South African leadership seems fixated on creating advances in many sectors that are often at odds with the real issues or the reality of the lived experiences and situation on the ground.
There is talk about Smart Cities, when existing cities such as Johannesburg, a key business centre in the country and others are in a state of complete decay and in disrepair. There is much talk of high-tech, high-speed train services, when the existing basic PRASA rail service is functionally not in operation in most areas in South Africa.
And then there is the rising monumental ambition to create a modern universal healthcare (UHC) service that will deliver world class medical services to all when and where they need it within the framework of the National Health Insurance (NHI), an undertaking without a clear path of how this can be accomplished.
Roundtable Discussion on NHI
Today (2 April), the European Chambers of Commerce and IPASA, hosted a roundtable dialogue in Pretoria in an effort to kick-off a serious discussion around how and if implementing the NHI is feasible and how this might look.
This is according to some delegates, was the first time ever, that there has been a discussion including all the major Pharma players in the market and as such was a good starting point for the discussions. Also included in discussions were government, National Treasury, the Board of Healthcare Funders as well as a few patient advocacy groups.
The NHI was hurriedly signed into law prior to the 2024 national elections, despite extensive reservations expressed across society, business and political structures, about its viability and concerns as to how the act would actually be implemented and the potential impact on the existing healthcare sector and service providers.
President Ramaposa, responding to widespread criticism at the time said that “This is going to happen whether they like it or not”. Business Leadership CEO Busi Mavuso responded to this statement saying, “The Presidents comments are incredibly damaging”.
Facts Around the Current Healthcare Situation in South Africa:
- South Africa spends more on healthcare than any other country in Africa – with around 14-15% of the total national budget of 2,47 trillion in 2024, allocated by the state run healthcare.
- The Government has allocated an additional R28,9 billion in the new 2025 / 2026 budget proposed for 2025 /2026 year.
- This money is spent on providing healthcare to only 54% of the population via government healthcare services, with the balance of citizens using private healthcare services privately funded via medical aid or medical insurance or via cash payments.
- The figure of only 16% of people in South Africa using private healthcare, that is often quoted, is a misnomer as there are an additional 30% who use private healthcare facilities but who do not have medical aid or medical insurance cover and use cash or financing options to do so.
- Despite the massive budget allocation, most government healthcare facilities in South Africa are battling to meet their remittance requirements and have enormous budget accruals, according to Mark Blecher from the national treasury, while currently areas such as the Eastern Cape making large debt accruals and are unable to service its outstanding supplier payments to the tune of around R7 billion.
- The private healthcare sector generated over R547 billion in revenue in 2023 and employs in the region of 400 000 people.
What are the Issues Around Universal Healthcare?
The key issue around healthcare is cost. Cost of facilities, high cost of equipment, increasing cost of qualified and skilled staff, that are increasingly becoming scarce, and the high cost of pharmaceuticals required for treatments.
A number of well-established and well-funded universal healthcare facilities around the globe have failed. With the likes of the UK healthcare, that was once lauded as the best example of universal healthcare, now a sad shadow of what it was, with patients waiting months for medical treatments and diagnostics.
The World Health Organisation itself has emphasised that UHC is difficult to achieve even in wealthier nations, and has acknowledged that as a foundation for and a way to move towards UHC, countries should rather reorienting health systems using a primary health care (PHC) approach, as this is the most inclusive, equitable, cost-effective and efficient approach to enhance people’s physical and mental health, as well as social well-being.
Key Roundtable Talkin Points:
- Outcomes of existing healthcare expenditure was questioned with Treasury saying that “on many indicators, we are not doing well in our expected outcomes”. According to Mark Blecher. There would seem to be a big gap between what is spent and what is currently achieve and closing this gap alone would improve healthcare in the country.
- Some, such as Dr Stan Maloabi of the Government Employee Medical Scheme, believes that “There is no option but to support the establishment of a NHI”. Though other delegates questioned why this was the only approach with Raluca Pauna emphasising that innovation and technological advances such as AI could hold many solutions in providing services that would fill the current gaps in healthcare.
- Patient Advocacy Group CEO Kelly du Plessis raised the issue of little to no engagement with the public and with patients in terms of creating a workable framework for decent healthcare.
- Apart from the obvious funding issues, a major stumbling block to providing proper healthcare is certainly the lack of proper data that can be analysed and used in the formation of better services. Without this foundation it would be foolhardy to even try, as services provided may not be remotely what is actually required.
Focused Leadership Required
Lauren Pretorius from Campaigning for Cancer gave a concise view of what was required to create a better healthcare system in South Africa
“So I’m going to talk about three things that we can compare the future with. And we can look at that future cooperation. And, the number one is leadership” Lauren states.
“We can ask ourselves if we have leadership by saying, are patients getting the right thing at the right time with as few problems as possible? We can look at innovation. We can ask ourselves the question, if we carry on with the same mindset, will we change anything, or are we dead in the water?
And then commitment, not so much collaboration, but commitment. Now, commitment is a word that I’d like to throw out the door, because commitment is a science obligation”. “I’d like dedication, because that comes from passion. As people, we’re generally driven by passion”.
A clear perspective from all the discussion, is that there is a great need for changes in healthcare but quite how that looks, how it is funded and how it creates patient centric services to a broader community is still to be determined.
What will be required to accomplish a better healthcare service, without question, is a large amount of cooperation, innovation, new health-tech adoption and high levels of accountability.
