A personal reflection …

I have not posted anything since July 2022. This is not because there has been nothing worthy of comment in the health sector but rather that I have felt a deep sense of despair with what has transpired in the preceding months and years. Since my retirement in 2015 I have been involved in various initiatives to address challenges in the South African public health service as a member of nationally appointed task teams and most recently as a consultant requested to address financial management in a South African provincial health service. Whilst I accept that as an outsider and consultant not directly responsible for the management of health services, that which I have provided have been recommendations, advice stated differently, that the recipients have every right to “use or lose!” Regrettably in review over the last seven years, I fear that many of the reports, which I was paid to compile, have simply gathered dust on the metaphorical shelves of offices or hard drives of computers in the offices of health departments. The possible exception would be the most recent report which would not have yet had time to gather dust!

Why do I say this? Simply put, because the challenges and problems that the recommendations were intended to address continue largely unabated. Services in public health facilities remain far from what they should be and the causes identified in the reports I refer to, remain unsurprisingly unchanged. I am not so arrogant to believe that only I have the answers to the many challenges that face health care in South Africa, but others have highlighted both similar challenges and solutions which similarly appear to have gone largely unheeded.

As an example, recent media reports have again highlighted the poor conditions prevailing at the Pelonomi Academic Hospital in Bloemfontein, a hospital that I have visited on two occasions in the last seven years and where I worked as a clinician in the 1980’s and early 1990’s. The recommendations made in this regard, if even partially addressed, would have ameliorated the situation at the hospital but appear to have fallen on deaf ears. Similar visits to other provinces and hospitals have had similar outcomes as have the similar activities of others. This experience has made me review my involvement in exercises of this nature which waste State resources in paying for my services but also consume time which is precious to one in the eighth decade of his life.

Reflecting on why this has occurred I do not believe that the country lacks the capacity to effectively manage public health services. I have met many capable individuals over the last seven years both in clinical and managerial positions in the health services who I believe if given the opportunity have the capacity to effectively manage health services. What is apparent however is stifling bureaucracy and meddlesome political involvement in health management often by people who have little of no direct knowledge of the services for which they are responsible. Political correctness dictates who and what  is acceptable rather than sound management principles. This may seem harsh but political correctness has resulted in people being appointed into positions for which they lack the requisite skills and are ill suited.

I also do not believe that the much vaunted National Health Insurance (NHI) system, on which I have commented on previous occasions, that is winding its way slowly through the parliamentary process will be the “golden bullet” that solves South Africa’s health woes. In fact, as I have also stated previously, in its current form despite the best intentions of its proponents, NHI has the potential to make the situation worse. What makes the situation particularly fraught is the trend in South Africa, despite investigations and commissions, for those in positions of authority to abuse their positions for personal gain. This has been prevalent in public health services and appears to continue despite the best efforts of those who are committed to honest and ethical management. The most recent experience in South African public entities, of which the NHI Fund would become one of the largest, illustrates how public funds intended for services to the poor are dissipated by a greedy and unprincipled minority.

So am I lost in a fog of despair? Well almost but not entirely! Let those in positions of authority allow those will skills and competency to adopt the advice of those who have the experience to provide it and lead us out of the mess in which South African public health services in many areas find themselves. It should be possible for an individual who sees a situation that is wrong to be able to speak out and be listened to rather than suppressed. It should be the responsibility of those in charge to make bold decisions to remedy the situation without fear of recrimination or retribution. Political correctness should not stifle initiative as wisdom does not resort only on high. If this was to occur maybe, just maybe, I could see a way out of the fog that currently envelopes me.