Healthcare is a mess in South Africa. For a number of years, there have been serious shortcomings with the South African Public Health System. The issues are broad and range from staff shortages and poor infrastructure, to inadequate supplies and seriously out of kilter remuneration. As working conditions for medical staff have steadily deteriorated, a vicious cycle has been created: frustrated staff leave for greener pastures, leaving behind an even worse staffing crisis. The doctor-patient ratio in South Africa is already significantly higher than is recommended by the World Health Organization.
Both provincial and national health departments have failed to acknowledge that there is a problem. The healthy portion of the public, in turn, are also blissfully unaware of the magnitude of the problem and of the imminent collapse of the public health system.
The primary reason for the public health system having not yet crumbled is that the remaining employees, in both medical and paramedical fields, have extended their services far beyond their contractual requirements and responsibilities, and remuneration. They have provided a crutch for many years, with the hope that the numerous promises from the Health departments would eventually be fulfilled and would help to alleviate their burden. In fact, a recent independent study commissioned by the South African Medical Association showed that doctors are underpaid between 50%-75% compared to other public sector professionals.
After a previous strike action in mid-2007, protracted delays and ineffective negotiations which resulted in an offer of a 0.28% – 5% increase, medical staff have had enough. The realisation of empty promises have resulted in an unprecedented event in South African history: the withdrawal of services by doctors, dentists, pharmacists and paramedics until their demands are met.
Strike action by essential services, particularly medical doctors is generally harshly criticised by the public. Doctors will no doubt be accused of being materialistic, selfish, cold, callous and unethical. I am public service doctor, currently working in a large public health hospital and I would like to express my point of view about why this strike is ultimately in the best public interest.
In the past few years I have worked in many government healthcare facilities, ranging from small day-clinics, to primary level rural hospitals, to the “by-referral only” specialist hospital that I am at currently. I have personally experienced the frustration and hardships associated with working in the South African public health sector. I have literally run a kilometer in pouring rain to drop off samples at a laboratory or pick up an X-ray from radiology when there is no messenger on duty due to staff shortages. In the last few years, I can count on one hand the number of times I have taken a tea or lunch break – with the volume of work I am expected to do, there is just no time. I have worked 30 hours shifts on many occasions, often going without eating, drinking and sleeping for the entire shift. This is what we have been forced to regard as a normal working environment.
When some much-needed posts were suddenly frozen in the department I currently work in, we did not cut down the number of in-patient beds we have. Instead, I took on the work of 3 people and worked many hours extra every day, with no extra pay. And I know I am not alone – I have witnessed dozens of my colleagues experiencing these very hardships and having to make the same sacrifices. How can this be considered fair in any sense? And worse, how can we be expected to serve the public effectively under these conditions?
While I am not sure how my conscience will react when the actual time comes for me to refuse medical assistance to patients, I still take great exception to being labeled as materialistic, selfish, cold or callous. If I, or any of my colleagues were any of these things, we would not be working in the state sector to begin with. Every time I feel a pang of guilt at the thought of patients dying as a result of a doctors’ strike, I remind myself that thousands more have already died, and thousands more will die, if drastic measures are not taken by the South African government soon. As contrary as it may sound, I do hope that the public will support us in applying pressure for reform despite the inconvenience they will face – our ultimate goal after all is to enable us to serve them better.
By – A Frustrated Doctor, guest writer.
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Its shocking when a government is too ignorant to admit that a problem exists. Now I suppose nothing will be done to address the issue and, just like crime and hiv/aids, they will just hope that if they ignore it, it will go away.
People are probably going to castigate me for saying this but even in the apartheid era the public health care system was far better than it is now.
Its so sad that this government only knows one way to run anything, and thats into the ground.
It seems like strike is on fashion nowadays, do we really need that kind of things at the moment
The government acts on a group of self imposed “intellectuals” who arrogantly determine what they want for a situation. Lets not be fooled into thinking that they are ignorant. It takes a sharp immoral mind to get their way with the masses. Its the masses that are ignorant. They are being preyed upon by floor walking, power grabbing hedonistic, arrogant people who run democracy on promises that have no intention of materializing. Yes, there has been a lot of good come out of this government, but how sad it should be that it is overshadowed by those who are only in it for themselves. The apartheid government was noted for caring only for it’s own, but current democracy is capable only of promises and examples of how to get away with being corrupt. Human entities will never get it right as long as there is big money in it.
The reason I made that statement about the apartheid era was because, from personal experience and observation, your traditionally non-white hospitals (a number of which I have had dealings with) prior to 94, were far better managed, far better staffed, far better maintained, had far better resources and equipment and were far cleaner and more hygienic than what they are now.
The 15 years we have been under the ANC everything has gone downhill – anybody noticed the shocking condition of our roads. Railways, education, all government services, municipalities. In 15 years they have managed to turn us into a poverty-stricken 3rd world failed state.
In response to the comment by Jimmy, the sad answer to his question is, YES…we DO need this strike now. I am also a public service doctor, and have personally witnessed the exponential deterioration in the public health system over the last few years. It is understandable that the public in general are not entirely aware of how bad the situation really is, not only because of government denial and cover-up, but also because it takes having background medical knowledge to actually recognize mismanagement of a patient. And the mismanagement that I speak of here (which I see on virtually a daily basis) is usually not as a result of lack of knowledge or neglect on the part of the treating physician, but as a direct result of a lack of resources. So I reiterate that, YES, this strike is needed desperately. In fact, it is regrettable that public health care workers did not take a more aggressive stance earlier on!
