Our health needs a jab

2017-12-24 00:01
Long wait for health patients queue at Rob Ferreira Hospital, Mbombela. PHOTO: Thandy Ndlovu / Aens

Long wait for health patients queue at Rob Ferreira Hospital, Mbombela. PHOTO: Thandy Ndlovu / Aens

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When our health system needs healing, who do ordinary citizens turn to? I have pondered this question for some time, not least while watching the #LifeEsidimeni arbitration process.

Let’s face it, the public health system is in desperate need of a jab.

A healthy population is a necessary catalyst for economic and social development.

As the country seeks to improve productive capacity and the economy, the health of its citizens is paramount to ensuring a sustainable future.

Also, the right to healthcare is necessary for the exercise of other human rights, including the pursuit of an adequate standard of living.

Our reality is that we live in a country where 87% of people who depend on the public health system are in s*&%!

Poverty has been identified as both the cause of and the barrier to access to basic health services, according to the SA Human Rights Commission.

Access to healthcare services, especially for the poor, is severely constrained by expensive, inadequate or nonexistent transport, by a serious shortage of emergency transport and by long waiting times.

Beyond the socioeconomic constraints on the poor, they are provided with a substandard level of care.

Someone I know once opined to a hospital chief executive officer – and asked about the emergency trolley that was not fully stocked with essential medicines: “Why don’t you put a sign at the gate written: Enter at own risk?” He was correct!

The fault lines can be traced in the approach to healthcare delivery, which is mainly focused on volume and process rather than true value for patients/end users. Value here refers to the outcomes that matter to patients relative to the cost of delivering those outcomes.

This, therefore, militates for a fundamental recalibration of focus, ie from volume to value, that is urgently needed to ensure a system where the outcomes that matter to patients are prioritised.

A value-based approach, it is argued, starts by measuring outcomes that matter to a particular population segment and then using those measurements to tailor interventions for that population segment along the continuum of care.

“Four game-changing enablers”

The World Economic Forum last year identified “four game-changing enablers” to accelerate the shift towards a patient-centric value-driven approach:

- Informatics: the ability to use technology to collect, analyse and reuse data to measure and compare value;

- Research and tools: creating transparency for evidence-based comparisons that spur innovation while creating algorithms to help clinicians and physicians make decisions;

- Payments: compensation and reimbursement mechanisms that support value improvement rather than increased volume of care; and

- Delivery organisations: adapting the way providers and partners collaborate for better patient outcomes.

Importantly, these will remain academic if the barriers that enable them are left untouched. The most important barrier is the willingness to attract people with the correct skill mix and the temperament to lead public health in the 21st century.

There is a strong need for political will to depoliticise public health and the public service. The implementation of merit-based appointments is important for the public service to turn the corner. An independent public service – one that feels free to offer “frank and fearless” advice – is the bedrock of accountable government. Without it, bad public-spending practices, misconduct and corruption can fester.

Unless healthcare systems change, there is a big question mark over how sustainable they are. As chronic diseases grow more widespread and public spending fails to keep up with demand, the healthcare system is being asked to do more (and better) with less.

At the centre of the system change is the need for new leaders. While there was a time when leaders were idolised (especially in the current public service), the tide is turning.

Our public health system has not allowed leaders to develop; we do our best not to foster a leader’s development. Rather, people depart for greener pastures.

But with the emergence of a well-informed and ambitious young population, we will soon start seeing the impact of this dynamic between a powerful, old elite and the next generation of aspiring public health leaders.

The sad reality is that people with no capabilities are promoted to senior positions only because they are liked by the political authority of the moment. Worst cases are when capable people are sidelined, or even fired, for dubious reasons.

Leaders in public health are generally driven by a profound sense of mission. A sense of purpose motivates them to leave the comfort of the sidelines and wade into controversy.

Many are “wounded healers” who have suffered greatly, but channel their pain into power for the common good. Their souls swell with both the passion and compassion of those who have seen suffering and want to stop it.

Different types of leaders

The demands on today’s healthcare leader are more stringent than ever before. Leaders must be experts in their fields and highly competent in many others.

They must be able to be personable yet gritty, compassionate yet driven, down to earth yet all-knowing. This sounds like a tall order for one person.

On the other end, healthcare environments are diverse and there is room for different types of leaders. There is no magic formula for leadership. In short, public health requires its leaders to stretch their minds and souls in almost unimaginable ways. The core job of policymakers is to constantly be grooming and working closely with these people, so there are always opportunities available for them to thrive.

At the risk of being controversial: isn’t it time we rethought or re-evaluated our “legitimate” concerns about private sector participation in healthcare? I wish to argue that the sheer size of the public health challenge should drive an about-turn in engaging and developing the private sector as an important part of the strategy to improve healthcare.

By serving broad segments of the population, increasing access, expanding the range of services and products available, and improving the quality of services, the private sector can have a positive impact on health and quality of life.

Healthcare provision accounts for roughly half the investment opportunity, with the remainder split across distribution and retail, pharmaceutical and medical product manufacturing and medical education.

Private sector investments will fund capacity expansion, new businesses and renovation of existing assets.

While we grapple with the realisation of the National Health Insurance, we must admit that the private sector has a positive role to play in healthcare systems by expanding access and improving quality and efficiency. Government needs to engage with the private sector as part of an overall strategy for improving healthcare.

The vast range of financial and developmental opportunities that the health industry presents will require significant involvement by all segments of the investor community: financially driven private investors, angel investors, double-bottom line investors and donors.

The vigour of the private health sector will rely on the commitment, creativity and integrity of the people.

In conclusion, the precarious state of public health can be seen through the window of Gauteng health. Opinionistas agree that unfortunate incidents are a manifestation of a crumbling system and poor quality of leadership.

While we face growing health and financial challenges, we have an opportunity to build resilient, equitable, effective and sustainable health systems faster and more cost-effectively than ever before.

There is a triple chance to follow a new path.

Firstly, we have advancing technologies, multiple models of delivery and behaviour change interventions to halt the spread of diseases.

Secondly, we have bigger budget allocations for public health and we need to make smart choices about how to allocate these resources.

Finally, there is greater opportunity to invest in new solutions once we have optimised spending and eliminated corruption.

The world’s increasingly complex health systems need a culture that continuously develops new leaders.

The challenges are even greater for health systems, which are extraordinarily complex and must coordinate and account for many people, products, services and resources every day – and the stakes can be life or death.

Given increasing pressure to improve outcomes, enhance quality of care, and reduce costs, the need to strengthen health systems has become dire.

Great challenges require great leadership and health systems now require a culture that develops new leaders.

- Maxon is a public servant based in KwaZulu-Natal

TALK TO US: Do you have ideas on how SA’s ailing public health system can be rejuvenated?

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