospital. Khayelitsha District Hospital was officially opened in 2012 – a relatively new facility. Yet, when you read news stories about it, most are unflattering and tell of ill treatment of patients, overcrowding, and a lack of beds.

 My mother had to spend at least 36 hours sitting on a chair and waiting for a bed at the Trauma Unit. During that period, I discovered she had scratches on her back and after about 6 days discovered no one attending to my mother had even noticed. That drove me to lay an official complaint with hospital management. Thankfully, they listened to me and were never defensive about poor conditions at the hospital. They were open about the challenges they face as a district hospital. They told me about the high disease burden in Khayelitsha, a township with just over 1 million residents. This number from a census done a few years ago.

Challenges are even more pronounced in the psychiatry department of the hospital. Firstly, there’s no ward dedicated for this specialised treatment of mental illnesses. Patients like my mother make do with what they have and are crammed like sardines into a makeshift cage-like ward. Hospital management told me there might be a possibility for the public works department to build a few wards in a few years' time. There's no timeline for this. So, while my mother and others continue to suffer the humiliation, we will wait for the department to make the necessary changes. Things turn very slowly in government.

Those who can afford private healthcare must count themselves lucky. Having to choose between private and public healthcare can be a matter of life and death. Hold on to your medical aids and fight with everything you have for a right to access quality healthcare. In the public healthcare system, you won't find that.

As someone who has a history of using public healthcare facilities because of my mother, I'm always shocked when I hear people advocating for a policy document like the NHI. How can so-called experts be so blind to reality?

Government claims that we need NHI to level the playing fields. They believe that private healthcare is the reason we have seen a deterioration in public healthcare over the last 26 years. They refuse to acknowledge the role cadre deployment, jobs for pals' schemes in hospital management and employing incompetent leaders – not forgetting corruption of massive scale – have been the cause of the crippling of public healthcare. There is no amount of money in the world that will fix this.

Government's own pilot project failed dismally, and most facilities don't meet the safety standards required to implement NHI. Gauteng alone doesn't have a single public healthcare facility that fits the requirements. They need billions to be able to bring them up to the standard required. Politicians are always quick to ignore facts on the table, but they won't change. Until such time that those in power are honest enough to face reality, not even NHI will be the magic pill to fix the patient that is public healthcare.

Private healthcare has been innovating over the years and coming up with solutions to provide more options so that more people can be covered by medical aids. However, through the NHI, government is seeking to severely restrict and marginalise private medical scheme options. How can government claim to want quality healthcare for the majority of people while at the same time cutting off thousands dependent on their private medical schemes? This alone shows government has absolutely no interest in bringing quality care to the majority of South Africans. What they want is another bloated system where bureaucrats managing NHI will continue to fleece the state, earn themselves fat salaries, and what little money is left being shared by the people. How will this improve public healthcare?

During the corona virus pandemic, we are seeing private laboratories doing the lion's share of the work in testing individuals who suspect they may be infected by the virus. Nine out of 10 tests are performed in private laboratories. The state cannot keep up because, over the years, we have seen deterioration even at state laboratories. Private businesses have an incentive to be the best at what they do. Government, on the other hand, has no such incentives. It’s easy to see when you compare the quality of service that you receive at a private facility compared to the public healthcare sector.

Despite the glaring failures of the government-controlled healthcare system, we continue to hear some people call for NHI. This is extremely concerning. Firstly, because I love my freedom, I believe that all individuals have a responsibility to take care of themselves and their families in the best way they know how. Secondly, because, government must never have the power to dictate to us how we should exercise our rights and responsibilities. It's not government's place. Please fix the healthcare system by allowing the private healthcare sector to continue to innovate and come up with more solutions to problems that face us in the 21st century. They are best placed at doing this. Do not destroy them. The fight against coronavirus has shown us that we can work together to achieve the common good of society in both private and public healthcare systems.

This article was first published on Med Brief Namibia on April 23 2020

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