With Panyaza Lesufi's populist promises and Leon Schreiber's pie in the sky plans, will public hospitals and Hell Affairs ever get better at serving South Africans?

Dear DM168 reader,

I picked up Business Day in the OR Tambo Airport lounge while waiting for a very delayed Lift flight to Cape Town with my colleagues Ray Mahlaka and Ferial Haffajee.

We were off to a senior writers’ meeting, led by our new editor-in-chief Jillian Green, to discuss how we can pool our existing resources and talents to keep serving you, our readers, after completing a very traumatic cost-cutting exercise to keep Daily Maverick afloat.

Why has government not acted on the Health Market Inquiry recommendations?

In Business Day I read with interest an article about the Board of Healthcare Funders (BHF) criticising the government for failing to act on several recommendations from the 2019 Health Market Inquiry (HMI) that were aimed at reducing private healthcare costs.

Any one of us almost 10 million South Africans who are on some kind of medical aid scheme know that we pay an arm and a leg for a basic private hospital plan and then give away our other arm, leg, neck, shoulder and head for dentistry, medication, any sort of physical or mental health therapy, X-rays or blood tests in the savings portion of our medical aids. All this while the cost of medication, doctors, dentists and specialists goes through the roof.

So I was intrigued about why the government, having pushed through the National Health Insurance Act, which it seems it is nowhere near implementing, would not in the interim do something, anything, to control skyrocketing medical, dental and medicine costs after it was suggested five years ago by the Competition Commission.

In its HMI report, the commission recommended setting up a tariff negotiation forum, allowing medical schemes to collectively determine prices with healthcare providers, which could reduce healthcare costs.

The commission also recommended a supply-side regulator to ensure pricing was determined transparently.

Business Day reported that the BHF said these changes would ease the financial burden on medical scheme members, making private healthcare more accessible while reducing pressure on public facilities.

But, according to the article, the BHF claims the government has not done anything, leading to a growing gap between what medical schemes are willing to pay and what healthcare providers charge – and forcing patients to make high out-of-pocket payments.

Pivoting grand plans so that the work can get done

In a very small way, Daily Maverick’s challenge of serving you better with fewer resources echoes the challenges of our government. We had grand plans to expand, with an education desk and metro desks in every province, but we have tried and failed to raise funds for the full rollout of these plans.

It’s back to the drawing board for us to find ways of doing what we dream, with partners who share our dream, be they philanthropic donors, investors, readers or advertisers. And while we chase this dream, we must continue serving you the quality journalism you deserve every day and every week on every platform we have, including our weekly newspaper, DM168.

We’re nimble and agile, so I have no doubt we will thrive with the amazing collection of talent we have at Daily Maverick, but government is a much bigger, unwieldy bureaucratic morass, bound by debilitating systems, processes, structures and, let’s face it, people.

Turning an uncivil service into a civil service

The public often experience the civil service as cruelly uncivil because political party members in positions of power do not always hire the brightest and best, or the most caring and people-serving talent that South Africa has to offer.

More often, they choose people according to the party or individual politician’s interests – hence the blight of corruption and incompetence that the ANC’s cadre deployment bequeathed to the public. And, sadly, the DA’s John Steenhuisen, although diving into his new Kortbroek Minister of Agriculture job with gusto, fell into the same trap by hiring alt-right trash-talking influencer Roman Cabanac as his chief of staff.

Any son or daughter of the soil with a legal, people management and agricultural background might be closer to what the new Kortbroek needs as chief of staff but, for that to happen,  Cabanac needs to step aside.

It’s all well and good having grandiose plans like universal healthcare with the NHI Act, but I am baffled as to why the President succumbs to pressure to sign such a law when there is no sign of whether there is enough funding or the right management and professional skills to implement it.

And then there are the populists

Populist loudmouths like Panyaza Lesufi promised voters that directly after election day this year they would be able to access private healthcare, regardless of their financial situation, if the ANC won.

Fortunately, the people of Gauteng saw through this rhetoric and Lesufi’s Gauteng branch of the ANC garnered only 34% of the vote. That is a klap of note from the people, which Lesufi still seems not to grasp.

