Cabinet needs Hogan

2009-04-24 00:00

While victory is certain for Jacob Zuma’s African National Congress in these elections, the composition of his new cabinet is less certain. For Zuma owes his ascendancy to a number of different groups, and they will be expecting rewards.

But when allocating cabinet posts, Zuma and his team should not forget that they owe ordinary citizens ministers who can drive and implement service delivery.

In the past six months, Health Minister Barbara Hogan has proven she has the ability to lead the overhaul of the health system and to work with a variety of players to achieve this.

Our health system is sick, which the ANC acknowledged at Polokwane in December 2007. Yet for years under former health minister Manto Tshabalala-Msimang, malpractices were permitted to continue because the minister was a Thabo Mbeki loyalist.

HIV/Aids is by far the country’s biggest cause of death, yet its treatment and care were subverted and stalled by Tshabalala-Msimang, resulting in an estimated 330 000 unnecessary deaths and the needless infection of some 30 000 babies a year with HIV. Infant mortality is worse now than it was under apartheid. South Africa is one of only 12 countries in the world where the proportion of children dying has increased in the nineties and 2000s. Some 20 000 babies are stillborn in South Africa every year and another 22 000 die before one month of age, according to a report released last year called “Every death counts”.

At least 1 600 mothers die from complications of pregnancy or childbirth each year, but over half the deaths of mothers giving birth in clinics could have been avoided if patients had been monitored properly. Many of the stillbirths could have been prevented if pregnancies had been properly monitored, according to the report.

Patients wait for treatment at health facilities for hours, often with fatal consequences. Poor infection control in hospitals means that patients pick up other illnesses, particularly those patients with poor immune systems such as babies, the elderly and people with HIV/Aids.

Clinics are poorly resourced, and the referral system from clinics to district and regional hospitals is dysfunctional in many parts of the country.

There are massive vacancies in the public sector health institutions. Nurses and doctors are overworked and underpaid, and their working environment is conducive to making mistakes. Yet when they make mistakes, they and their managers are seldom held accountable.

The vacancy rate within the Health Department is substantial. Qualified audits are the norm as is massive overspending by provinces. This financial year, KwaZulu-Natal’s Health Department starts with a deficit of over R1 billion largely as a result of underbudgeting for HIV/Aids.

In a desperate attempt to deal with overexpenditure, the Free State adopted the opposite response to KwaZulu-Natal and suspended its HIV/Aids treatment programme last November, at a cost of an estimated 30 lives a day.

One small Barbara Hogan is not going to solve all the problems. But she has experience in financial management and is a systems person. Since her appointment she is beginning to bring a semblance of order to the shambles. In addition, she has shown herself to be someone able to listen to, and consider, other people’s points of view, rather than being a slave to ideology.

For example, her predecessor saw the private health sector as the enemy and there are many in the ANC, Cosatu and the SA Communist Party who believe that the National Health Insurance system — a key ANC election promise to be phased in over the next five years — should mean the end of private health. Hogan has been pragmatic in her approach, saying that it makes no sense to undermine the private sector when the public sector is performing so poorly.

In many health areas, there are no yardsticks against which health facilities are measured. To rectify this, on April 17, Hogan set up a Ministerial Advisory Committee for Quality, Safety and Standards. Three sub-committees — on standards, norms and guidelines, infection prevention and control, and patient safety and quality improvement — will drive the committee. This will go a long way to providing a framework against which health facilities can be measured, as well as a plan for how patients’ needs can be protected.

Hogan’s biggest challenge is to get provincial health departments to work with her. She has acknowledged that the country effectively has nine different health systems, as conditions between each province differ so greatly.

This too needs the ANC government’s urgent attention, as making the provinces the sole implementers of health and education has clearly failed. — Health-e News

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