Antiaa, relax! I almost fell of my chair this morning (23 June 2009), listening in to the After 8 debate on SAfm with Tim Modise, to hear a very black man admit the SAME: the health services during the apartheid era were generally better than they are now.
I’ve heard and seen the same in the political mismanagement of Zimbabwe’s resources.
Somehow, the freedom fighters forgot to do TWO things in their fight for freedom from either colonialistic or apartheid oppression:
(1) Learn from the experiences of other freedom fighters elsewhere on the continent and…
(2) Retire ALL freedom fighters with immediate effect as soon as the freedom sought has been attained.
The second point is to ensure a number of critical essentials:
(1) You never, ever have to hear militant songs like “Umshini wami” again; I mention this in context and in ALL seriousness. Songs do lose relevance when sung out of context. Can’t blame a freedom fighter for singing his fighting songs though. However, I’d love to hear such music straight from the shower and not a public podium.
(2) Any freedom fighting faction, for it to continue to be relevant beyond the point of attaining freedom, would have to train people who would take over the reigns of leadership from the oppressor. These people would need absolutely NO military training, BUT would need a comprehensive and continual study on the history of the quest and fight for freedom, know the enemy’s strengths and weaknesses, capitalise on the strengths of the enemy and then engineer ways to outsmart the enemy on their points of weakness.
The downfall of ALL African democracies (and, save for the bleak exception of Botswana, ALL of them have failed in my honest opinion) is this blindness to these simply lessons that those who followed in the wake of Ghana could have learned from their predecessors in freedom fighting and taking over from an oppressor.
Sad to say, but we HAVE to admit that the discipline of the oppressor is sorely missed in the simple reality that previously competent public services have deteriorated into chaos under the corrupt leadership of the country’s so-called freedom fighters.
SAD!
Pretty cool post. I just came across your blog and wanted to say
that I’ve really enjoyed reading your blog posts. Anyway
I’ll be subscribing to your feed and I hope you write again soon!
The ruling parties reluctance to pay the government medical staff as promised. It is a sure way of a sending a clear message to all future doctors. The government has the shotgun loaded, aimed at it feet and every day is blasting off both barrels.
Remember what Forrest Gump said, “STUPID IS AS STUPID DOES”
that politics for us,guess the doctors should wait for the next elections since thats when the concerns of the people are taken note of. for now nobody in goverment gives a dime about anybodies issues they are minding their own greedy life styles at our own expenses at that.
@PM thanx for the t-shirt its so lovely(hope i am the only one who has it in swaziland,and hope you get more swazi’s joining wonkie). all the best.
luv da cartoons and you guyz rock u keep on puting the smile bsck on my faceb chaw
So what is to be done besides complain? Come the next election the disadvantaged masses will again believe everything promised by dishonest politicains. I hear the older people complaining more and more that they had it better under the previous white government. There were jobs, better education, better healthcare, better housing for those who got houses. Someone should forward this whole column to parliament to be read out loud by the president himself.
In the State of the Nation address, President Jacob Zuma clearly stated that:
“We will introduce a National Health Insurance Scheme (NHI) in a phased and incremental manner. In order to initiate the NHI, the urgent rehabilitation of public hospitals will be undertaken through Public-Private Partnerships”.
This is all in line with the ANC 52nd National Conference 2007 Polokwane resolution that: “reaffirmed the implementation of the National Health Insurance System by further strengthening the public health care system and ensuring adequate provision of funding.”
The voters have given the ruling party a clear mandate, and therefore to the current government to implement NHI. It must be said however that the debate in the media came ahead of the release of details.
The idea of the NHI has been proposed to cure the ills of the health care system in the country.
Government stays committed to its goal of ensuring equal, accessible, quality health care to all South Africans.
I agree with Mphepo. The idea of the NHI has been proposed to cure the ills of the health care system in the country.
Currently principles of the NHI have been accepted by the ruling party. This allows for more detailed work to be completed and consultative processes be embarked upon. Even before the details are publicly debated, it has been generally accepted that revitalisation of all hospitals, improvement of the remuneration packages of the health care workers and transformation and capacity building of management is a pre-requisite for the NHI. This means that there is need for tremendous investment into the public health services. Hence the President announced that this revitalisation of public health institutions requires a public private partnership.
For clarity purposes, NHI proponents: are we talking about health here or disease management?
Despite former minister, Tshabalala-Msimang’s infamy, added to that the insult of not living by health example, she was dead right about promoting the use of foods originally created to be ingested by humans. That, to me, is health work. Managing the diseases of people who wouldn’t care less how they lived in the first place is, to me, a waste of money under the guise that the country is spending it on “health.” Let’s be truthful. It isn’t “health” but disease management.
I guess ignoring the core principles of health is another form of job creation. The expense of human lives is secondary to the prime achievement: job creation in the health sector.
:-S
In order to translate the policy statements on NHI into reality, as a transitional arrangement, the ANC government established a Task Team on NHI to prepare the necessary background materials that will form the basis of a plan for NHI to be handed to the Minister of Health.
The chair of the Task Team led a team that comprised of individuals from inside and outside government with expertise from health economics, finance, tax collection, health planning, human rights, social security, labour issues, private hospital industry, medical aid and politics.
These individuals came from Departments of Health, Social Development, Treasury, South African Revenue Service, science councils, universities, private hospitals, health care funders, private medical groups, labour movement-COSATU, SACP and ruling party, the ANC.
The role of the committee is to make evidenced based proposals on both the design and the processes of implementing NHI in South Africa by the South African government.
The NHI Task Team has a responsibility to design a plan for implementation of National Health Insurance in line with the ruling party’s Polokwane policy resolution in December 2007.
