Fix what must be fixed and keep what must be kept

17 February 2016

Note to Editors: The following speech was delivered in Parliament by DA Shadow Minister of Health, Dr. Wilmot James MP, during SONA Debate 2016. 

Madam Speaker

The real value of health politics is when, as a famous playwright once put it, the nation’s “long sickness of health and living … begins to mend.” 

President Zuma mentioned his government’s plan to mend our long sickness of health with the National Health Insurance (NHI) scheme, an elaborate, overcomplicated, convoluted and monumentally costly path to Universal Health Coverage (UHC).

Constitutionally and morally there is no question that we must have universal healthcare, but Madame Speaker, why go to all this trouble and expense when all we need to do is fix what we’ve got?

The NHI is nothing more than a Rolls-Royce that does not address our basic problems. 

Take the issue of maternal mortality. 

The Medical Research Council (MRC) confirms that about 1 500 pregnant mothers and mothers-to-be die every year. Limpopo has the highest maternal death rate and the Western Cape the lowest.

Hear this Eastern Cape story: “My uncle advised me a young pregnant mom living with HIV told Human Rights Watch to call an ambulance when labour started but I did not want to go to hospital. I was scared of how I would be treated. I hear the nurses are very rude and they are rough.” Even if she called the ambulance, they arrive late or not at all. 

Tumeka, a young East London woman, very ill with TB, told the South African Human Rights Commission that when she asked her brother to call an ambulance he was advised that it was “unlikely to arrive: they told us they did not come for bed-ridden patients.” Our total ambulance fleet is 2 690 strong (public and private), but only half of them are in working order. 

Do we need NHI to fix the problem?

No we don’t. 

We need: 

- An easy-to-remember emergency number like 911 called from any device;

- A National Critical Care Fund to underwrite all parts of the health system offering emergency services. The Fund would ensure that all residents face equal access to the nearest treating facility regardless of whether they are on medical aid or not;

- National and provincial emergency services’ war-rooms that track and performance manage response times. 

Honourable Members, you know a public hospital is well-run the minute you enter the premises. It is clean, visibly well-organised and without long lines of people waiting for help. 

Most of our public hospitals are not well run and are terrible places in which to work. 

The African Health Placement had one doctor speak for many when he said that “very poor management is one of the reasons I left. The management does its own thing, and they do not care for doctors or patients.” 

Do we need the NHI to fix it?

No we don’t.

The secret to good management is to appoint clinically qualified hospital CEOs, borrow from private hospitals’ systems and have robust protection against outside interference.

Honourable Members, medical waste removal is a critical back-hospital function. 

In surprise visits to five provinces, I found Kimberley Hospital and West End in the Northern Cape and Sabie in Mpumalanga to be in reasonable shape, but seven were breaking the strict regulations that govern medical waste segregation, storage, removal and disposal. 

At Livingston, Port Elizabeth Provincial and Uitenhage District hospitals the infrastructure was so inadequate that I laid a charge with SAPS against the MEC for Health, Dr. Phumza Dyantyi, for violating the Occupational Health and Safety Act and the Regulations issued under the National Health Act. 

At Raheema Moosa Mother and Child Hospital in Johannesburg, boxes of infectious and needle stick waste were illegally stacked in an unsecured area to which children had access. The medical waste removal company Buhle had failed to collect the waste. Buhle’s name also appeared on improperly stored waste at Mpumalanga’s Rob Ferreira Hospital. 

Buhle has been awarded the contract recently for the Free State.

Notorious for tender corruption and financial mismanagement, I have requested the Auditor-General to launch an investigation into this sector. 

Do we need an NHI to fix this? 

No we do not. 

Good and accountable management will do the job.

The DA offers a much simpler route to UHC that makes no additional fiscal demands:

Drop the means test;

Set a health subsidy based on current expenditure for every citizen and legal resident and protect it in provincial budgets;

Keep provinces as delivery agents but enable them to obtain services from the public and private sector; and

Use the NHI conditional grant of R1bn a year to underwrite the building and staffing of clinics nationwide. The Department of Health and National Treasury agreed that the “grant should be used to support the Ideal Clinic rollout” and we concur. 

Our health system is vast and includes extensive assets in the form of hospitals, clinics, modern equipment and services. We have a highly skilled workforce together with effective educational and training infrastructure, a wide range of regulatory institutions and a well-established public and private system, both with long histories.

The art of our politics must be to fix what must be fixed and keep what must be kept - and to know, in contrast to the infantile populists and one-dimensional evangelists in this House, the difference between the two. Our struggle today is to defend to the hilt the progressive values in which we believe – the right to health as required by Section 27 of the Constitution – and to mobilise everyone else in the fight to preserve what is best about our common life as a people.

But why buy a new Rolls Royce when all we need to do is fix the family Toyota?

Issued by the DA, 17 February 2016