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A new study has yet again pointed out South Africa’s healthcare system failures and emphasised an urgent need for an overhaul.
The study was conducted during the changing healthcare climate as a result of the Covid-19 pandemic.
The research report by public interest law centre Section 27 and the Concentric Alliance (CA) found that not only was the health system characterised by inequality in access to services but that in some cases it was almost overwhelmed by the pandemic.
The study noted that ‘fatal’ healthcare system failures, like the extended closure of Charlotte Maxeke Johannesburg Academic Hospital, nearly brought the public health sector to its knees.
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With healthcare workers burning out and the constitutional right to health not a reality for many, the study was driven by concerns over the stagnation of health reforms after a decade of discussion and debate on the National Health Insurance scheme.
Researchers noted that stakeholders were wary and did not trust each other’s motives and opinions with regards to NHI, warning that this stagnation was fatal as the system was under immense strain and its inequities well documented.
“Some people continue to receive insufficient care while others are over-serviced in the interests of profit. Healthcare workers are burning out. Uncertainty about changes that may never come is causing jitters in the middle class and impatience among those who cannot imagine a changed system leaving them worse off,” the report states.
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With the study, Section27 and CA sought to establish what stakeholders, away from the public eye, agree and disagree on, and if they could be brought closer to each other.
A total of 33 participants from the health department, regulators, medical schemes, public and private healthcare workers, unions, private hospital groups, academia, civil society and pharmaceutical companies were interviewed.
While there are some areas of profound disagreement, there are also areas of agreement. All agreed that the foundation of a health system was the right to access healthcare services.
Participants agree that there is a need for health system reform, in part to realise that right and that there are governance, accountability and management issues that must be urgently attended to.
Many agree with the need to monitor health outcomes and orientate the health system to respond to those outcomes, with most respondents also agreeing with the need to better regulate the private sector, including the pharmaceutical industry.
Researchers said areas of disagreement were less surprising. These include:
“These are the difficult areas of health system reform that may be holding up needed reform in other areas. Even within these areas of disagreement, however, there are glimmers of consensus, agreement on principles, and recognition of the need for change. Subjecting some of the more wicked problems to a good faith consensus seeking process could help to move the needle,” the study notes.
It recommended taking action on areas of agreement and to go deeper into consensus seeking to guide the way forward on areas of disagreement. However, taking action on areas where there is already consensus would need to be a government-led and funded process, in collaboration with stakeholders.
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