Health Reform – Perspectives and Proposals
SECTION27 and the Concentric Alliance are proud to share a new report entitled Health Reform – Perspectives and Proposals. It draws from updated research from interviews with 33 key stakeholders across the health system, including the health officials, academia, unions, medical schemes, private health providers, health journalists, regulators, and public tertiary hospital managers.
Health system reform efforts in South Africa appear to have stagnated. Following over a decade of discussion and debate, stakeholders are weary and do not trust each other’s motives and opinions.
This stagnation is fatal. South Africa’s health system is under immense strain and its inequities are well known. Some people continue to receive insufficient care while others are over-serviced in the interests of profit. Health care workers are burning out. Uncertainty about changes that may never come is causing jitters in the middle class and impatience among those who cannot imagine a changed system leaving them worse off.
It is within this context that this research has been conducted. SECTION27 and Concentric Alliance (CA) wanted to see what stakeholders in the health system (when they are away from the public eye) agree on, what they disagree on, and whether there is the possibility of bringing them closer together in the interests of fixing a decidedly broken health care system.
We interviewed 33 people from the national and provincial departments of health, health regulators, medical schemes, public and private health care workers, trade unions, private hospital groups, public health academia, health rights-focussed civil society, the pharmaceutical industry and government. We read submissions and statements on health system reform and National Health Insurance (NHI) from many other stakeholders.
This report presents what we found and what we recommend.
We found that while there are some areas of profound disagreement, there are also areas of (sometimes surprising) agreement. All of the people we interviewed agree that the foundation of a health system is the right to access health care services. Everyone agrees that there is a need for health system reform, in part to realise that right. Everyone agrees that there are governance, accountability and management issues that must be attended to urgently. Everyone agreed that there is a need for, and the possibility of, collaboration.
Many respondents agree on the need to try different mechanisms for harnessing private sector capacity to service the public sector and for establishing the systems to support more rational referral processes. Many agree that we need to monitor health outcomes and to orientate the health system to respond to those outcomes. Most respondents agree with the need to better regulate the private sector, including the pharmaceutical industry.
These areas of agreement give us somewhere to start: to take tangible steps towards health system reform on a foundation of consensus. Just starting could build the trust that will be needed to make further inroads.
The areas of disagreement are less surprising: the relegation of medical schemes to cover only complementary care; how to produce and keep sufficient and appropriately qualified human resources for health; how to establish the roles of national and provincial departments of health in relation to each other and to other structures; and how to ensure appropriate governance of funds and facilities. These are the difficult areas of health system reform that may be holding up needed reform in other areas.
Even within these areas of disagreement, however, there are glimmers of consensus, agreement on principles, and recognition of the need for change. Subjecting some of the more wicked problems to a good faith consensus seeking process could help to move the needle.
The recommendations are divided into two paths for the way forward: to take action on areas of agreement; and to go deeper into consensus seeking to guide the way forward on areas of disagreement. Taking action on areas where there is already consensus would need to be a government-led and funded process, in collaboration with stakeholders.
A consensus seeking process could be organised and facilitated by people independent of the health system and funded through the fund-raising efforts of stakeholders.
The report’s findings are encouraging! They illustrate hope for health system reform beyond the current impasse. The report findings on the areas of contention and of consensus provide a point of departure for reform of a health system in dire need of change; in the interests of the people of South Africa, in dire need of a system that serves them.