How South Africa’s health care system has changed since glory days of Prof Chris Barnard

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CAPE TOWN, November 30 (ANA) – On Sunday, December 3, it is exactly 50 years since South African cardiac surgeon Christiaan Barnard performed the world’s first successful human-to-human heart transplant at Groote Schuur Hospital.

How the Cape Argus reported the world’s first heart transplant half a century ago. PHOTO: ANA
Groote Schuur Hospital

The feat put the hospital in the world’s spotlight and turned Barnard into a celebrity, who went on to be feted across the globe for the achievement.

Barnard died in 2001 at the age of 78, and while South Africa will once again bask in the glow of he and his team’s remarkable achievement half a century ago, the golden years have long since faded. If the social and political landscape is much changed from then, so too has the state of its public health. And not always for the better.

Apartheid blanketed every facet of South African society so that even its public healthcare was segmented according to race groupings. Every hospital, including Groote Schuur situated on the slopes of Devil’s Peak, was structured to allow for separate facilities for the white, Indian and mixed race, and black populations.

The standard of facilities and care provided for the minority white population was markedly above that provided for other races. Barnard’s Groote Schuur was privileged South African healthcare held up to the world spotlight and lauded.

But as societal pressures, including population growth and the dismantling of apartheid, took hold, so the public health landscape opened up to all South Africans.

It was and still is a daunting task – to suddenly have to cater and provide quality healthcare to an entire population, the vast majority of whom had been desperately poorly catered to for decades.

Today, while cutting-edge medical advances and private healthcare are still comparable to the best in the world, public healthcare at citizen level is an altogether different story. A retired Cape Town doctor describes the current state of public health as a “total mess”:

Doctor Howard Paul has warned that South Africa’s public healthcare system is declining and will continue to do so and that ultimately indigent patients will suffer the most.

Paul, who worked at a number of state hospitals and clinics in his career, told the African News Agency (ANA) that much has changed since he first became a doctor in the early 1970s. He completed his internship at Groote Schuur Hospital.

“Back then we had real doyennes, we had Chris Barnard, world authorities. There was no pussyfooting around. If you got things wrong, you accepted responsibility for it.”

But that’s all changed, he says.

“I think it’s really collapsed. If you have a look at what is happening in all the provinces, it’s not very good news. There is no leadership in government. The health system in KZN (KwaZulu-Natal) has collapsed in the past four years, there are no oncologists,” says Paul.

“And the Life Esidimeni tragedy is just one of the issues highlighted in the media recently. The guys in charge just point fingers at each other.”

The botched transfers in 2016 of almost 2,000 mental health patients from private healthcare provider Life Esidimeni to unlicensed NGO facilities resulted in the deaths of at least 143 patients, many from starvation and severe neglect. Fifty-nine of the patients are still unaccounted for.

Paul, who worked at a clinic in Retreat where he was involved in setting up and running trauma units before retiring, said the motivation for equipment fell on deaf ears, and when he left after 10 years, they still had not received what had been requested.

But could the much vaunted proposed National Health Insurance (NHI) improve the situation for South Africa’s poor who rely on public healthcare, and for whom hugely expensive private health cover is a pipe dream?

The Institute of Race Relations last year published data that showed that just 17,4% of South Africans are covered by medical aid.

Almost 45 million South Africans are not medically covered, and according to their research, 72,7% of white people have private medical aid, as opposed to just 10,5% of black African people.

But the proposed financing system for the NHI aims to ensure that all South Africans are provided with essential healthcare, regardless of their employment or economic status.

The White Paper on the NHI, gazetted in June 2017, indicates that by 2025, it would cost the country R256 billion in 2010 terms to implement the NHI if the country had a GDP growth equal to 3.5 percent per annum. However, forecasts put South Africa’s growth rate for the foreseeable future at only around 1%.

For this reason, it has come under criticism from several quarters as an unaffordable way forward.

In a recent article for Biznews, Dr. Anthea Jeffery, head of Policy Research at the Institute of Race Relations, said: “South Africa’s tax base is too small to cope with the existing burden, let alone the enormous additional load the NHI will generate.”

“The NHI proposal overlooks the key reasons healthcare costs are going up. The main factors making for high medical inflation are increased utilisation and costly new medicines and technologies.”

Like Jeffrey, Paul believes if the government presses on with its plans for implementing the NHI, it will be catastrophic.

“The whole thing is down to money and a lot of politics too, between the different provinces. The Western Cape probably has the best health system at the moment. If you look at KZN, North West, Gauteng, they are all broke. They can’t pay bills to suppliers. The whole thing is a mess.”

But national Health Minister Aaron Motsoaledi has made it clear that he will soldier on with the NHI plan, telling Parliament in May that he would defend it “with my life if necessary”.

Tabling his department’s budget, Motsoaledi said his department has already spent over R40 billion on infrastructure and R1.7 bln on equipment in 10 areas deemed “pilot projects” for government to prepare for the introduction of NHI.

“Within the 10 pilot districts, we have completed the building of 34 new and replacement clinics and we are busy with 48 others. This will be a total of 82 new and replacement clinics,” the minister said.

He said the NHI may be partially funded through reducing tax credits to medical scheme members.

“The tax credits mentioned in the February 2017 Budget Speech by Treasury is a whopping R20 billion. Yes, R20 billion that in 2015 and annually will leave the fiscus through [the South African Revenue Services] SARS back to the pockets of people simply because they are members of a medical aid scheme,” he said at the time.

“Taking so much money back to rich people is like sending coal back to Newcastle when you have a neighbour without a simple fire to cook their food. How do we as public representatives, honourable ones for that matter, justify this type of thing happening in our country under our watch?”

– African News Agency (ANA),