Monday, January 24

South Africa’s healthcare system is on its knees: the budget offers no relief


South Africa’s medium-term budget policy statement for 2021 was more of the same old narrative. He was not talking about the high expectations that the impact of poverty and inequality would be strong.

Instead, the South Africans got:

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be patient, let’s keep the dream of a primary account surplus, then maybe we can make the necessary investments to implement expanded social security, invest in health system strengthening, etc. Until then, let’s do more with less.

Budgets alone do not solve structural problems such as state effectiveness. Reducing the wage bill does not address budget mismanagement or execution. Instead, it increases the risk of execution. But they provide insight into the government’s plans to address its broader development priorities.

In the case of South Africa, addressing the impact of poverty and inequality on broader development is and must be our priority. For example, the youth unemployment rate is 60%. This is structural, as many discouraged job seekers do not have the skills and training necessary to access opportunities. Government plans will not address this. If there is very large growth, it will not benefit these groups, especially those in rural areas where job opportunities are scarce.

Given the cost that Covid has had on the country’s socio-economic life, including health, there were high expectations that Enoch Godongwana, the Minister of Finance, would indicate in the medium-term budget policy statement how the government planned to mitigate the impact of Covid. in the health system.

In fact, the government has invested heavily in mitigating risks related to Covid. Examples include the introduction of a social problems grant, reduced interest rates, and tax incentives for businesses hardest hit by the closure. Investments in the purchase of vaccines have also been significant.

The government also implemented a number of other public policy measures. These included various regulations to limit the spread of the virus, imposed alcohol bans to reduce the impact of trauma-related injuries on the healthcare system, and made significant allocations for vaccines.

But all this was not enough as 265,000 more people died between March 2020 and November 2021 compared to deaths from natural causes in previous years. This is almost three times more than the official number of reported Covid deaths. It will take some time to fully unravel this anecdotal evidence from district health administrators investigating unexplained deaths at the facility. But these figures demonstrated the disruption of services and the need for strategies to address this in the future.

Covid-related restrictions had some unintended consequences. These included restrictions on access to routine health services. TO poll carried out in the first 150 days of the South African blockade in 2020 showed a sharp drop in access to health services. In particular, access to HIV and TB testing decreased by up to 50%.

Additionally, Covid exposed the inefficiency of South Africa’s parallel healthcare system. More than 50% Covid testing were conducted in the private sector, despite only 15% of the population enjoying the coverage of a private medical plan. More than 40% of Hospital admissions related to Covid they were in private admissions. Official Covid deaths were also higher in public facilities, often as a result of delay in seeking care.

Considering all this, the government was expected to seize the moment and make the necessary investments to improve access and the response capacity of the health system. Instead, the budget framework proposed additional cuts to an already collapsing public health system.

The National Health Law defines the governance of the South African health system, assigning the three spheres of government: national, provincial and municipal.

The national Department of Health provides a framework for a structured and uniform health system. The provincial departments are responsible for the provision of health services. They employ the majority of health care workers and depend on the provincial equitable share of national revenue to finance health care. Cuts to provincial equitable participation will put further pressure on struggling rural provinces like Eastern Cape, Limpopo, Northwest, Free State to make the necessary investments to address health inequities.

Impact of budget cuts on publicly funded healthcare

Effective governance of health systems depends on good quality data on a number of indicators. These include burden of disease, health service delivery, outcomes of interventions, and gains in equity, particularly limiting out-of-pocket costs.

An indirect grant from the National Health Insurance (NHI) was introduced to strengthen health management information systems to improve decision-making and prioritization. Cuts to this grant delayed this crucial investment in strengthening the response capacity of the health system. The NHI grant has a poor spending record. But the grant has been redesigned to support the development of the infrastructure necessary for the establishment of the NHI Fund.

TO recent report by the Medical Research Council examined the readiness of public hospitals to use diagnostic-related groups – a patient classification system that helps standardize the cost of care. The report highlighted the sorry state of the hospital’s administrative systems. Approximately 40% of the hospitals evaluated were unable to produce discharge records, among other challenges. Cuts to this indirect grant from NHI will compromise efforts to address this.

Then there is the Health Revitalization Grant, which is intended to support the construction of new facilities and the renovation of existing ones. Your participation in the budget remains static for the next three years. Given the significant cost overruns in the management of these projects, this may have been an opportunity to reduce expenses while prioritizing the strengthening of organizational systems that the grant also takes into account. Investments in infrastructure are essential to improve the health system. But more attention needs to be paid to how projects are identified, evaluated and approved. With limited fiscal space, revitalization of existing infrastructure should be given higher priority.

The allocations for HIV and TB and the community outreach grant remain static. But given the need to respond to Covid-related outages, it’s essentially a cut. Furthermore, the effectiveness of the current subsidy should have been taken into account. To end HIV as a threat to public health, the UN had to establish objectives that by 2020: 90% of people living with HIV should know their status; 90% of people with HIV who know their status must start treatment and, finally, 90% of those who start treatment must be virally suppressed. South Africa currently scores low across the waterfall. You need a more thorough questioning than the answer limits. Continuing to do more of the same is clearly not the way.

Abdication of the obligations established by the Constitution

Article 27 of the Constitution guarantees everyone the right to health services and commits the government to the progressive realization of this right.

And the budget, the vehicle to make this constitutional guarantee a reality, must prioritize the interests of the most vulnerable. Instead, it puts the interests of the elites before the needs of the majority.

The elites do not depend on the public provision of basic services such as education and health care. Private health spending coincides with government health spending even though it only covers 15% of the population. Similarly, the expansion of low-cost private schools will erode the capacity of publicly funded education. And the elites will not feel the cuts in the number of teachers.The conversation

Russell Rensburg, Director of Health Programs, Systems and Policy, University of the Witwatersrand

This article is republished from The conversation under a Creative Commons license. Read the Original article.


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