After the virus, SA needs a new healthcare outlook

As the deadly coronavirus continues its inexorable march around the globe, with tens of thousands of deaths reported worldwide, experts say South Africa’s dream to achieve a preventive healthcare system is a long-term plan.

Lessons drawn from the Spanish flu of 102 years ago continue to highlight the need for a paradigm shift from curative to preventive healthcare.

The country still has a long way to go, according to two leading medical experts.

The Spanish flu, lasting from 1918 until 1919, infected 500 million people – about a third of the world’s population at the time. The death toll is estimated to have been between 17 million and 50 million.

About 300,000 people died from the pandemic in South Africa.

While underscoring the importance of preventive healthcare, which has proven to be effective in Scandinavia and Cuba in averting outbreaks of diseases, Dr Gilles van Cutsem of Doctors Without Borders said he believed that although South Africa was on a progressive public health path compared with other African countries, achieving the preventive system was “much more long-term”.

“In times of the Covid-19 crisis, it becomes difficult to implement a strategy to overhaul the public health system, to take the model of Scandinavia or Cuba.

“As these countries will attest, it takes years to fully transform from a curative to a preventive health system.

“South Africa, which should be applauded for its good primary healthcare, is slowly re-engineering public health. But given the current challenges, it is more of a long-term plan, with vaccination being one of the cornerstones,” said Van Cutsem.

Professor Renata Schoeman, head of the healthcare MBA leadership programme at the University of Stellenbosch Business School, said the country needed “more than universal free healthcare” to achieve a healthy nation for productivity and economic growth.

“If nothing else, the vulnerability to Covid-19 infection of people with serious underlying medical conditions that are not well-managed, such as respiratory conditions, asthma, diabetes, hypertension, heart disease and compromised immune systems, has shown that achieving the healthy nation that South Africa needs for productivity and economic growth will take more than universal free healthcare,” said Schoeman.

Social health determinants, such as safe living environments, access to healthy food, education and employment, played much more of a role in creating healthy communities, along with lifestyle choices like diet, exercise and substance abuse.

“The continued focus on health as a human right and on the accessibility of care, disempowers people from taking responsibility for their own health,” said Schoeman.

“We confuse healthcare with health – having access to care is not a promise of health.

“When people are given the opportunity to be active participants in their own care, instead of passive recipients – their human rights respected – the outcomes are better and health systems become more efficient.

“It doesn’t help to have free healthcare, such as the proposed [National Health Insurance], but people make poor lifestyle choices – in terms of healthy eating, exercise and substance abuse, for example – and don’t take responsibility for their own health.”

The NHI alone, said Schoeman, was “only part of the solution”.

She said disincentives to unhealthy lifestyles, such as “sin taxes” and loyalty rewards for healthy food purchases, were measures that should be extended to the public sector – “significantly more affordable than the NHI”.

“Ensuring access to healthcare is a social and government responsibility, but this needs to go along with promotion of health, which goes beyond the health system to entrenching health as a shared and social value,” said Schoeman.

“This is the task of all those involved in shaping and influencing values – families, schools, the media and the legal system.”

– brians@citizen.co.za

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