The initiative focuses on both National Health Insurance as a funding model and delivery models that seek to eliminate the impoverishing out-of-pocket payments and co-payments, redistribute human and material resources in a highly inequitable system, improve the quality of health services, enhance access to essential services and ultimately improve health outcomes for the majority of the people.
The proposed initiative is aimed at providing both technical and consultative support to the Task Team on National Health Insurance, as well as research advice, evidence, expert inputs to the design and implementation of NHI plan.
Changes to the funding model for health care in South Africa require robust engagements with empirical evidence and key stakeholders if it is to become successful.
@Antiaa, your statement: ” even in the apartheid era the public health care system was far better than it is now.”
This must be put into its proper context. The formerly ‘white only’ hospitals were always better resourced and had lower bed occupancy while the overcrowded formerly ‘blacks only’ institutions were familiar with floor beds and long queues. The integration of facilities brought the reality of the situation to the fore. The increasing burden of disease exacerbated by the HIV and AIDS pandemic together with Tuberculosis, poverty, high unemployment and apartheid backlog in service delivery has put extreme pressure on the public facilities and its hard working and ever-dedicated health care staff.
The private health system has become less affordable. For many years the country’s expenditure in private health systems was equal to or more than the expenditure in the public health system. Whereas the private health system catered for 20 percent of the population in the past fifteen years, that number has decreased to about 15 percent Most of the funds are managed through medical aid schemes which had been increasing the premiums to less affordable levels. This accounts for the increasing percentage of the public (85 percent) relying on the public health service for service. In 2007/08 the expenditure in private health service catering for about 7 million people cost about R56 billion and a similar amount was spent by the provincial Health Departments to collectively cater for 41 million South Africans.
Many doctors in private practice are only too familiar with the situation of members of medical aids who get disqualified from seeing private practitioners because they exhausted their annual medical scheme allocation mid-year. They get dumped into the public health system as they cannot afford the fees in private hospitals.
@Nda. The challenge is not to look at specifics, but to come up with a sector wide approach and solution. Salaries is but only one of the many issues. So how do we go about addressing the many other challenges facing the health system.
Once again, unlike most of the Wonkie ‘objectionists’ who only want to criticise and complain, we endeavour to offer solutions and to craft out plans to address our SA health system.
And in doing so, one need to talk about the structural ills that are so entrenched within our health system. Issues over which many of our fellow South Africans feel very uncomfortable to talk about.
All the medical aid schemes have the risk rating policy i.e. they recruit the younger and healthier members who are employed and need less medical attention, only to dump them or charge them more when they get sicker with age and cannot afford premiums after life-long contribution to the schemes.
With poor and overcrowded conditions, many public institutions cannot compete with the private hospitals, even though they could use the additional revenue from private patients. The costing in the private health sector is not conducted under conditions of transparency raising the question of what drives the spiralling costs.
For the economic status and the total expenditure in both public and private health sectors South Africa has unacceptable health outcomes. The morbidity and mortality rates especially on preventable diseases remain worse than countries that spend less on health.
This points to the inadequate internal distribution of resources available in the country.
This means that rigid separation of the public and private sectors is not desirable, especially since government also contributes in the financing of both the public and private health sectors.
The NHI has been proposed to create a mechanism to level the playing field and create equitable distribution of resources resulting in high quality of health services for ALL the people.
Universal access to a basic package of services for both the rich and poor will be achieved by the NHI. With such a well developed private health sector, South Africa needs to ensure a regulated coexistence of the two sectors to find a balance between the two extremities.
This must include the increased funding for the public health sector and regulating the medical aids industry to pool the resources available for the whole country and create a common platform for improving health outcomes.
@Mphepo. if you had bothered to read my second post you would have seen that I qualified my first statement about the hospitals during the apardheid era.
Furthermore, this so-called NHI is just another hair-brained scheme of the government who are just looking for a way tio get their hands on the financial reserves of the existing medical aid schemes and which, like everything else, is doomed to fail.
@ Isaac Plaatjies: May I take the inference to criticisers, complainers and objectionists to also refer to me? That is the inference that I read.
Let us return to my original take on the subject matter. For one thing, could you respond to this question DIRECTLY: are we dealing here with matters of HEALTH (absence of dis-ease) or we are dealing here with matters of disease management (presence of dis-ease but TRYING to manage the dis-ease)?
What is objectionist about my promoting prevention rather than cure? Any normal, thinking human being can tell you that that adage will never lose its relevance–EVER. Prevention is far better than cure.
With that in mind, it is still far cheaper to once again outlaw all legal drugs like alcohol and nicotine and pour resources into policing the resultant drug underworld, than it is to permit it and then claim to regulate it when BOTH of those drugs cause the largest fatalities due to dis-ease in the whole, wide world. If the ANC is serious about tackling matters of health, here is a constructive suggestion: centre EVERYTHING that you do, including putting your money where your mouth is, on PREVENTION rather than cure.
Talk about the woe of simple dis-ease conditions like constipation which results in auto-intoxication. By that, I mean the toxins that arise from a clogged alimentary canal end up causing such dis-eases as cancers, sepsis and, in its complicated stages, gangrene, overweightedness, you name it. Chief behind these dis-eases are the lack of educational resources on the use of highly refined foods like white flour, refined cooking oil, the free use of animal products and animal fat, including the use of unclean animals like swine, ostriches, most sea foods, and the like.
While each individual is free to eat as he pleases, the same individual cannot turn on the nation’s tax resources to be cured of his self-inflicted, dis-eased condition. With the exception of cases involving trauma (like assault and accidents), most of the money pumped into the so-called health system is misdirected. I have already hinted on where it OUGHT to be directed. I see NO such attempt in the post-Polokwane ANC to entrench the health department in a GENUINE attempt to actually promote the health of a nation.
