Ramapromises: Quality healthcare just a pipedream at clinics with no water

Like many others in South Africa, the people of Moutse in Limpopo are yet to enjoy the quality public health care which has been promised for several years now, with their local clinic in a dire state and forced to operate without water.

Residents of the village outside the Elias Motsoaledi Local Municipality and those visiting the Marapong clinic in Ntwane have been subjected to inhuman conditions, forced to use containers to fetch water elsewhere.

According to residents, the municipality brought in private contractors to keep water tanks at the clinic full after the local borehole broke down.

Bolsheviks Party leader Seun Mogotji has, however, said the tanks ran empty after the contractor stopped filling them because the municipality allegedly failed to pay invoices.

The Provincial Department of health is yet to respond to questions about the reported issues at the clinic.

The conditions here fly in the face of promises made by the President Cyril Ramaphosa, who vowed to improve access to healthcare, but sadly they’re not limited to this clinic.

Vague promises

In his State of the Nation Address (Sona) last year, Ramaphosa promised to strengthen the healthcare system and expand access to care, with a focus on improving quality of care, reducing waiting times, and expanding access to essential medicines.

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According to Professor of Public Health at the University of the Witwatersrand, Laetitia Charmaine Rispel, this promise is very vague and open to interpretation.

She said because the last inspection report of the Office of Health Standards Compliance based on inspections of a sample of health facilities was dated 2019/2020, there was no objective data available to evaluate quality of health care.

“Nonetheless, anecdotal evidence suggests that quality of care is poor, and people dependent on the public health sector get a raw deal, such as long waiting time, poor staff attitudes…,” she said.

The recent measles outbreak, Rispel pointed out, was a clear indicator of a weak and sub-optimally performing public health care system.

She said the Covid-19 pandemic resulted in collateral damage to the health system, with many routine health programmes such as childhood immunisations adversely affected.

“In an optimally performing health system, there should be zero preventable childhood infections.  There are staff shortages, worse in rural areas, and high turnover of staff, especially health facility managers, with negative consequences for service delivery.”

Smoke and mirrors

She said the Presidency’s Sona commitments review was also misleading and referred to the Covid-19 vaccination programme only.

According to Rispel, at face value – the number of doses appears to be high at 38.4 million doses, however, this figure included booster doses, and the Pfizer vaccine requires two doses per person.

“A more appropriate indicator would be the proportion of the eligible population vaccinated, broken down by age group. This is because people older than 55 years are more vulnerable to illness and death and hence critical to be vaccinated.  

“Should that be done, we will find that Covid-19 vaccination coverage is poor,” she said.

Rispel said the other reported targets achieved, such as strengthened vaccine manufacturing capacity and the end of the State of Disaster, were irrelevant in strengthening the health system.

She added that the National Department of Health, which is meant to steer policy implementation in provinces, is weak and blamed provinces for most of the problems such as lack of absorption of young health professionals after community service.

Universal health care

The prevailing poor state of public health has also brought questions about the state’s capacity to implement the National Health Insurance (NHI) or universal health care.

Last September, The Citizen reported how there has been little or no improvement in the quality of public health service at the test sites, despite R5.1 billion on the pilot project.

ALSO READ: National Health Insurance pilot sites suggest scheme is dead in the water

Dr Atiya Mosam, public health specialist, said SA can’t afford not to roll out universal health care.

She said it was of utmost priority and that the country certainly has the capacity and a baseline of resources currently that could be used to achieve it.

“Achieving universal health care cannot be done overnight without significant resource allocation and where there is significant inequity in the system. Therefore, we need a sustained increase and redistribution of resources across the health sector in order to do so and this can only be done over a number of years,” Mosam said.

In the interim though, she said, SA needs to ensure that the current services were optimised in terms of quality whilst building and strengthen the system.

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