What Lesufi was admitting in essence when he offered everyone free access to private hospitals was that public facilities are dysfunctional. He does not admit culpability but we have had several stories by Mark Heywood and a brilliant investigation by News24 into whistle-blower Babita Deokaran’s murder, as well as the auditor general reporting that public health in Gauteng does not work which all point to Lesufi's ANC running public health in Gauteng into the ground.  A disaster designed by incompetent management, poorly managed resources, and a  politically connected mafia who are robbing hospitals blind, placing profiteering over patient care.

What Lesufi does not acknowledge in his rhetoric is that private hospitals and private-sector healthcare are not always better than public services. A friend of mine has been going for treatment for Stage 4 breast cancer at Steve Biko Academic Hospital in Tshwane and her care, support and treatment is nothing short of world-class.

On the other hand, I have heard of a woman with a similar diagnosis who died in a private hospital after being poisoned by a new cancer treatment that cost more than R100,000 a session.

Lesufi & Co seem to have no understanding that value lies in well managed and adequately resourced service, patient care, communication and the right treatment for the right diagnosis. It is not about waiting in the plush rooms of an overcharging specialist who is more interested in the fastest route to his next Lamborghini than in the terrified patient in front of him.

Instead of wild, ignorant populist promises, what about starting by fixing existing public services, clinics and hospitals that are poorly managed and poorly resourced? What about getting every public facility NHI-ready first?

How NHI could work in practise if politicians are kept at bay

I saw an amazing video produced by Bhekisisa, a health journalism organisation, which showed how a well-managed, community-oriented primary healthcare clinic in Chiawelo, Soweto works.

[embed]https://bhekisisa.org/bhekisisa-tv/health-beat/2024-09-30-health-beat-23-what-the-nhi-could-be-if-run-well/[/embed]

Located in the local government community health centre, the clinic uses community health workers to gather and write up health information for 30,000 residents they’re assigned to and regularly visit. They run exercise groups for residents, which are a fun, non-medical preventive measure against lifestyle diseases like high blood pressure, cholesterol and diabetes.

Ten years after the clinic started, patients are more resilient and less ill. Quite telling is what Bhekisisa found when interviewing a group of community members who sit on a board that oversees the clinic. They say the clinic is not as efficient as it was in the beginning in 2014.

The reason for this is that health MEC Qedani Mahlangu – yes, she of horrific Life Esidimeni infamy – saw the clinic doing so well that she told it to increase the number of patients it should serve, without increasing the number of staff. It’s a case of politicians who think they know best interfering with something that works.

Turning Hell Affairs into Home Affairs

In this week’s DM168, Victoria O’Regan interviews a bright and bushy-tailed young minister in the Government of National Unity who also has grand plans to fix one of the most inefficient government departments. It’s a department that Daily Maverick has dubbed Hell Affairs because we have experienced the excruciating depths of hell in the endless queues of Home Affairs.

While Leon Schreiber has hit the ground running and has done well to speed up visa applications, he too seems to be falling into the trap of politician pie-in-the-sky with his “Home Affairs at Home” digitisation project. All the minority middle-class and people like me who have Wi-Fi, fibre or data will greatly benefit from making our Home Affairs applications at home. But Home Affairs is not just about those of us who can afford digital access.

Schreiber forgets that the majority of the people Home Affairs serves have no data, Wi-Fi or fibre. All they have are their basic cellphones. Unless he finds a way to serve the digitally disconnected, who make up the majority of citizens, with easy and free online access to Home Affairs services, and he sorts out the incompetent  and uncaring Home Affairs office management, lack of staff and the poor queue management in most Home Affairs offices, his plans are going to fall flat.

I hoped the GNU would get all the political parties who are involved to set aside their biases and differences and collectively focus on solving the big hairy problems our country faces, piece by piece. There are some positive signs of progress in their first 100 days, but populist promises and pie in the sky plans need to be kept in check in order to move us in a trajectory that caters for all the citizens of our country, not just the politically connected elite or those of us in the middle class.

Send to me your thoughts on this at [email protected]

Yours in defence of truth,

Heather

This story first appeared in our weekly DM168 newspaper, available countrywide for R35.