Wasting billions of Rand to equip the hospitals and their personnel in equipment and other resources to man massive projects in offering curative measures to a general public that has its government’s permission to live ANYHOW is not merely being negatively critical, complaining and objectionist.
Suffice it to say that the ANC government has a decision to make. I’ve stated my case as candidly as I possibly can. The remainder of the case will argue itself as truth is its own advocate.
Until the ANC, or whatever other government, begins to invest much more in preventative measures than curative ones, then almost all the money flowing into the coffers of the health deparment has been misspent.
Lastly, there is also the demonisation of the humble but far more effective (both in offering relief and in cost terms) option of non-traditional Western medicine. I am not referring here to the world of the deceased upon whose authority most sangomas and their ilk would depend. The simple use of medicinal plants is FAR more effective in keeping a nation healthy than the millions and billions spent in researching synthetic drugs that burden the health of those that they seek to alleviate of dis-ease.
Will the ANC also invest in such? It is clearly absent in the post-Polokwane ANC, though bits and pieces of it were present in the pre-Polokwane one.
Money talks, huh? 😉
@ Nda.
Your words, “are we dealing here with matters of HEALTH (absence of dis-ease) or we are dealing here with matters of disease management…”
I think you would agree with me that HEALTH is not just the abscence of disease, but rather the holistic well being of the person – physically, mentally, and emotionally.
The constitution furthermore declares access to universal health care as a basic human right.
I agree with you that prevention is better than cure, but unfortunately, it cannot be the only way to deliver/ ensure HEALTH.
Therefore, the continous development of, and investment in the national health system cannot be seen as “misdirected”, or “waisted billions” as you put it, but it should be seen as being in line with World Health Organisation (WHO) resolutions (and other international treaties) and as an important milestone in government’s persuit to live up to its constitutional responsibility of ensuring equal, quality and accessable, universal health care for all its citizens.
Government can never be only focussing on prevention as a modality to deliver health care, and ignore other modalities such as promotion, and curative care.
The challenge for us is to stop thinking/ operating in silo’s. We have to move towards a more integrated approach.
Your words: “I see NO such attempt in the post-Polokwane ANC to entrench the health department in a GENUINE attempt to actually promote the health of a nation.”
You would remember that as far back as the 1990’s, the ANC developed a document called the ” ANC Health Plan”. This document later became the guiding principle in the development of the National Health Plan for South Africa.
This document was the first post apartheid ‘piece of paper’ that introduced the notion of Primary Health Care as a package of service for South Africans. It outlined the need to focus on “prevention rather than cure”, and how this should be achieved.
More than two decades ago, the nations of the world issued a call for “Health for all the people of the world by the year 2000,” in the Alma Alta Declaration, the product of a World Health Organization-UNICEF conference.
In 1978, at the time of the Declaration, that goal seemed achievable. There was serious talk of a New International Economic Order, to begin to remedy the wealth and technology gap between the global North and South.
Primary healthcare was held “the key to attaining th[e] target” of health for all.
Now, with 2000 upon us, it is evident that the world failed to turn the vision into reality.
Earlier this year, approximately 1,500 public health activists from 93 countries gathered at the spirited and historic People’s Health Assembly (PHA) in Bangladesh to assess this state of affairs, and to map the way forward so that health for all is in fact achieved.
The emerging PHA diagnosis, which focused primarily on healthcare failures in developing countries, was multifaceted: Governments have failed to invest sufficient resources and empower localities to assure adequate nutrition, clean water, maternal and child health care and other components of primary health care.
This governmental failure is rooted in many internal problems, but especially reflects the budgetary and policy squeeze imposed by the International Monetary Fund and the World Bank and foreign debt repayments, as well as the World Trade Organization. These funding giants are very powerful and should not be ignored in this entire process. They are very manipulative and presciptive.
Meanwhile, multinational corporations are also pushing a privatization agenda for healthcare which removes control of crucial health decisions and delivery systems from the public sphere, where it is subject to popular influence, and often removes access to healthcare altogether from poor people.
The World BANK’s lending programs also pushed national healthcare systems in the direction of a ‘for profit’ , corporate-dominated model.
For the ANC government however, Primary healthcare remains a top priority, but it was unlikely to be achieved broadly in the absence of fundamental transformations in the local and global political economy.
Hence the move towards the radical tranformation of the Health System in the form of introducing the NHI program.
I hope i managed to clarify some of the broader issues that influenced health decisions to you as well.
@Antiaa.
We are aware of the debates in the media which are obviously not based on facts because no details of such plan have been officially announced by government. Your negative remarks about the NHI are not only ill-informed but are also highly speculative.
We are also aware that the debates are coming from a few individuals from specific sectors of the private sector, who have vested interests in maintaining the status quo in which the majority of our people continue to struggle in accessing quality health care – a Constitutional and a basic Human Right.
Accusing the ANC of pursuing an ideological agenda robs the country of a balanced debate in search of a lasting solution which a strictly market oriented approach cannot solve.
We need to acknowledge the role of each of the sectors but seek a solution to correct the shortcomings. For that we require a sober and evidence-based debate, not an alarmist and confrontational discourse that currently characterises your attitude as well as the debate in media.
The work of the ANC on the NHI will be formally released to the public through appropriate channels when it is complete. We appeal to the public to be patient and wait for the release of the formal NHI plan in the near future.
The plan will include processes of consultations with all key stakeholders to ensure that the voices of the public, private sector, labour, civil society and others are heard and considered in the finalisation of the plan.
