As we enter the last days of 2022, it is worthwhile to reflect on some of the events impacting on the health sector in the year that was. It was an eventful year with both the good and bad. Those who have read my posts during 2022 may feel that I concentrate too frequently on the negative and rarely focus on the positive. That may be true but I only reflect the world around me as I see it. I accept that there are amongst us many good people doing great things who are rarely acknowledged and I also accept that maybe I have failed to focus enough on them. For instance during my most recent activities in the Northwest province I met health workers who, despite an at times dysfunctional provincial department of health, had come up with individual initiatives that benefited their patients. A hospital pharmacist through dogged persistence managed to establish more efficient systems that significantly improved the availability of pharmaceuticals in the hospital in contrast to challenges experienced at a provincial level.
It was disappointing when in September 2021 what became known as the Digital Vibes scandal surrounded the erstwhile Health Minister, Dr. Zweli Mkhize, resulting in his resignation. I first met Dr Mkhize in the 1990’s and felt he had generally done well both as an MEC for Health and latterly as the National Minister through the height of the COVID-19 pandemic. For the latter months of 2021 and first months of 2022 several senior officials were suspended and later sanctioned for their role in the irregular awarding of the Digital Vibes contract. South Africa entered 2022 with a new National Health Minister, Dr. Joe Paahla, previously the deputy health minster, who is a politician and medical practitioner with a long history in the public health sector and whom I first met when he was the MEC for Health in the Limpopo province from 1994 to 1997. His appointment brought much needed stability to the National Department.
Having progressed through the COVID-19 pandemic during 2020 and 2021, the beginning of 2022 was dominated by the identification of the Omicron variant of the COVID-19 coronavirus initially in Botswana and then South Africa in November 2021. This that lead to many countries disappointingly imposing knee jerk restrictions on travel to and from South Africa severely impacting on the country’s tourist industry. The prevalence of the Omicron variants extended well into 2022 but was subsequently shown to result in a milder form of disease than the previous Delta variant without a significant increase in either COVID-related hospitalisation or deaths in South Africa.
While “Alert level 1” COVID restrictions remained in place from October 2021, the National State of Disaster was finally lifted on 5th April 2022 ending all restrictions imposed over the preceding two years intended to limit the spread of COVID-19. Citizens were still encouraged to continue wearing masks in crowded spaces and take measures to ensure good personal hygiene, but masks and sanitisers, a way of life for two years, mostly disappeared rapidly from public view. COVID-19 PCR testing previously obligatory for hospital admissions and international travel became unnecessary. For those that could afford it international travel became significantly easier.
The healthcare consequences of the COVID-19 pandemic and the actions taken by the healthcare sector for its duration persisted during 2022 with significant persisting backlogs in surgical procedures, particularly in the public sector, due to cancelations of elective surgery during the height of the pandemic. In the private sector revenue increased with the normalisation of hospital admissions for elective procedures. An increase of childhood infectious diseases, such as measles and whooping cough became apparent in 2022 due to falling childhood vaccination rates during the preceding two years. There had also been a decline in the testing for TB and HIV as well as the screening for non-communicable conditions such as diabetes and hypertension. Patients were found to have failed to continue both TB and HIV treatment schedules for example with increased morbidity and mortality as a result. The consequence of this was an increased burden particularly on the public health sector during 2022.
As with other sectors of the South African society, where online purchases and home delivery became a way of life. In the health sector the home delivery of especially chronic medication to patients was a positive development increasing exponentially and reducing the need for patients to wait in long lines for hours at a hospital or clinic just to collect medication. This has been mirrored in the private sector with home delivery of medication by the large pharmaceutical groups becoming the norm for many.
National Health Insurance (NHI) legislation progressed through community participation and health portfolio committee stages during 2022 with Dr Kenneth Jacobs, replacing the previous chairperson, Dr Dhlomo, who was appointed Deputy Health Minister. I have written on several occasions during 2022 and will not repeat here my concerns related to the NHI Bill and the fact that the parliamentary health portfolio committee and government has dealt with the draft legislation along what appear to be strict party lines. We await to see what the final version will contain as the legislation progresses further in 2023 through the legislative process to its possible final approval and enactment.
The COVID-19 pandemic has changed the manner in which we interact both personally and in organizations. As during pandemic, in 2022 many meetings remained virtual. For instance the boards of the two public health entities on which I served during the pandemic interacted solely through virtual platforms, which while reducing the time and costs consumed by travel, limited person-to person contact. Possibly reflecting my age, I feel that in-person interaction increases both the commitment and understanding of one’s colleagues. Many health practitioners utilised virtual platforms to interact with patients during the pandemic a development which in various forms is likely to persist. Nevertheless person-to-person contact has increased subsequently with in my view concomitant benefits for both parties after the restrictions were lifted.
As the year drew to a close, load shedding (blackout is probably a more appropriate term) became more acute as the South African power utility ESCOM struggled to provide electricity to the country. While efforts were made to exclude health facilities from load shedding and larger hospitals were indeed spared from the power outages, the overwhelming majority of health families, more especially in rural areas, remained exposed to the negative consequences of load shedding. Back-up generators installed at many health facilities provide only limited relief and in addition add an additional financial burden on already constrained health budgets across the provinces. Unfortunately the prospects for a significantly improved situation in 2023 seem unlikely. I am struck by the fact that South Africans, who a year ago would have raised an angry protests at persistent Stage 1 load shedding, now regard Stage 1 as a relief facing higher stages of load shedding that leaves communities without electricity for up to 8 hours and more daily!
The now Chief Justice of South Africa, Judge Raymond Zondo, handed over the final report of the State Capture Commission in June 2022, which although the report did not focus on the health sector in multiple volumes meticulously outlined what has been termed State capture. The degree to which dishonesty, fraud and corruption orchestrated at the highest level impacted on state institutions was staggering and sadly has been mirrored to an extent in the public health sector. The good news is that light has been shone on the nefarious activities of those who wish to steal what belongs to the South African nation. I sincerely hope that in 2023 and beyond those responsible will be held to account and that others will be discouraged from following the same path. The role of the judiciary in recent years is indeed a South African good news story.
In conclusion, thank you most sincerely all who have read and commented on my posts during 2022. I am humbled by the fact that my posts have been read by people across South Africa and the world. I remain keen to engage with all for whom healthcare issues are important whether impacting South Africa or elsewhere.
Wishing all my readers a happy and successful 2023!
One Comment
Shona Sturgeon
Thanks, Prof. A very good summary of the year, which always helps when looking forward and identifying priorities etc.
Personally, I feel that the impact of corruption and the delay in convicting those accountable has led to a feeling impotence and a lack of energy and commitment in many of us.
Imagine what would happen if every person involved in the health sector really believed they could make a positive difference and felt comitted and energized to do so in their daily work.
Imagine what would happen if civil society on all levels. took the stand that corruption and apathy were not acceptable, whether in their neighborhood or on a provincial or national level.
I am an optomist and believe that if every individual felt they could make a difference all the small actions would inspire others, and in 2023 we could start turning the boat around!