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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Facing budget shortfalls in the South African public health sector
In 2023 in my health blog I described the budget shortfalls facing most South African government departments. From my perspective the most pressing consequences of these shortfalls are those affecting provincial health departments. Recent developments including an open letter addressed to the Minister of Finance from health professionals in the Western Cape have again highlighted this issue. Many provincial health departments in South Africa have a history of what are euphemistically termed “accruals”, which stated otherwise is an inability to settle outstanding accounts within either the required 30 days or even a financial year. These departments have in the past been unable to remain within their approved budgets. An implication of “accruals” is…
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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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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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Does quality healthcare depend on money alone?
Recently I met with the management of a health department as part of my work in the healthcare field. I arrived early at the venue located in a large hospital and as the meeting also commenced later than scheduled, I had time to walk around the hospital. I encountered various staff members and patients and was cordially greeted although none asked whether they could assist me or what I was doing in the hospital. What was striking was the dilapidated state of many areas of the facility. Paint peeled from the walls and there were signs of water damage to the ceilings in various places. A pane of glass was…
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National Health Insurance … noble in intent but is it a bridge too far?
In the summer of 1944 during the Second World War the Allies launched an airborne operation, named Market Garden, aimed at securing a crossing over the Rhine River and thus an advance into the heart of Northern Germany. The aim of the operation was to seize key bridges with airborne troops allowing ground troops to advance over 100 kilometres to the Dutch town of Arnhem and by so doing outflank the German frontier defences. The plan which was backed by the British General Montgomery and Prime Minister Churchill despite concerns expressed by others in the Allied High Command lead by General Eisenhower. The operation despite the heroic efforts of allied…
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Health and Wellness go together but are very different challenges.
The World Health Organisation (WHO) defines Health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” and defines Wellness as “the act of practicing healthy habits on a daily basis to attain better physical and mental health outcomes, so that instead of just surviving, you’re thriving”. Both without a doubt important concepts but result in different challenges for those responsible for their achievement. “A new name, a new direction?” is the title of a recent article published in Daily Maverick . The authors draw attention, as so many have done in the past, to the work of Sydney and Emily Kark…
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National Health Insurance … what is government saying?
I have written on several occasions about the proposed National Health Insurance Bill (NHI) that is currently before the South African parliament. I have proposed a rational debate and have raised my concerns about what is proposed in the draft legislation. I was thus interested in an interview with Dr Nicholas Crisp, the deputy director-general tasked with National Health Insurance in the National Department of Health published in the Sunday Times on 3rd April 2023. Dr Crisp, who is one of the most senior officials in the National Department of Health, was posed a series of questions by Chris Barron and his responses, if he was correctly quoted, I found…
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A reflection on “Echoes of Austerity” … the truth should be told!
I recently, completely by chance, came across a paper published in 2019 in a peer-reviewed journal, Focaal – Journal of Global and Historical Anthropology, authored by a United States based, South African academic, Theodore (Ted) Powers entitled, “Echoes of Austerity”. (https://www.berghahnjournals.com/view/journals/focaal/2019/83/fcl830102.xml?rskey=kneG81&result=1) It was disconcerting to find that I featured as a less than flattering central point of this anthropological discourse on, “Policy, temporality and public health in South Africa”. Further investigation revealed that Powers is an Associate Professor at the University of Iowa having previously been affiliated to the University of Pretoria. In the abstract of the paper he indicates that his intention was “to explore how policy principles associated with…
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Piles of Refuse are relevant to Public Health
My thoughts reflected in this post were stimulated recently while driving past both formal and informal housing areas occupied by the less affluent communities in towns and feeling aggrieved by heaps of refuse piled against fences and in gullies in close proximity to homes both formal and informal. As a health professional my immediate thought was of the health risk that this posed to the residents with the rodents and vermin that are likely to flourish in this environment. On a human level, however, I reflected on how unpleasant it must be to live alongside these unsightly and I am sure malodorous piles of rubbish. It was unclear to me…