@Mphepo- You mention “robs the country of a balanced debate’. The unfortunate reality is that the ANC is never up to a ‘balanced debate’. If they decide on a course on action, that is exactly what they do and no cognizance is ever taken of any sensible contrary point of view or suggestion.
You also refer to my ‘negative remarks’. In all the years since 1994 that the ANC has been in power, I am yet to see something positive created by them. Unemployment is up, crime is up, SABC is collapsing, ESKOM is mismanaged, service delivery by central, provincial and loacal government is worse than it has ever been, and I could go on and on and on.
Furthermore, I am too long in the tooth to be taken in by any ANC propaganda, so I suggest you go and ‘sell’ it to the illiterate uneducated masses who voted you into power and who are unfortunately continually fooled into believing all the undelivered promises made by the ANC during the past 17 years.
Enough said. End of discussion.
Is it just me or Mphepo and Isaac are ANC deputy spokespersons, somewhere in the offices of Jesse Duarte?
Sir Isaac, let’s not talk about papers. Let’s talk about the reality on the ground. If the stuff that is in your ANC papers is NOT on the ground, then I have all the reason and grounds to comment as I do and the MOST that you can say is to apologise for lacking the drive and initiative to implement your own policies if they do indeed contain ANYTHING in the realm of making prevention a priority instead of cure. If the inverse were true, I would have not even had the energy to voice an opinion. There would be NONE to voice save, maybe, to heap accolades at the door of the ANC.
In case you missed my line of argument, IF you also KNOW that prevention is better than cure, then the monetary resources that you invest in prevention OUGHT to be better than those that you invest in cure. As we speak, such is definitely NOT the case, never has been, and with NHI on the horizon, it will NEVER be the case.
Admit it: the situation on the ground simply states that such is NOT the case. In my layman opinion, and a layman isn’t necessarily a dimwit, the NHI does NOT signify an investment in prevention, which investment outweighs the one in cure (and the NHI is basically cure, cure and more cure). You still have NOT put your money where your mouth is.
Until that becomes reality (i.e. putting your money where your mouth WAS), you are basically selling propaganda. I’ve said it before, I am a layman, and that does not necessarily mean that I am a dimwit.
If anyone is in a silo here it is the individual who drafts a document that ought to become reality and, after 15 years of repeated chances to implement the said document’s contents, still hasn’t done so. The same individual then wants the whole country to believe that the continued lack of implementing his own policies IS progressive, and anyone who talks to the truth on the ground is commenting from a silo.
[Sigh] Not all people were born yesterday, so let us just be truthful about this whole matter and the ANC either has to step down voluntarily OR start pulling up its socks. After 15 years of continually declining performance, a voluntary step down would be the most magnanimous deed that the ANC can ever do, else they will top the rotten record of ZANU-PF immediately up north.
Sizwe i’ve just lost another long response that i drafted! And its very frustrating! Why is this happening? Even yesterday, i had to redo two of my responses. Let me try again.
@Nda.
Im beginning to think you are not from South Africa. Because if you could just open your eyes properly, you would notice that a lot of developments have taken place “on the ground” as you put it.
The construction of hundreds of clinics, community health centres and hospitals, even in the most rural areas of South Africa, can never be said to have slipped your sharp mind. These are all in line with government’s efforts to live up to its constitutional responsibility of ensuring universal access to health care for all its citizens.
The bucket eradiction system, the provision of clean running water and sanitation services, the electrification process, all of these are important miles stones in ensuring better health outcomes and a healthier nation. These speaks directly to issues of disease prevention. South Africa is signatory to the Millenium Development Goals. We are working tirelessly towards the achievement of the ambitious goals of the program in terms of the lowering of child and infant mortality, the improvement of maternal health, etc.
The prevention strategy that you are advocating is part of an overarching government health strategy (not just one element) and is fully incorporated and fully funded through the Primary Health Care package.
Traditional medicine is for the first time in the history of this country been given full status in terms of the national health act and the establishment of the council for traditional healers (a statutory body, established in terms of the national health act). Traditional healers can even issue sick certificates.
I am no sure if you are familiar with these developments Nda. But these are indeed very positive developments for the millions of apartheid victims in this country. They have seen and experienced how their living conditions have changed and they will continue to give the ANC the mandate to lead govt on their behalf.
There will be no “voluntary step down” because the masses of the people have spoken loud and clear in our recent elections, they want an ANC government, and an ANC govt is exactly what they will get, like it or not.
@Anitaa.
You are too emotional. Dont argue with your emotions. Your country requires a sober and evidence-based debate. Not an alarmist and confrontational discourse as you do right now.
@ Mphepo – Too right I’m emotional. I get extremely emotional when I see the country that I love being destoyed by an incompetent Government. I am not an alarmist but I do get alarmed when I see schemes put on the table which any person with half a brain can see is not feasible and which once again will just be a waste of us taxpayers hard-earned money.
These were now my final word with you on the subject but if you want to be like a woman and have the last word, go right ahead.
🙂 Isaac, what’s the point of putting up buildings called clinics and when the post-apartheid poor of the poorest, as the tripartite alliance likes to call them, get there, there is either NO one to serve them, or the service is so appalling that they could very well have stayed home and died (if their dis-eased condition was serious enough to be fatal)?
I see that you have assigned yourself to be on my case, and Mphepo is on Antiaa’s, but may I refer you to Antiaa’s points in this regard? I more than agree with her sentiments because they are founded on FACT.
Too bad that Mphepo now wants to sound insulting and argue (with himself) that Antiaa is commenting emotionally when she clearly isn’t. If these so-called positive developments were indeed positive, why would we be having a MAJOR strike in the public health sector right now, with a likelihood that the strike action will be stepped up tomorrow if more nonsense is placed on the table of negotiation by the end of today, 30 June 2009?
