Healthcare, the elephant in the room?

This past weekend I attended interesting debates at the Franschhoek literary festival.   Some discussions I attended were around politics. Areas addressed were party politics, opposition parties, political leadership, strength of parties, potential focus areas for political parties. It was insightful and repeated priorities included governance, trust in leadership, economic growth, education, social grants. Well-known names included Max Du Preez, Prince Mashele, Eusebius McKaiser, Salam Badat, Richard Calland, Stephen Grootes and Adam Habib.

I know that none of the above authors/speakers has a focus on healthcare, access to healthcare, health system functioning or potential impact of not having a functional public health sector. However I still find it interesting that there was no mention of health care manifestos or the importance of healthcare as a political tool. Think Obama 2008 and Obama 2014…it even feels strange not to type Obamacare. Affordable health has been a key concept during Obama’s campaign and subsequent presidency. In the USA Healthcare has consistently been in the news and has in many ways been a political driving force.

I agree that education, transformation and economic growth are vital to our country. However I can’t help but feel that healthcare should at the very least share an equal priority with the above and that it deserved mention.

Health systems offer value beyond health and impacts on quality of life, which includes other related factors such as level of income, nutrition, environment, safe water and sanitation. Health systems are widely recognised to be vital elements of the social fabric in every level of society.

We all require baseline health to be economically productive or to attend school. Should we or a family member fall ill we have an expectation that one should not need to spend an entire day at a clinic or an entire month’s income on medication. Our jobs should not be threatened as at it is for some because off spending a day in a queue at a clinic for medication. It should not be disruptive to our daily routine to attend to a clinic for cough medicine. Neither should out of pocket purchases financially ruin us and be unaffordable.

Beyond the debates at the literary festival, analysing the political party manifestos of the six bigger parties for the May 2014 elections the main priority areas across the parties focused on job creation, safety, education, skills development, entrepreneurship.

Yet again healthcare was typically mentioned close to the bottom of the lists and some parties only had a one-liner discussing their views on health care. Is this enough? In 2011 Healthcare was the third greatest expense of the South African government, and yet healthcare is not mentioned as a top priority on the manifestos?

In South Africa healthcare access for all is constitutionally enshrined but we need to consider whether we are failing.

  • We don’t have enough beds for sick people.

The amount of beds per population in the public health sector has declined. In 1986 during apartheid the bed: population for black people was 4.2 per 1000 persons and for white people it was 8.2 per 1000 beds. The current ratio in the public sector is 0.9 beds per 1000 people. When private facilities beds are included it’s only 1.6 beds per 1000 persons. (National Care Facilities Baseline Audit 2013)

  • We have more people and fewer beds. 

The population growth rate in 2012 was 1.2% with an estimated 52 million people living in South Africa. In 1995 the population   was estimated to be 41 million.

  • Health expenditure has not changed.

According to the World Health Organization in 2004 our government spent 8.4% GDP on health. In 2010 our government spent 8.4% of GDP on health. So effectively we might be spending less on health.

  • We have fewer medical practitioners.

Medical practitioners in 1998: 6.7 per 1000 people. Medical practitioners in 2011: 4.5 per 1000. It is estimated that most of them are working in the private sector.

  • Our nurses are old.

According to the South African Nurses Council in 2005 36% of all nurses registered were over the age of 50. In 2013 45% of all nurses registered were above 50 years of age. This is potentially disastrous as these nurses are likely to retire in the next 10 – 15 years.   Only 4% of all nurses registered with the council are under the age of 30. Nursing is just not an attractive career option.

Ignoring the importance of a healthy society seems to be a global trend. Service delivery sectors in Africa received 70% of the foreign direct investment in 2012. However Healthcare investments were not even listed within the top ten sectors to receive investments.

So my question is: is it healthy to ignore health care?



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