A robust health system for the future

2016-09-04 07:45
Mamphela Ramphele. Picture: Rodger Bosch/ AFP

Mamphela Ramphele. Picture: Rodger Bosch/ AFP

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The strengthening of health systems has become an urgent global strategic agenda in the aftermath of devastating pandemics, such as HIV/Aids in sub-Saharan Africa and Ebola in west Africa.

The unnecessary deaths of 11 312 people from Ebola in the past two years, and the accompanying pain and anguish of loss, made a powerful case for intervention.

In an interdependent, globalised world, supporting the development of resilient health systems is essential for a stable, sustainable global community.

The Brenthurst Foundation’s report on the Ebola-related deaths makes the case for building health systems with the capacity to constantly adapt to long-term epidemiological and demographic changes (visit brenthurstfoundation.org).

Similar calls were made at the height of the HIV/Aids pandemic that put strain on weak health systems across the continent for the global community to work together to strengthen health systems in vulnerable countries. But nothing much came of that.

South Africa has reason to be proud of the seminal role it played in Sierra Leone to contain and reduce the mortality of the west African Ebola epidemic.

Professor Janusz Paweska, the head of the Special Pathogens Unit of the National Institute for Communicable Diseases, is a pioneer in viral diagnostics, detection and discovery.

He provided the leadership for South Africa’s effective and efficient response to the Ebola epidemic, demonstrating the capacity of African countries to work together to tackle major challenges.

Paweska’s establishment of a mobile Ebola diagnostic laboratory in Freetown, Sierra Leone, in August 2014 enabled the World Health Organisation Global Outbreak Alert and Response Network to have the capacity to contain the Ebola epidemic.

Paweska trained and deployed eight teams of local Sierra Leonean scientists and health workers to do on-the-spot testing that accelerated the identification and isolation of those infected.

The laboratory remains a key player in west Africa in surveillance in the post-epidemic period.

It is encouraging that Health Minister Aaron Motsoaledi has committed Paweska to work with colleagues in the Southern African Development Community to strengthen their surveillance and preventive capacity to ready them for any infectious-disease threat.

The effort needs all the budgetary support it can get to execute its mandate. The African Union is also working with the US Centers for Disease Control to build five regional centres in Africa.

South Africa’s healthcare system remains the strongest in Africa. It has more scientists, healthcare professionals and facilities than any other African country.

Yet, it remains fragile and vulnerable to crises.

Imagine if state-of-the-art private healthcare facilities were to be used optimally in partnership with the public health system – the integrated single platform created would bring together the strengths of these professionals and facilities, with high-quality research, training and service, backed by world-class personnel.

We need to reimagine how we can design and build a resilient healthcare system that would provide equitable, excellent and affordable healthcare for all, as promised by our Constitution.

Such a robust system would be in a much better position to respond to pandemics in Africa. It would also be able to play a critical role in training personnel and strengthening capacity in Africa.

South Africa is able to train only 1 400 medical doctors a year, leaving us with six doctors per 10 000 people, well short of the 15 per 10 000 needed.

If we combined private and public health facilities to train medical doctors, nurses and allied health professionals for our own needs as well as for the sub-Saharan region, it would be a significant foreign exchange earner in the same way that Australia has become a lucrative training mecca in east Asia.

We would also be able to attract many thousands of African health professionals in the diaspora to become members of teams to contribute to building their own countries’ health systems.

Africa cannot afford to continue to rely on other regions for its health and education expertise or to lose so many health professionals to the rest of the world.

We need to create an attractive world-class training, research and service platform to attract and retain African expertise.

We need to have deep, honest conversations that take us beyond the standoff between the public and private sectors.

The inequity of more resources being spent on a minority of middle and upper class users cannot be wished away.

Users go where they believe they will get safe, expert services. Nor will punishing the private sector for profiting from an underperforming public sector benefit citizens in a sustainable way.

We have to acknowledge the wounds of past injustice that have created deep mistrust between the private and public sectors.

The burden of disease created by past and continuing injustice has overwhelmed the public sector and undermined its performance.

We need to acknowledge the failure of those who benefited from such injustice and encourage them to be sufficiently conscious of their privileged heritage to recognise the need for humility and willingness to contribute to the greater good.

We also need to acknowledge that we have collectively failed to work together to transform our public health system into a more effective and efficient one, and that the flight from the public into the private sector is driven by the risks posed by the too-frequent cases of indifferent, disrespectful and unaccountable health workers and low service quality.

Imagine if we were to commit to working together to build a resilient, equitable, excellent system that would serve all citizens.

This would enable us to reimagine more efficient and effective utilisation of our shared assets.

We also need to do realistic projections of our future needs with different demographic and epidemiological variables.

A reimagined and rebuilt healthcare system would promote wellbeing, prevent diseases and provide sustainable care against epidemics, as well as chronic diseases.

Africa has demonstrated its capacity to mobilise its resources to tackle its challenges.

We now need to build resilient, robust systems for the future. We can only do so by reimagining and rebuilding what we have.

Ramphele is an active citizen


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Read more on:    mamphela ramphele  |  ebola  |  hiv/aids  |  health care

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