Pretoria - Dr Aaron Motsoaledi rubs his forehead and repositions himself in his chair, leaning forward as if to make sure the point comes across clearly: “I will say it upfront. There is no way National Health Insurance (NHI) will function anywhere if the public health system is not functioning well.”
The health minister has been on a long overdue mission to transform SA’s health system since he took office more than three years ago.
Speaking to Health-e News Service, Motsoaledi said he had two conditions to the NHI that he was not going to compromise on: overhauling the quality of care in the public health system, and reigning in and regulating the pricing of health care in the private sector.
The minister says he has identified five areas they are already working on in the public sector.
The first is infrastructure with a number of projects in the pipeline including the revitalisation of nursing schools, more mother and child health facilities and the incorporation of breast milk banks and kangaroo care rooms in maternity facilities.
The next area in his sights is human resources: “There are people who wrongly believe we can do NHI without addressing our human resources challenges.
“Nowhere in the world, not in the UK or Norway, did countries introduce NHI when everything was hunky dory, they introduced it when they were not well off. It was a political decision,” he says.
Motsoaledi reveals that, for the first time ever, the department has a human development strategy which includes among others plans to increase the number of doctors trained, build a ninth medical school in Limpopo, rebuild other medical training facilities and increase the number of South African doctors trained in Cuba.
The minister aims to increase the current number of doctors trained in SA from 1 200 to 3 600, with the current medical schools already upping their intake by 160 this year. This was made possible by a R48m grant from the health department.
Going for what he coins a “big bang” approach, Motsoaledi has also sent 1 000 matriculants to Cuba where they will be trained as doctors.
Cuba, which has a population of 11 million and excellent health outcomes, has 27 medical schools with doctors trained very specifically to deal with issues at primary health care (PHC) level, an approach that suits Motsoaledi’s focus on PHC or preventative medicine as part of the NHI rollout.
His third focus is the quality of health care in the public sector and legislation to enable this is at an advanced stage. The Office of Health Standards Compliance will see the establishment of units of inspectors to scrutinise all healthcare facilities, a health ombudsman office to handle complaints and the appointment of specially trained facility improvement teams to address and solve problems in hospitals and clinics.
Motsoaledi’s fourth emphasis is on what he calls “the heartbeat of NHI”, the re-engineering of the PHC system.
“Our health care system must be based on the prevention of disease and the promotion of health,” he states.
The first phase, launching this month, involves the deployment of retired nurses to schools falling in the 10 NHI pilot districts. The second phase will include ward-based PHC teams led by professional nurses.
Children will have their eyes, ears and teeth tested and corrective measures will be taken where needed. Their immunisation schedules will be checked and corrected if not up to date. Programmes focusing on drug and alcohol abuse will also be rolled out.
Acknowledging that it is a sensitive area, Motsoaledi said he was determined to address the booming teenage pregnancy incidence, coupled with the spike in illegal and legal termination of pregnancies.
HIV counselling and testing programmes will also form part of the schools intervention, with condoms made available.
Already there are 30 custom-made trucks ready to roll out to the schools, with the number increasing to 90 in the near future.
Each vehicle is equipped with what the minister describes as world-class equipment to test the pupils’ eyes, ears and teeth, and take corrective measures on the spot, whether dispensing spectacles or filling cavities.
Male circumcision services will also be available.
Motsoaledi was at pains to point out that these services will not interfere with the children’s school time and will move to outlying communities and farms while the children are writing exams or tests.
Motsoaledi’s “last dream” and fifth focus involves the deployment of teams of specialists, including gynaecologists, paediatricians, family physicians, anaethetists, midwives, paediatric nurses and PHC nurses to the health districts.
“I want to start in April and I want it as a permanent feature,” he says.
He reveals that Cuba has offered to send specialists, but adds that he wants to first exhaust all avenues, including requesting universities to send specialists on a rotational basis.
Quizzed on the huge challenges in Gauteng, a visibly angry Motsoaledi repeated his assertion that health care had become “tendercare” in the beleaguered province.
Motsoaledi is a man on a mission - to make sure that a patient’s ability to access good health care and to be treated, does not depend on their ability to pay for it. He needs to succeed.
Health-e news