Winston Churchill once said “Failure to plan, is planning to fail”. Planning is, however, not a guarantee of success. The SA government has proved itself quite adept at drafting plans and policies to fix everything from SAA and Eskom to the ailing economy. What has proved elusive is the capabilities to implement these plans.
Now a grand plan to solve the public health system crisis has been launched with much fanfare. But it remains a plan, one that will only succeed if it can be implemented successfully. It seems the future of the entire health system is being bet on the government being able to implement its plan and turn the public health system around, without even waiting to see if it makes any difference.
President Cyril Ramaphosa is indicating that the success of this plan will lead to the implementation of National Health Insurance (NHI), and the government is proceeding with the legislation to enable an NHI fund to be established. The question remains: what happens if the presidential health compact fails to fix public health care?
SAA has had 10 turnaround strategies in the past 15 years and is still nowhere near profitability. Strategic plans at Eskom and the SABC are being hamstrung by unions that are concerned with job losses and the retrenchments required to implement the tough, unpopular strategies required to turn these entities around from the brink. It seems those same unions are oblivious to the fact that the implementation of NHI will move almost all health service delivery out of the provincial responsibility sphere, making most administrative staff at provincial health departments redundant.
The same union members who receive treatment for injuries on duty in the private sector will be expected to use state facilities for future treatment, along with the waiting times prevalent in the state sector. The fact that union federation Cosatu has been largely silent on the NHI Bill being approved in parliament might be an indication that its members have started raising concerns about the project to their union leadership.
As much as one would not plan to fail, in the instance of the SA healthcare system it would be prudent to start looking at alternatives to NHI prior to the presidential health compact failing in its aims. Actually, I don’t believe it’s a question of “if it will fail” but rather “when it fails”.
A great many of the proposals in the compact are things that already should be happening in the health system, and others that are legislated and regulated to happen. It is wishful thinking to assume that the same management personnel who have been failing to apply regulations and doing their jobs for years are miraculously going to become competent and efficient because this document has been signed.
Currently, 95% of public facilities do not attain the required standards for contracting with the NHI fund. The government is going ahead with the NHI Bill despite this. If the compact fails to radically improve the quality of state facilities to levels where they qualify to contract with the NHI fund, which facilities are going to render services to South Africans under NHI? The NHI white paper has stated that public facilities will form the backbone of NHI service delivery. If the backbone is missing due to not being able to contract with NHI, it will leave the entire health system totally paralysed.
The government is putting all its eggs in one basket with the presidential compact/NHI plan, with little thought being given to a scenario where the compact fails to completely turn around every failing facility in the entire public health system, and NHI therefore cannot be implemented. Little consideration seems to be given to all the small, interim measures that can be implemented to improve public health quality and reduce costs in the private sector. Why must government policy always rely on grand, ideologically driven systemic changes, rather than focusing on the small, practically implementable steps that can be taken to fix problems?
If — or when — the presidential health compact/NHI fails, the systemic damage caused by its attempted implementation will be so severe that it will take decades to fix. The NHI pilot projects have shown that success is unlikely, and yet the government is blindly rushing forward with NHI, every devastating step taking SA health care closer to the abyss.
• Dr Serfontein is a member of the Free Market Foundation health-care policy unit.
This article was first published on BDLive on 02 August 2019