SA must move to a health system focused on prevention – Minister

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If this happens, the much-debated National Health Insurance system will become an affordable option and will see all South Africans having equitable access to excellent health services where primary health care is the foundation. But in order to achieve it prevention programmes need to be bumped up.

Motsoaledi was speaking in an exclusive interview with Health-e, his first since taking office. ‘What we are doing is not sustainable in the long run. For example the issue of antiretrovirals. We have to issue them, its normal in every health system to do that. It’s also an issue of human rights. But at this rate it’s not sustainable if we are going to increase the number of people who must be on ARVs. Common sense should tell us that we need to prevent and stop this disease from spreading otherwise it’s just going to become an expense to everybody,’ says Motsoaledi who is adamant that more resources will be going to immunisation campaigns, school health programmes, HIV prevention, TB case finding, infection control and primary health care.

Motsoaledi agrees that NHI is unaffordable if based on the current public health system, which leans heavily towards curative services and an expensive private healthcare service. He believes that South Africa took its eye off the ball after South Africa’s first democratically-elected health minister Dr Nkosazana Zuma established a primary health care system as a central part of the bigger system. ‘Now it’s gone. By en large South Africa is running an extremely expensive curative health care system

‘And at the moment we are aware that the public health system is not working very well we can’t hide it. I’ve been open about it. Some call it a collapse, others call it a crisis, and others say it’s an emergency. But the bottom line is that we have some of the world famous hospitals like Chris Hani Baragwanath hospital and world class institutions like Charlotte Maxeke (Johannesburg hospital) being skeletons of their former selves. At the back of that people are now looking at this national health insurance and they believe it is a reflection of what will happen in the NHI.’

‘When last did you a nurse in any school checking kids, checking their teeth, their eyesight, their ears , tonsils, whether they have been immunised, nutritional status?’ he asks.

‘They must get sick first and go to hospital and then we calculate what it will cost the National Health Insurance. That’s what everybody is focusing on. I want to change that mentality. I want to change it dramatically. Not only the mentality but the practice, it has to change dramatically.’

Motsoaledi finds it ironic that not a week passes without him signing approval for a SADC patient to access the health care system for a kidney transplant, cardiac surgery, ophthalmic surgery or cleft palate surgery. ‘We are regarded as a superpower in health on the continent,’ he exclaims. Yet, the irony lies in the fact that most of these countries that turn to South Africa for hi-tech healthcare have low infant and maternal mortality rates. South Africa is one of ten countries in the whole world which over the past decade dismally failed to bring down infant mortality. ‘’¦ the others are Bangladesh, Pakistan, you know countries which are at constant war. Which war are we fighting?’ says Motsoaledi, growing more animated as he tries to get to the point.

‘How do we successfully do all this high powered medical procedures for the rest of the sub continent but fail to bring down the rate of death of mothers and children? These things can be changed. It’s clear that there is something wrong somewhere and when you check budgets there is no country in the whole continent of Africa, none which has got a budget that we have in health. These are very poor countries which depend on us for high powered medical procedures but they are able to save their mothers and children. So there is something wrong, grossly wrong we are doing which South Africans don’t want to face.

Motsoaledi is adamant that it can no longer continue and he is set on overhauling the whole system and redirecting it to primary health care. ‘Where South Africa knows that promotion and prevention is always better that cure – we can only go to cure as the last resort, not the other way round as the whole South Africa seems to be thinking.’

The minister will later this year undertake a study tour to Brazil where he is interested in learning how the country has implemented an NHI which in turn brought down infant mortality rate. ‘They established 30 000 primary health care teams and that have brought infant mortality down. Our infant mortality is between 60 and 70 per thousand live births. In Brazil it is 19. They didn’t bring the infant mortality down by instituting NHI, but they also put emphasis on primary healthcare in terms of prevention, promotion of nutrition, immunisation, school health programmes and all that. Then your hospitals won’t be as congested as they are in South Africa,’ says Motsoaledi.

The other area he is set on overhauling is the management of the health system and Motsoaledi believes it is a case of the health system being both underfunded and mismanaged.

Motsoaledi believes these factors compel him to overhaul the health system under the banner of a so-called NHI. However, it will not be an event as many fear.

‘We are not just going to wake up and say today it’s NHI. It’s not going to be an event it’s going to be a process and a process that will take a long time.’