Lastly, broer, I would also like to highlight that you keep shifting the goalposts. I have already made it clear that an investment in curative medicine is a non-negotiable. I’ve mentioned that from the start. My critical point, which you keep on sidestepping, is that the government’s priorities are twisted. If prevention is indeed at the apex of public health policy, then why doesn’t the ANC government put public money where it’s mouth is? THAT, whether you want to hear it or not, is NOT happening.
I’ve also highlighted some highly relevant, related issues which you have TOTALLY ignored since you started commenting (like the appropriate and due regard to be given to complimentary, non-Western medicine and–with added emphasis–we leave out the rather dubious practices of most traditional medicine men and women as they are steeped in useless superstition and the worship of evil spirits). The point that you mentioned about the clout of the likes of the IMF and World Bank clearly shows, to me, that the ANC government, like almost all other secular governments worldwide, is reallying marching to the beat of the financier of most of these healthcare projects, and they do NOT prioritise prevention as your papers say the ANC IS prioritising prevention.
I therefore find myself arguing with you cyclically because, while prevention is on the plan on paper, the financiers and implementers of the plan have NOTHING to do with prevention. I therefore find reason, and rightly so, to make a comment here in that regard. You, however, are sounding like a typical ANC spindoctor. You will insist on having the last word on the emperor’s new clothes when all that Nda is saying is that the emperor walks among us stark naked.
By the time the general populace catches up with that reality, the New World Order will be in place, and these public strikes will have heightened to maximum. I’m just glad that I have a conscience that can keep clear of such overt, gross inconsistencies, and my choice of words here has been VERY polite indeed.
Since I am now suffering from vertigo, I will allow you to have your last word, and it will be true to form. Watch this space. I can no longer maintain my balance at this pace. I need a discussion that moves FORWARD and not in circles.
🙂 Adios, my broer.
@ Nda.
I have you on record for saying, “…Let’s talk about the reality on the ground. If the stuff that is in your ANC papers is NOT on the ground….”
I am shifting no goalpost when I try to explain to you that “on the ground”, the ANC government did infact “put its money where its mouth is”, and that unlike those that are suffering from chronic objectionitis, the millions of poor apartheid victims have seen and experienced the results of government’s policies “on the ground”.
To the contrary, you are the person that keep on shifting the goalpost because after i explained government’s progress in terms of the thousands of new health facilities built, the water and sanitation projects, the bucket eradication project etc, you now shifting to the staffing of facilities etc.
I also endeavoured to explain to you that prevention as a strategy, is largely embodied in, and funded through the primary Health Care program.
In addition to this, every provincial dept of health have got a Chief Directorate for Health programmes. This means that there are sub directorates for every health programme.
These subdirectorates include Hiv/Aids, Substance Abuse, TB, Woman’s Health, Health promotion, Mental Health etc.
Theses subdirectorates have got a deputy director at their helm and each have got its own budget. They are primarily involved in advocacy, prevention campaigns, school health, developing of promotional materials, road shows etc.
I am still trying to show to you how government prioritises “prevention” as a health strategy. I explained to you that it started in 1978 in Alma Alta already, when the World decided to adopt primary health care as an overaching health strategy. All member states of WHO are signitories to this.
I cant understand why you are failing to understand me in this regard because you are insisting that i am trying to circumvent your ‘line of argument’ when i feel that i have answered you sufficiently.
Anyhow, you deserve an ANC t-shirt! Both yourself and Antiaa!!
Cheers
@ Wonkie disciples in the presence of Isaac: I WAS watching this space, and true to form, you have the last, disgusting word. 🙂 Bravo!
The beauty about commentary on Wonkie is that there is a history that is easily traceable.
As for the ANC T-shirt, that is another reason NOT to have ANC T-shirts. That money spent on worthless ANC T-shirts could be spent in preventing disease, in educating youngsters that having a shower after having irresponsible sexual activity will NOT cure you from AIDS.
That, my broer, including the FACT of the prevailing strike of doctors in the public health sector, plus the FACT that the ANC top dogs do NOT use public health facilities themselves, are the FACTS on the ground to which you are NOT speaking.
Let these FACTS therefore stand their ground as I am now receding into silence. Don’t even have to say: “Told you so!” It’s not worth the breath.
What I pray for, however, is that you will one day wake up to the enormity of the criminality of your sins and repent. All it takes to do that is to swallow your pride, mend this broken situation by retracing your steps to refusing to be moved by the promises of money, power, and more power. Appealing to a politician’s greed, as far as all evidence has shown, is the easiest way of corrupting a WHOLE political programme.
The ANC, in its 15 year history at the helm of RSA politics, has been NO exception to that seeming rule, sadly.
Antiaa, I’ve just donated that T-shirt to the cause of promoting prevention in the public health sector. I have a sick feeling that my donation will be disregarded.
O, by the way, Isaac, regurgitating material that circulates in ANC meetings and sits on ANC blue and white papers is NOT a response to the crisis on the ground. If you can get that through your thick head, then we will at least begin to talk, broer.
In ANY human endeavour, we map progress by the impact ON THE GROUND, and not by the PLANS to make that impact, plans, especially, which continue to sit un-utilised on paper (and the evidence is the horribly poor performance where the SURE implementation of the said plans would have meant a completely different situation ON THE GROUND, with remarkably good performance).
For as long as the ACTUAL experience ON THE GROUND is contrary to the high-flown plans on your papers, you have NOT begun to speak, and it is a shame to continue to come onto public forums like this and actually pretend that you ARE doing something about the gravity of the situation ON THE GROUND.
