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As President Cyril Ramaphosa prepares to deliver his State of the Nation Address (Sona) on Thursday, healthcare experts anticipate few substantive changes in the government’s approach to South Africa’s struggling healthcare system.
Vice-chairperson of the Unity Forum for Family Practitioners, Dr Angelique Coetzee, paints a stark picture of the current healthcare landscape.
“Currently, SA’s healthcare is not in a good space, whether it’s public or private. I would say the public sector is in ICU, and the private sector is in high care,” she told The Citizen.
The metaphor is particularly poignant coming from a medical professional.
The challenges plaguing the system are multifaceted, according to Coetzee.
“We’ve got infrastructure, funding, and HR problems. Then we are sitting with more or less 14 000 people being paid via Pepfar [United States President’s Emergency Plan for AIDS Relief]. Also, some of them will be unemployed,” she explains, highlighting the paradoxical situation where healthcare professionals remain unemployed despite system-wide shortages.
While last year’s address outlined ambitious plans and celebrated certain achievements, healthcare professionals like Coetzee remain concerned about the gap between political promises and practical implementation.
During Sona 2024, President Cyril Ramaphosa emphasised the gradual implementation of the National Health Insurance (NHI), focusing on health system financing, workforce, medical products, vaccines, and technologies.
“Currently, I think people don’t understand that we have universal health coverage in South Africa. You can go to the public or the private sector, and you will get care. We are not saying that it is quality, and I think that’s where the problem lies,” said Coetzee.
She emphasised that access to healthcare facilities doesn’t necessarily translate to quality care.
The implementation of universal health coverage faces particular challenges in rural areas.
“The problem lies with better access, especially in the rural area where people have not always had access to universal health coverage due to transport or other issues,” Coetzee explained.
She added that even when people can access facilities, they may not receive appropriate treatment for their conditions.
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In his 2024 Sona, Ramaphosa celebrated significant health achievements, including increased life expectancy from 54 years in 2003 to 65 years in 2023.
He also highlighted improved HIV treatment statistics, with 95% of diagnosed persons knowing their status and 79% receiving treatment.
However, Coetzee argues that fundamental issues need to be addressed before such statistics are celebrated.
“We need to fix the public health care sector. We need to fix it at the primary healthcare level. We need to make sure that there’s enough posts for doctors and nurses to give proper service at a primary healthcare level,” she insists.
She also emphasised the need for better collaboration between sectors.
“We need to understand and know what is in need. There should be transparency and openness, and there should be less hostility. People must work together, whether in the public or private sectors.”
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While R20.6 billion was promised last year for hospital infrastructure and staffing, Coetzee doubts its implementation.
“I don’t think it was achieved. We need to know exactly how much money should be made available by looking at what each and every clinic needs.”
The disconnect between available resources and their allocation remains a critical issue.
“We need to understand that clinic A needs 50 doctors for the amount of patients, [ a certain number of] nurses and physiotherapists. If you do not do that, it’s not going to help to come up with a round number because we do not know what you’re going to cover with that number,” Coetzee explained.
This misalignment extends to the employment of healthcare professionals.
“For the doctors that don’t work at this stage, there’s actually not a lot that we can do except to say that they should go to the private sector, or they sit at home. There are no other options because there is not enough money.”
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Looking forward to Thursday’s address, Coetzee remains sceptical about the likelihood of meaningful change.
“It’s difficult to say because we always get the same stuff, and nothing really changing the current situation. We’ve been in the situation for the last few years, so no Sona has got us out of this.”
She argues for a fundamental shift in healthcare management.
“Healthcare should be left to the people working in the healthcare sector, not to politicians,” Coetzee asserted.
She advocated for the elimination of political interference in healthcare decisions and emphasised the need to address basic infrastructure and staffing needs before implementing broader reforms.
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