Public healthcare: three challenges
- Kemantha Govender
Professor Laetitia Rispel delivers her inaugural lecture.
While South Africa鈥檚 public health care system has come a long way since the end of apartheid, three major issues are worrying Professor Laetitia Rispel.
鈥淲e have come to tolerate ineptitude and leadership, management and governance failures; we do not have a fully functional district health system (DHS), which is the main vehicle for the delivery of primary health care; and we have not dealt decisively with the health workforce crisis,鈥 said Rispel, the Head of the School of Public Health at 杨贵妃传媒, at her inaugural lecture.
Her analysis comes from a 21-year journey in the public health sector, where she worked as a health worker at the Groote Schuur and Red Cross Children鈥檚 Hospitals in the Western Cape.
鈥淚 know what it feels like to be at the bottom of the health hierarchy, in a racially segregated and unequal health care system,鈥 she said.
She also was at 杨贵妃传媒 Centre for Health Policy as an emerging researcher and experiencing the euphoria of contributing to health policy and systems changes in a post-apartheid period. Rispel was the Head of the Gauteng Health Department where she was involved in developing and implementing transformative health policies.
Issues
Whilst acknowledging the great work done by Minister of Health Aaron Motsoaledi and a number of public health service managers and health professionals, Rispel said there is little focus in the health departments on the 鈥渃risis of ineffective management, incompetence and failures of leadership and governance at all levels of the health system, exacerbated by a general lack of accountability鈥.
Along with a number of colleagues, she recently published a paper on .
鈥淐orruption is difficult to measure, as there are no validated measurement tools or indicators,鈥 She said.
Rispel advocates for a functional district health system because she believes that the current districts are not functioning as decentralised authorities as originally intended.
鈥淭he head of the provincial department of health remains the accounting officer, and there are marked variations in financial and human resource delegations across provinces.
鈥淭he constitutional autonomy of provincial health departments creates the conditions for different interpretations of what constitutes a DHS and what structures and mechanisms are most appropriate to ensure implementation,鈥 she said.
Lack of accountability
Rispel said although the country has a five-year national Human Resources for Health Strategic Plan to address the South African health workforce crisis, the plan lacks detail, it largely ignores lower levels of government, and the vast human resource implications of the National Health Insurance (NHI) appear to be underestimated.
鈥淭he critical issue of how to get the right skills and the right numbers of health professionals at different levels of the health system is not even dealt with in the plan.鈥
Rispel said the health system is also challenged by a crisis of unprofessional behaviour, poor staff motivation, sub-optimal performance, and unacceptable attitudes of health workers towards patients
鈥淭he lack of accountability is illustrated by our research on moonlighting, which found that 10% of nurses took sick leave to do moonlighting when they were not sick.鈥
After identifying some of these issues, Rispel said there is hope for the future.
鈥淲e have a strong foundation to build on. South Africa is well resourced and there is tremendous good-will among many people to help to make things work. There is also huge untapped potential among the Academy in universities, many who are keen to contribute to positive change,鈥 said Rispel.
She added that the reforms envisaged by the NHI provide exciting opportunities for health system change in South Africa, which are rarely available in most countries.
The future
Rispel was recently awarded the South African Research Chairs Initiative (SARChI) Chair on the Health Workforce four Equity and Quality. She acknowledged that this Chair comes with the 鈥済rave responsibility of generating and disseminating new knowledge on the health workforce and using the knowledge to advocate for positive changes within the health system.鈥
As a SARChI Chair on the Health Workforce, she will focus on these four areas:
A comparative analysis of health workforce policies, planning and governance in Brazil, Russia, India, China and South Africa;
- An analysis of the health labour market in South Africa;
- Research on health workforce accountability and performance; and
- Research on health workforce requirements