'Bad management to blame'
Cape Town - Bad management, not lack of funding, is the main reason for the deteriorating state of South Africa's public health system, DA leader Helen Zille said on Friday.
"It is extremely important to realise that the failure of our public health sector is not just a matter of funding," she said in her weekly newsletter, published on the DA's SA Today website.
The deaths of 22 babies at Mahatma Gandhi Hospital in Durban in 2005, and the deaths of 2 000 babies over 14 years at Frere Hospital in East London were not caused by lack of funding.
"They were caused by bad management, which failed to implement the most basic standards of healthcare.
"Bad management at Ukhahlamba in the Eastern Cape failed to give babies simple rehydration with water, sugar and salt (items that do not require large funding) and so caused their deaths.
"Bad management is the primary reason for the decline of our public health."
Worse than under apartheid
Zille said some public hospitals were worse now than they had been during the apartheid era.
"It would seem almost unbelievable to anyone living in apartheid times that some public hospitals would be worse after apartheid had ended, but such is the case, thanks mainly to bad health managers."
South Africa had a private health sector that provided an excellent but expensive service to a minority - seven million people were covered by private medical aid schemes - and a public sector that provided a poor and deteriorating service to a majority.
Reform of the health system had to be aimed at correcting the failures in public health and spreading wider the successes in private health.
"Unfortunately the ANC's proposed National Health Insurance (NHI), which is estimated to cost R100bn a year, would do neither.
"It would deepen the failure of public health and reduce the benefits of private health. It would spend a bigger proportion of funds on bureaucrats rather than doctors."
Zille called for hospital manager appointments to be based on qualifications, experience and record.
"You cannot change a bad manager into a good manager by doubling his salary. In the Free State, only five out of the 31 hospital managers have the necessary qualifications.
"The manager of the East London Hospital Complex, which includes Frere Hospital, is an ex-ANC councillor with a degree in politics.
"It is essential to appoint properly-qualified managers to run our hospitals, rather than unqualified cronies, family friends and party loyalists.
"The state hospitals that do have good managers provide a good quality of care. However, even the good managers are hobbled by an antiquated administrative structure that requires hospitals to be managed by provincial departments.
"They cannot use the money they earn from fees, but must pay it to the province. They cannot make their own senior appointments in the hospital. They are impeded by a remote, slow moving and incompetent bureaucracy."
Zille called for "a fruitful co-operation between the private and public health sectors".
"The private sector could help provide managerial and administrative support to the public sector. It could help with the training of medical interns.
"There could be a requirement that, in order to stay registered, private doctors would have to work a certain number of hours in the public sector each year," she said.