Health inequity in South Africa is rising to crisis proportions. The 20th edition of the South African Health Review which was recently released presents a dire picture of the future, if the problems of inadequate funding, acute staff shortages and policy/legislative gaps are not addressed immediately, with the seriousness this deserves.
The public health system which serves the immense majority of South Africans has been persistently underfunded and understaffed over the years. The Democratic Nurses Organisation of South Africa (DENOSA), Hospital Personnel Association of South Africa (HOSPERSA) and National Education Health and Allied Workers’ Union (NEHAWU) have repeatedly called for this increased funding and staffing. The response of government has however been grossly inadequate.
Earlier in the year, Aaron Motsoaledi the Health Minister denied that the government had frozen employment and promotion of health workers. But in the chapter on “health spending at a time of low economic growth and fiscal constraint” in the Health Review, experts including South African treasury officials confirmed that “restrictions in terms of filling vacant posts”, “reducing capital infrastructure spending” and delay in maintenance have been part of the government’s cost-cutting “strategy” in the health sector since 2012/2013.
It is poor working-class people, particularly blacks (and of these, women most especially) that bear the brunt of this deplorable strategy of austerity, further exacerbating class, racial and gender inequalities. The wealthiest 16% of the population use the private system where they are assured of first class healthcare delivery, where half of the 270,437 nurses in the country work because of much better working conditions than in the public sector.
Almost the entire white population utilise the private health system, while 95% of non-whites must rely on ill-funded public healthcare delivery. This is an important reason for the government to put people over profit and bolster the public health system which is entering a crisis state.
Simphiwe Gada, the DENOSA Chairperson for the Gauteng province put the impact of inadequate funding and staff shortages in perspective when she informed that “the shortage of staff at Baragwanath seriously compromises the quality of healthcare that patients receive at that facility”. 1,300 new-born babies died over the last three years at the Chris Baragwanath hospital, which is the third largest in the world.
Nurses and other health professionals have to battle with unsafe and ineffective staffing levels for health on one hand and increasing shortages of support staff on the other hand. They have had to work longer hours doing their work and also serving as clerks, porters and cleaners!
Per capita expenditure on health by government over the last five years has reduced or stagnated. And from all available indices, this will further decline by 1.3% to 2.2% by 2019, compared to 2015. Government’s argument of depleted resources for health because of the global economic crisis is not tenable.
At the beginning of the year, Oxfam South Africa revealed that “the wealth of three South African billionaires is equal to that of the bottom half of the country’s population”. This was barely a month after the United Nations General Assembly received the report and recommendations of the UN High-Level Commission on Health Employment and Economic Growth (UN ComHEEG). President Jacob Zuma of South Africa was a co-chair of the UN ComHEEG (along with Mr Francois Hollande, who at the time was the French president).
The Commission’s recommendations formed the basis of the Working for Health: Five-year Action Plan for Health Employment and Inclusive Economic Growth, which was adopted by the 70th World Health Assembly in May. To accelerate progress towards attaining universal health coverage and attaining the goals of the Agenda for Sustainable Development, Working for Health calls for equitable access to health workers within strengthened health systems, by governments’ investing in both the expansion and transformation of the health and social workforce.
The South African government is dutybound to provide leadership in walking the talk of the ComHEEG’s recommendations, considering its central role in the formulation of these. Cuts in capital expenditure, caps on staffing levels and other austerity measures are contrary to the spirit and letters of Working for Health.
These will only lead to a health crisis for poor South Africans, and worsened social inequalities in South Africa.
Public Services International thus joins its health sector affiliates in the country in calling for urgent and fundamental steps to be taken by the South African government to revamp the public health system, including: enhanced funding, filling all vacant posts and expanding the health workforce.