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Major changes have been introduced to the country’s public health sector and plans have been put into motion by the frank and hard-talking Health Minister, Dr Aaron Motsoaledi, hailed as the man to revolutionise health.
Chief among his achievements, has been to roll out the initial phases of the controversial National Health Insurance (NHI) plan and to fast-track the revolution of the public health system.
Motsoaledi’s passion for improving service delivery during the past year has shone through the mess of how health facilities has been run – from administration level and service delivery to the supply of essentials.
Hospitals, community health centres and clinics have been dogged by reports of inadequate administration; chronic shortages of essentials like medication and a shortage of equipment and staff.
Patients have also been turned away for major procedures because of a lack of space; there were food problems ranging from shortages to questionable quality; and complaints about the general attitude of hospital staff.
Amid all these problems and more, the minister admitted that his charge was in a shambles, outlining the corruption and greed that characterised the post-1994 governance.
He said problems started in about 2007 when health care was replaced by “tender care”.
Large tenders were given to unscrupulous people whose interests had nothing to do with health care.
They lined their pockets, leaving patients high and dry.
Motsoaledi said the looting of health coffers was ongoing, but some service providers continued to dispense essentials, and the failure to pay them meant the government’s bills were mounting.
In the past few years, these bills had hit the roof and came crumbling down on everyone involved, leaving facilities without the means to deliver quality care.
While admitting to this and gaining the public’s sympathy and understanding, the minister steered the ship – fraught with problems – in a positive direction.
His major challenge had been convincing stakeholders of the viability of the NHI plan that has as its major focus to make quality health services available to the poor.
By the end of last year, the plan was launched, clear-cut steps on its delivery were outlined and two aspects of it were already in motion.
A school health programme was launched to ensure that children would be assessed and have their eyes and oral hygiene checked; and the recruitment of general practitioners for public health centres was gaining strength.
Motsoaledi placed a major emphasis on strengthening the fight against HIV/Aids and TB, non-communicable diseases, as well as injury and violence. Improving human resource management at state hospitals and strengthening co-ordination between the public and private health sectors were also addressed.
After concluding that hospitals were not well managed because their chief executives were not trained for the tasks they faced, Motsoaledi set up a list of requirements for chief executives and went on to open an academy at which they would be trained.
He launched the Academy for Leadership and Management in Health Care in November, and said hospital chief executives and their managers would be offered training and refresher courses in a system that would overhaul the health system and boost the NHI.
Stakeholders called the academy a quantum leap and hailed it as a solution to the system’s problems, as it would churn out a new breed of managers and see the development of a national management and leadership competence framework for the health sector.
Unannounced inspections would also be carried out to ensure that no lessons were lost along the way.
The burden of diseases and a lack of skills to fight these have weighed down the country’s health sector. In recognition of these problems, Motsoaledi met and coerced chief executives of private health companies to work with him to develop skills, improve the delivery of health care, address debilitating diseases and improve accessibility to medical schools for disadvantaged communities.
His efforts led to collaboration between the department and 23 private companies, and the formation of a Social Compact, whose initial injection was R40 million for 2013.
This collaboration was called the SA Joint Public Health Enhancement Fund, and the agreement was to pump in more funds and initiate debates and discussions on improving the programme as it went along.
As the year starts, training and mentorship will be given to 100 aspiring medical students from disadvantaged communities; some of the money will go to the training of chief executives; and some of it would be pumped into the development of programmes to fight HIV/Aids and TB.
Expertise would be developed from within the country and PhDs and Masters degrees would be produced from the Social Compact, Motsoaledi said.
The fight against HIV/Aids has been a major challenge for the country, and an area of focus for the minister. Shortly before World Aids Day last year, he launched a new concept to provide intervention and reduce the infection rate.
He launched A Re Dlale Safe for Zero new HIV and TB infections. Its target audience is the youth and men who play soccer, the country’s most popular sporting activity.
The minister said men and the youth would be found in large numbers.
Men were the biggest perpetrators in the spread of HIV, he said.
The campaign would take the message to sports tournaments and soccer fields in communities and at national venues.
Also targeted was the upcoming African Cup of Nations tournament, which will bring national and international participants, and soccer lovers together.
The plan was to expose them to the fight against HIV/Aids in a space where they could not ignore it.
Motsoaledi’s efforts have not gone unnoticed by critics and stakeholders, with medical journals at home and abroad labelling his performance outstanding, saying the dramatic turnaround in life expectancy, which has increased from 56.5 to 60 during his tenure, could be likened to the abolition of slavery.
His crusade against alcohol and smoking, and calls to banish attractive adverts for these products, were received with mixed feelings – one group condemning the possible loss of revenue and jobs, with the other praising him, saying if people were bombarded less with adverts, the less tempted they would be.
Motsoaledi ranked among the DA’s top achievers in its end-of-year cabinet scorecard last year, getting an “A” for his performance in his ministry and parliament.
Motsoaledi has announced major plans for this year, and the health public will be watching him anxiously, with the hope that everything falls into place.