Health Amendment Bill must be reconsidered before crucial health skills are lost

The proposed National Health Amendment Bill risks creating a situation where certain kinds of medical care will be available only to a small elite who can afford to fly to places like Europe for treatment; one in which all the potential that exists for widening access to the private sector in South Africa will be lost. This will be disastrous for all South Africans both rich and poor. It is therefore crucial that the warning given by the South African Medical Association's recent survey of doctors' opinions - which shows that two thirds of doctors may leave if the Bill is passed - be heeded, and that this law be reconsidered before it is too late.

Instead of the enormous interventionist powers proposed by the Minister in this Bill, the Democratic Alliance believes that we need to be actively pursuing ways to enable the private sector to co-operate with the public sector in the delivery of public health services.

The liver transplant operation that Health Minister Manto Tshabalala-Msimang received last year could only have been performed in the private sector, because resource constraints in the public sector mean that strict age cut-offs - which she would not have met - must be enforced. Had the Health Amendment Act been in place at the time, and the pricing regime been implemented that made the Donald Gordon Clinic's functioning unviable, she would have needed to leave the country to obtain that life-saving operation.  The millions of other South Africans who rely on the private sector would face the same disastrous situation.

It is not only patients who use the private sector who will suffer from this proposed law, however, as the implications of an unstable and unsustainable pricing environment for the private sector will be felt by all patients. In general, the private sector contributes significantly to the overall level of medical knowledge in South Africa, and there is a considerable amount of overlap in the functioning of the public and private sectors.

Last year, more than 5000 nurses completed their training in institutions run by the private sector and a number of these nurses are now employed by the state. Private hospitals sponsor and run various mobile clinic services, private doctors have contributed to programmes to reduce waiting lists for procedures such as cataract removal, and during health emergencies the state frequently uses spare capacity at public hospitals. Many doctors in the private sector do some duties in public hospitals as well. Public hospitals cannot afford to lose them.

Instead of this Bill, the DA proposes the introduction of two key measures:

• The speeding up of the creation of an Office for Standards Compliance already provided for in the National Health Act, which would oblige all health providers to meet quality standards and be fully transparent in their operations; and
• A decentralized model for hospitals which allows private hospital groups to tender for contracts to run state hospitals. The state would subsidize hospitals on a per-patient basis, and hospitals would be required to provide services to the indigent for free and to meet certain delivery outcomes. This would widen opportunities for private hospital groups to make the service they provide more widely accessible.

South Africa simply can not afford to risk a health skills drain of the magnitude that the departure of two-thirds of the country's doctors would precipitate. The negative consequences of ignoring the concerns of the country's health professionals - for those citizens dependent on both public- and private-sector health care - are just too dire to contemplate.

Statement issued by Mike Waters MP, Democratic Alliance spokesperson on health, May 20 2008