Thought Leadership

Better managing our public healthcare infrastructure, imperative for sustainable, inclusive growth

22/04/2021 | By Busiswe Mavuso

What was a certainty at the start of the Covid-19 crisis last March was that the pandemic would severely test the country’s public sector healthcare infrastructure to degrees that it has never been tested before.

Locking down the economy for large chunks of past year was necessary to ensure the system didn’t buckle under the pressure of case numbers that have now reached more than 1.5-million. Much credit goes to the brave women and the men who’ve worked in both the public and private healthcare sectors to help avert the collapse of the system. They’ve provided a necessary and important last line of defence in the war against the pandemic while putting their own health at risk. Their job, however, hasn’t been made any easier by just how poorly the state has done in managing a public healthcare system that has in the region of 85,000 hospital beds.

The thought came to my mind over the past week as we watched helplessly as fires ravaged through some of the most important institutions in our country, including Johannesburg’s Charlotte Maxeke Academic Hospital and parts of the University of Cape Town campus. While we don’t yet know whether the cause of the fires were acts of God or something of a criminal nature, the fires raised a question about just how well we are looking after some of our most important infrastructure assets.

The fire at Charlotte Maxeke is particularly worrying in terms of the pandemic, with a third wave of infections likely in a couple of months’ time. The hospital has been closed with patients being diverted to nearby hospitals. We have lost 700 hospital beds in our “war” against the pandemic.

That’s one important institution crippled at a time where every single hospital is an important piece of infrastructure, not only in terms of the pandemic but also in ensuring the most important element to any economy, its people, have sufficient and adequate healthcare access. But considering the Public Protector’s report into the state of public sector healthcare released last December, the state has come up short in its management of a critical asset.

Most critical flaw in our economy

We’ve focused much of our time and energy on electricity capacity constraints as the most critical flaw in our economy, but I’d suggest healthcare may be just as important to the structural reforms that the administration of President Cyril Ramaphosa must undertake. In the Public Protector’s inspection of 17 hospitals in Kwazulu-Natal, Mpumalanga, Eastern Cape and Limpopo, it found there was a shortage of personal protection equipment and staff, poor hygiene and substandard ambulance services. “Linen staff washing the laundry of Covid-19 patients with no gloves. Poor maintenance of laundry machines leads to them breaking regularly,” the report found.

Corruption is also endemic in the healthcare space with a 2020 Corruption Watch report singling out a number of illegal practices over the course of a seven-year study beginning in 2012. It highlights corruption such as the embezzlement of funds (especially when funds are transferred from national to regional entities) and the procurement of medical supplies and pharmaceuticals, including fraudulent and counterfeit equipment and drugs, to name just a few.

The maladministration in our public healthcare sector comes at a great cost to the country and to the economy, with about 80% of South Africans relying on the 4,300 facilities spread across the country. These are critical institutions, on par with our schools and the ailing electricity infrastructure of Eskom.

In the all-out war that we are waging against the pandemic, we need to be removing barriers to our economic recovery and to sustainable growth in the years ahead. Maintaining and improving the assets that we already have will be essential. The state of our healthcare facilities in the public sector is dire and this needs attention. For any real chance of inclusive growth to bridge inequality levels that have made us a poster child of what is a global affliction, the state in partnership with the private sector needs to ensure access to the best possible healthcare for its people.

In the immediate, term however, we need to counter the healthcare threat by ensuring the vaccine rollout motors ahead. We are woefully behind nations of a comparable economic size, even though elements of the delay are related to vaccine efficacy and are understandable. Still, the rollout needs to move forward and it’s a programme that will require the state’s public health facilities to be at an acceptable level. As a business organisation, I know that many of our members stand ready to assist.