The Life Esidimeni tragedy happened in the early months of 2016 when a long-standing contract with the Life Healthcare Group was terminated by the Gauteng Department of Health. Thereafter despite warnings that this was unwise around 1500 vulnerable mentally retarded patients were transferred from Life Esidimeni facilities in Gauteng to Non Governmental Organisations (NGO’s) in what was known as the Marathon Project. Many of the NGO’s did not have the capacity or resources to manage patients of this nature and as a result at least 144 patients died of neglect and many more suffered inhuman and degrading conditions. This occurred less than a year after I had retired as Head…
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South African Public and Private Healthcare … there is good and bad in both
The recent high profile signing of the National Health Insurance Act set me thinking about the public perceptions of healthcare in South Africa. In a South African context one hears much about problems experienced in the public health sector but less about those in the private health sector. In the public health sector issues relate to the poor quality of healthcare while in the private sector the issue most frequently is the high cost of services. I have had the advantage of having worked for forty years in the South African public health sector and subsequent to my retirement being part of, or having undertaken, various investigations into public health…
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The dilemma of unemployed doctors in South Africa
Currently there are according to reports several hundred unemployed young doctors in South Africa, a country that according to recommended doctor to population ratios requires more and not less doctors. It has been previously reported that some amongst other categories of health professionals are similarly finding it difficult to find employment in the South African public service leading to some even emigrating from this country to find work elsewhere. This situation has been attributed to the shortfall in funding for public health services. The current financial crisis in government departments largely results from a wage agreement with organised labour that increased the salaries of all public servants by 7%. These…
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Cystic fibrosis … the conundrum of scientific progress
I recently read a review article on cystic fibrosis which highlighted for me the tremendous advances in the field of medicine since I left active clinical practice as a paediatrician in 1995. During my training as a paediatrician and subsequently as a senior research fellow I worked for various periods in a clinic at the Red Cross Children’s Hospital that managed children with cystic fibrosis. As a result of this experience when in 1983 I moved to Bloemfontein, I started a similar clinic to manage children with the condition in the Free State province. Over the 12 years that I spent in the Department of Paediatrics and Child Health at…
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Nutrition … a marker of poverty or privilege
A recent headline in the Daily Maverick read as follows, “Child malnutrition in the Eastern Cape qualifies as a disaster” quoting from a South African Human Rights Commission report on child malnutrition in the Eastern Cape province. The article cited the fact that 25% of the provinces’s children have stunted growth and over the period of one year over 1000 children were diagnosed with severe malnutrition of whom 120 died. Juxtapose this with a more recent media headline in a Afrikaans National Sunday Newspaper which reads translated from the Afrikaans, “You cough up R24 000 per head so that Cyril’s (the State President) guests can feast while they fly”. The…
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Healthcare … a victim of a self-inflicted government funding malady?
Various questions trouble me when I hear that a public sector health department has a major shortfall in the budget allocation that will result in people being unable to receive the healthcare that they need. Who is accountable? Who is responsible for the consequences? Is it immoral that the cost of healthcare should limit access? Who should decide which treatment should not be provided? What is an acceptable package of healthcare? What can be done to alleviate the problem? I could go on … I have great empathy with a doctor who although the treatment plan is clear must inform the patient that due to affordability constraints that either a particular…
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Cholera in South Africa … is it a marker of government failure?
As a paediatrician I specialised in childhood diseases of the gastrointestinal tract. I obtained a doctorate for a study of infants presenting to the Red Cross Children’s Hospital in Cape Town with acute diarrhoea. In the introductory chapter of my thesis, I quoted the researchers Rohde and Northrup (1975) who stated that, “the incidence of diarrhoea is more closely related to socioeconomic conditions than to climate, to poverty rather than place.” At that time (1981-1982) diarrhoea in infants was an annual summer epidemic in Cape Town located largely amongst the black and coloured communities of the Cape Flats. In recent times the frequency of the disease amongst children from these…
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Politics, policy and implementation … there is a vast difference!
President Ramaphosa speaking at the 5th South African Investment Conference on 13th April 2023 made the following statements; “We are now confronted with the consequences of years of under-investment, mismanagement and corruption in our electricity, rail and logistics sector.” and that, “We are on a long journey to rebuild our country and recover ground we have lost. Our recovery is a mission and will take time to accomplish”. He continued that, “The lack of reliability in electricity supply weakens business and consumer confidence, taints international perceptions about our country and affects investment sentiment and decisions” concluding that, “If the focus of our struggle for liberation to end apartheid and achieve political freedom, the focus of our efforts must be to address inequality…
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Some thoughts on health service management
I am often asked what are the requirements to manage public health services or a public health facility? What qualifications are ideal? Is a health background essential? What about a health related MBA? I wrote on this topic in a post dated 21st December 2021 and if these are questions that still entertain you that post is worth another read. Previously my recommendations in that post were: Time spent in the health services either as a health professional or employed in another capacity within the health services is essential. Particularly, if one is not a health professional a postgraduate qualification in public health to provide an understanding of the field…
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When is enough, enough?
As a health professional and health manager, it is understandable that most of what I write about is health related. But I am also a citizen of this country and live some of the realities that South Africans experience, albeit not fully experiencing what my less fortunate fellow South Africans experience. For this reason I reflect here, accepting that I am a privileged citizen of this country, on the general state in which South Africans find themselves. Whilst the abolition of apartheid removed discrimination on the basis of race, we are still a country divided along racial lines between those who have and those who have not. South Africans are…