I thought all adults KNEW that only children below the age of two a easily deceived by the kind of ploys that you and the ANC are using: pretending that something is when it isn’t, or vice versa.
Eish! 🙁
@Anitaa
Im not letting you off the hook, not yet! How do you propose should government proceed in terms of addressing the health problem in SA? Lets be constructive.
Stop just criticising. Be part of the solution.
@Nda.
Lets stick to the issues, please dont shift the goal posts, again. 15 Years is a relatively short period in politics. You might have forgotten about where we were 15 years ago but the millions of poor apartheid victims have not.
When they saw the clean running water, the sanitation, the new schools, clinics, houses, roads, electricity etc coming to their neighbourhoods they knew that the ANC government is serious about its war on poverty.
Nda, im taliking about ‘ON THE GROUND’. The results of ANC policies on the ground.
The recent elections confirmed that South Africans (the youth in particular) have put their confidence in the ANC to lead on their behalf.
Come on, tell me that these millions of people are “illiterate uneducated masses who voted you into power and who are unfortunately continually fooled…”, as sister Anitaa has put it.
Our delivery record in terms of pushing back the frontiers of poverty, racial discrimination, inequality etc speaks for itself, in that no previous government have ever done what we did for the masses of our people.
These are the facts that will speak for themselves, not me.
By the way, the ANC is a politcal organisation, not a health NGO. So ANC t-shirts are for political purposes, and cannot be construed with your prevention cause. Good luck.
@Mphepo – This is now my FINAL word on the subject
During the past 15 years the ANC goverment has allowed the Public Health Sector to degenerate into the mismanaged mess that it is at present. Now you expect me to tell you in a few words on this forum how to get it out of the morass your Government created? Get real!! All I can say in closing, is that an NHI is not the answer and will NOT work. It will only succeed in driving the few Doctors and other health care professionals left in this country, to leave.
@ Isaac: Let’s forget your deliberate attempt NOT to get it, shall we? It’s called politicking and I have a particular aversion for it. Let’s stick to the ground.
Why are the doctors on strike? If you cannot give a straight-forward, coherent response to why, you haven’t been on the ground for the past 15 or more years.
Why don’t the ANC aristocrats use these public health facilities that they built? Why do they receive exclusive medical attention in PRIVATE health facilities? It’s all very good to say that an individual has a personal choice about matters of that sort, but then these individuals CHOSE to represent public good (or at least pretended to). The BEST advert for your supposed progress on the ground is to utilise your very creation.
Lastly, were I involved in a traumatic accident as we speak, I would rather be taken home than to most of the public health facilities that we have. My chances of surviving the trauma are far greater at home than in your public health facilities. There are obvious exceptions to this odd rule, but they are so few and far between that to even attempt to lump them into the aggregate case is totally meaningless.
THAT, broer, is the situation on the ground. I have NOT shifted goalposts (if you are still taking alcohol, I would like to remind you that you will eventually need a new liver, and little wonder that you are not following what I am saying; alcohol does that, you know). I am ON THE GROUND.
If your mind tells you to say something that does NOT address these matters, be certain now that you will not hear from me on this issue, ever. Just promise not to sear your conscience through continual denial.
As for the seething masses who continue to vote ANC, we all know that you are right: 15 years is too short a time in politics. However, a year is TOO long for your hold on a national budget counted in the billions of Rand NOT to begin to make a permanent, decisive difference for all people in RSA.
However, until such icons as Nelson Mandela have been laid to rest, eventually, as we all do die, the majority of people in this country vote with their hearts not with their heads. They have an emotional attachment to the likes of Madiba, and will continue to vote ANC until Madiba dies. Only then, when no such icon exists, will they be compelled to let their heads consider what their hearts have prevented them from seeing all along: it was all a farce.
Right here and now, that FACT that the ANC-led government is a liability to RSA still stands, irrespective of the voting trends in RSA. I wasn’t born yesterday, and I know for a fact that the machinery on voting is not based on intellect; it is an emotive exercise. 15 to 30 years from now, the reality that Mugarbage up north is facing right now will be staring the ANC in the face. Emotions have a set lifespan. Even Msholozi himself will most likely be no more by then, and all who have been privy to these discussions will just wag their heads and say: “But we told them.”
I am telling you NOW, while you can do something about it. >:-(
Wonkie – I am 1000% on your side!! When so called “Parliamentary Leaders” ??? sit on their fat, lazy and incompetent backsides contributing nothing to our country and fellow citizens have the crass nerve to criticise overworked and underpaid professionals who sacrifice years of their lives and get paid the equivilent or less than lazy pen pushing clerks and a fraction of what no-good, lazy good for nothing “representatives” it is time to say “This far and no further” Yours is a great deserving cause, stick to your guns. The real citizens of this country are with you. I have a son who is a registrar in Jo’burg so I know more than most how badly you are treated.
GIVE THEM HELL AND DON’T LET THEM TIE A GUILT TRIP ON YOU. GO FOR IT WE THE REAL SOUTH AFRICANS ARE WITH YOU.
Good Luck and hold your head high
Whatever is said in the article is true. So much needs to be done in our health department for the betterment of our people’s lives. The govt has been ignorant to the plight of the people in various depts. I should also say i’m very optimistic with their our present administration resonse in regard to public uprisings. The concern is with health dept i do not see the minister in the media informing the public about how he is addressing issues at hand. The last time I checked the govt agreed to the doctors demands and the only problem leff is how to implement. Now my concern is do doctors have unions that address them on how to go on strike? Others there are rules to be followed in the strike. Please tell minister to inform the public about progress.
