Curing health system

I get calls all the time about the poor state of public health service. Most often it’s about uncaring hospital staff, long waiting times for operations, day-long queues for medicine or alleged malpractice.

It’s easy to say extra money would help, but it is especially unlikely in the present economic climate.
Already the Gauteng health department is over budget by R1 billion, and estimates about R5 billion more is needed a year for a proper service. There are four key steps, however, to dramatically improve matters free of charge.

Firstly, we should appoint purely on merit, and oust non-performers – usually those who got their jobs because of who they know, not what they know.

Hospitals are complex and need specialists, but many good people no longer apply for top posts as they feel only the politically-connected will get them.

An appalling case is the ANC councilor appointed to run East London hospital complex. He had no relevant expertise, and on his watch, 200 babies were still-born in a year at Frere Hospital. When this was revealed, he kept his job but the whistle blower was fired.

In Gauteng, we have difficulty getting permanent CEOs for Chris Hani- Baragwanath and Charlotte Maxeke Johannesburg Academic Hospital, impacting badly on their performance.

Despite a freeze on hospital posts, the Gauteng health department is hiring 32 more senior managers at its head office; R20 million more a year.

Head office staff has grown dramatically to about 1 000, from 412 in 2003. Many are patronage appointments – fairly useless people, grossly overpaid for doing very little.

Appointing the best people possible is probably the single intervention that would have the most positive effect without costing an extra penny.
Secondly, we need to give hospitals full management autonomy by converting them into non-profit corporations outside civil service restrictions of the civil service.

It is impossible to run an efficient hospital with red tape and head office interference. The one-size-fits-all pay scales restrict the flexibility needed to attract and retain skilled personnel.

Poor patients would benefit most as they would get a better service, as the non-profit hospitals would face strict performance and quality criteria. Ironically, the best run government entity is the Revenue Service, possibly as it is not part of the civil service. If it’s good enough for tax, why not use a similar model to run hospitals?

Thirdly, more private-public partnerships would provide a cost-effective and efficient service – hospital queues could be cut by outsourcing medicine distribution to local pharmacies. In rural areas, we can contract private practitioners to aid in prevention such as mass immunisation.

Fourth, our medical skills shortage can best be eased by lifting crazy restrictions on private training of doctors and nurses. In 2006, 15 794 applied to study at 1 226 places at medical schools – a huge demand private medical schools could meet.

A delay in implementing the accreditation regulations in the Nursing Act has led to a moratorium on new nursing facilities that should be lifted.We should ease restrictions on foreign doctors and nurses, and scrap the quota that keeps foreign-qualified doctors at 5%; the global average is 25%.

But then again we have learnt that nothing is this simple under ANC misrule and our healthcare is now well on track to follow in the footsteps of Zimbabwe.