The May 29th 2024 election delivered a parliament for the first time in the 30 years since 1994 in which no single party had a majority. During the past 30 years the African National Congress (ANC) had a significant majority at both national and provincial level with the exception of the Western Cape province where since 2009 the opposition Democratic Alliance had a majority which was maintained in the 2024 election. Clearly after the 2024 election the ANC which was the largest party with just over 40% of the votes had to seek coalition partners. After tough negotiations a coalition was formed with the Democratic Alliance as the second largest…
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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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National Health Insurance NHI … the “final countdown” … or not!
In May 2023 I wrote a post titled “National Health Insurance … will logic prevail?” Now a year later, in May 2024, it appears to me that emotion and political necessity rather than logic has prevailed certainly amongst the ruling party. I do not intend to repeat an analysis of what is contained in the now NHI Act signed by President Ramaphosa but rather to consider the consequences of his doing so 15 days prior to a general election in which the political party which he heads faces for the first time possible, but probably unlikely, election defeat. The President has defended his actions with the argument that the delay…
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2023 … some reflections on the year that was!
At this time last year I published a similar post reflecting on the happenings of 2022. It is interesting to reflect on what I said then in the light of what has transpired in 2023. In December of 2022, the echoes of COVID-19 still remained, something that has now almost vanished from the public consciousness despite reports of new variants, similar to the amnesia that may follow a very traumatic event. In Britain, however, the country continues to anguish over the consequences of what was and what was not done during the pandemic in the public hearings of a commission of inquiry into the actions of those in positions of…
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Politicians, policies, plans and their promises
Recently the South African President has extolled the virtues and achievements of the political party that he leads. This is totally understandable since as the leader he faces an election in 2024 which according to analysts could be the closest since the first democratic election in 1994 when the ANC assumed power. There have undoubtedly been achievements and the President focused on these including the fact that many indigent South Africans now receive a social grant that eases the poverty with which they grapple daily. In the public health sector, of which I have first-hand experience, there have been significant achievements for example the introduction of a comprehensive national immunisation…
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National Health Insurance in South Africa … will logic prevail?
Following my last post describing an analogy between the space shuttle disasters and the possibility of a system failure following the envisaged implementation of National Health Insurance (NHI) in South Africa my thoughts have returned to what I wrote in March 2022. This post reflected on the alternatives to what is proposed in the South African model of NHI. As I wrote then since 1994 the divide between those who have the ability to afford what in South Africa is termed private healthcare and those dependent on the State operated Public Health Service for the provision of healthcare has regrettably grown. The widening gap cannot be laid at the door…
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National Health Insurance … potential for system failure?
I recently read about the two disasters affecting the American Space Shuttles. The Challenger exploded shortly after launch in 1985 while the Columbia was destroyed 20 years ago over Texas on its 2003 return to earth after a 16-day mission. In both cases an accident investigation board (AIB) was established to investigate the causes of the disasters and make recommendations to address what had occurred. In the case of Challenger, a faulty o-ring on one of the solid rocket booster rockets, due to the abnormally cold weather during the launch, lead to flames leaking from the rocket igniting a catastrophic explosion in the shuttle’s external fuel tank destroying of the space…
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Hospitals are key to an effective health service
Having recently been a patient requiring major surgery in a hospital, I have reflected on the vital nature of a fully functional hospital to the integrity of a health service. Despite spending half my professional life as a clinician working in a hospital, being a patient requiring complex care without which I may not have been here today to write this, provided me with another perspective. Hospitals, be they in the public or private health sector, are complex organisations focused on, and vital to the well being of the patients admitted to their wards. Hospitals are essential to provide a range of services that cannot be provided elsewhere which is…
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2022 …the year that was!
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.…
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What lessons were learned from the COVID-19 pandemic?
I often read, and at times hear, that many lessons were learned during the COVID-19 pandemic. It has been said by some that these can be used to determine the future direction of health care. I have been reflecting on whether there were lessons to be learned and, if so, to what extent they provide insights into the future of healthcare in South Africa. From the position now as an outsider to the mainstream of healthcare policy and management I am aware that the efforts of many in the health sector across the globe went far beyond what was normally in their job descriptions. Health professionals faced with the uncertainties…