Dear Antiaa
The “mess” that you are referring to were created by the illegitimate, white minority government, not by the ANC.
We are working towards correcting that apartheid “mess”.
It is suprising to see how you want to shift all apartheid’s bagage onto the ANC and even allege that it (the mess) were created by the ANC!
We know the history of this country VERY WELL and we will make it a point that it be remembered by generations to come!
That is why we are preserving places such as Robben island, lest we forget!
We know very well about the fragmented, racially aligned health system that we inherited with hospitals being devided into half – one section for whites and the other for blacks – in an attempt to preserve white supremacy.
We know about the lack of access to health for the millions of poor blacks and how they had to travel hundreds of kilometres on donkeys and wheel barrows only to access inferior and racist health care.
Today health facilities are right on their doorsteps! I am posing the challenge to you, what do you propose should be done to improve our health system! Come on, you are a South African, be constructive!
The NHI is our suggestion, what do you suggest since you are already negative about it – a plan that is still under discussion and not even released yet!
Can you tell us what is in it? What is it that you dont agree with regarding the NHI? Why you are against it? What do you think should happen to improve the situation? Dont be a pessimist, be constructive.
@ Nda. The difference between us is that I am talking about measurable, evidence based, well reserched processes and outcomes while you keep on talking about assumptions, emotional speculation and thumb sucking.
Strikes are by no means unique to SA, and to any other country for that matter. They are IMPORTANT instruments to effect societal change!
The good thing about this government is that it listens to the populace and engage them in debate.
This is why these platforms such as the bargaining council were created. These are dialoguing chambers! This testifies to the spirit and culture of the ANC led government as opposed to the regimes of Verword, Malan, PW Botha and FW De Klerk – where striking workers were bitten by police dogs and beaten to death with “donkie piel” (batons).
What i can tell you about this doctor’s strike is that in the end there will be an outcome and the situation will return to normal the day after that. And next year there will be another strike by another groups of workers, also wishing to influence government and trying to effect societal change or so on.
This is how it works Nda. But when it comes to the election, they (the striking workers) will vote again for the ANC. You see Nda, im not talking about assumptions and emotional thumsucking (like when Mandela dies etc), im talking about evidence based stuff.
South Africa is a multi party democracy. There are more than 100 registered political parties in SA.
To say that, “the majority of people in this country vote with their hearts not with their heads..” is far-fetched and a grave insult to the general populace, the youth, the academics, the religious sectors, women’s organisations, business sectors etc that voted for the African National Congress, in that you allege that all of them cannot think but only yourself.
All i can say to you at this stage is that youve been proven wrong over and over again in the past, and you will be be proven wrong again in the coming local government elections.
Up to date however, elections are and remain unfortunately the most trusted and reliable, yardstick (as opposed to assumptions) to measures the mood of the population. Because if citizens are not happy with a government, they have an opportunity to remove it at the ballot box.
It seems as if the opposite is true here, Sir Nda. I suggest you pause a little bit and have yourself checked out for paranoid dillusions. Because what you see might be a dillusion, because the millions of people are not seeing this ON THE GROUND. And im really putting it very mildly.
There is not even a point at which you can begin to draw comparisons between the ANC and Zanu PF. Because the two are worlds apart. South Africa is having its forth president in fifteen years!
So lets compare apples with apples and stop arguing on the basis of assumptions, but empirical FACTS.
If you bothered to read the Burden of Disease Study (conducted by the government in collaboration with the University of Cape Town and the Human Sciences Research Council), you will clearly see how disease patterns and outcomes have positively changed as a result of the impact of the ANC government’s policies, programmes and interventions on the grassroots – i mean, ON THE GROUND.
Again, im not talking about assumptions, im providing evidence based, well researched stuff, Nda. Im not thumb sucking. Go read this document, i can even email it to you.
Its one thing to talk about emotional stuff (like when mandela one day dies), but its another to substantiate it with evidence.
And im by no means saying that there are no challenges or shortcomings in our health system, but we also need to acknowlege the achievements of the ANC government in this regard and as it currently stands, the populace have recently mandated the ANC overwhelmingly, to build on its achievements of the past fifteen years in terms of pushing back the frontiers of grinding poverty, deprivation, racial discrimination and sexism because they realised that they are today far better off (in many respects) than they were during the days of the apartheid gettho’s, the days of Verwoerd, Malan, Botha and De Klerk.
If you are longing back to these days, then going to Zimbabwe will not even be measurable to what we have endured under the apartheid hell. So for these millions of poor blacks, the ANC is indeed a blessing (as opposed to being a ‘liability’) to the millions of black poors in SA.
The majority of these strikes are indeed of a political nature. They usually seek to influence government decisions, spending patterns, etc.
They usually revolve around issues of municipal service delivery, housing, water and electricity, unemployment, household evictions, HIV/AIDS policy etc.
So Isaac is indeed one hundred percent correct to say that strikes seek to influence/ effect societal change.
I’m currently working in Saudi Arabia, I left the country i love due to conditions in healthcare. Now I’m able to study, have more contact with family and have confidence in my future. I’ve worked in conditions of understaffing and underpayment in SA healthcare, and feel that every person who works hard, especially in a high disease exposure job(very stressfull!), needs to be compensated accordingly. after experiencing international work, i doubt if i will return to the depressing conditions in South Africa. I fully support every healthcare professional who fights for a better quality life!
i udrestand all ur pain but i really think the stike was selfish because there were people in the hospitals and clinics that were not responsible 4 ur problems but had to suffer 4 it
During old SA health system was way better than A NC health system. The Key word here get out those ANC gangsters out.’