Africa-Press – South-Africa. The government is committed to implementing the National Health Insurance (NHI) scheme as envisaged, despite evidence of the public healthcare system falling off a fiscal cliff.
South Africa’s public healthcare sector is sitting on contingent liabilities totalling R120 billion, with the state paying out nearly R2 billion in damages per financial year.
This not only indicates severe financial mismanagement but also deteriorating levels of healthcare despite increased expenditure.
Experts, such as governance expert Professor Alex Van den Heever, say this shows the government needs to focus on fixing the root cause of poor healthcare in South Africa, which is mismanagement and corruption.
Rather than doing this and reforming public healthcare, the Department of Health is increasingly allocating resources towards implementing the NHI, which may never see the light of day.
All the while, South Africa’s healthcare sector faces a growing financial crisis, which threatens to significantly impact access to and the quality of healthcare.
Legal practitioner Dr Robyn Conradie told Newzroom Afrika that there has been a sustained decline in the level of service delivery in the public healthcare sector over the past decade.
“This is a result of resources which are severely depleted. Coupled with this are patients who are increasingly aware of their rights and what they can demand from the public system,” Conradie said.
“Specifically, people are more aware of their right to access healthcare and the fact that they do not have to accept adverse outcomes or poor service delivery.”
The combination of declining healthcare in the public sector and greater awareness of patient rights has resulted in increased legal action against the Department of Health.
This has left the department with R120 billion in contingent liabilities, which are a direct result of historic claims that have been instituted because of medical malpractice.
“This is systemic negligence that we are now talking about. That can be a result of understaffing, badly maintained equipment, or a lack of resources,” Conradie explained.
This makes it a difficult challenge for the department, with an increasing share of its thinly stretched resources being allocated to legal battles or to paying off malpractice claims.
Malpractice, the NHI, and corruption
Wits professor Alex van den Heever
Ultimately, the root cause of these medical malpractice claims is a lack of capacity, mismanagement, and widespread corruption.
Conradie explained that many of the claims instituted against the department could be easily avoided by implementing proper controls and management.
To stem the flow of money towards legal cases and payouts, the public sector needs to be refocused on service delivery.
This means that resources should flow towards staffing hospitals adequately, maintaining and upgrading equipment, and building additional capacity.
However, the state has preferred to funnel resources towards preparing for the NHI through investments in administrative staff.
This not only wastes resources that could be used to improve service delivery and minimise malpractice claims, but also siphons much of the money off by corrupt actors.
Van den Heever explained that the government has repeatedly failed to address many issues in the public healthcare system that would provide a credible basis for implementing the NHI.
“What we have is that a lot of our funding for the public health system is being drained away through corruption,” Van den Heever said.
“If we just look at the Tembisa matter, about R2.3 billion was extracted from one hospital in Gauteng. This is by no means a unique situation.”
“The flaws in South Africa’s procurement system, which make them ‘capturable’ by political networks, are across the entire public system.”
This means that much of the money allocated to healthcare in South Africa does not end up in patient care, with much of it going to politically connected individuals.
“This is an enormous drain on the performance of our healthcare system, and it is not confined to Gauteng. It is something that is happening across the board,” Van den Heever said.
He urged the government to focus on closing governance gaps being exploited by corrupt actors, rather than pursuing the NHI.
In this sense, legal challenges against the NHI are necessary, as they are likely to force the state to engage with what actually needs to be done to improve healthcare in South Africa, he said.
“The closing of those governance gaps should have been the focus of a responsible government,” Van den Heever said.
“The structural gaps that are allowing widespread corruption to occur are not being addressed at all, and that is because there is potentially a lot of vested interests involved.”
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