The complex legacy of apartheid including the unequal distribution of resources between the public and private sectors, and the increasing disease burden are some of the issues that have led to a dysfunctional health system in the country.
This is according to the newly appointed South African Medical Research Council (SAMRC) president and CEO Professor Ntobeko Ntusi, who recently made a presentation on the state of health in South Africa.
“The health and well-being of most South Africans remain plagued by a relentless burden of infectious and non-communicable diseases, persisting social disparities, and inadequate human resources to provide care for a growing population, and a crisis of governance in health,” says Ntusi.
Ntusi adds that the skewed allocation of resources between the public and private sector has led to insufficient health professionals in the public sector. South Africa has the lowest doctor-patient ratio of 0,9 per 1,000 when compared to other BRICS countries.
“The health system is grappling with poor health management. There is poor quality of care in key programmes, and health workers’ morale is very low. The public sector is experiencing increased litigation because of avoidable errors,” he says.
“Even though the country’s poorest people have access to free treatment at 3,800 public clinics and hospitals, this is plagued by broken equipment and shortage of medicines,” he says.
He says only five of the 696 health facilities covered by the Office of the Health Standard Compliance (OHSC) in the recent report met 80% of their required performance criteria in areas such as drug availability and proper infection control.
Growing disease burden
The situation is made worse by the growing burden of disease. Health experts have been warning about the non-communicable disease epidemic which is driving morbidity and mortality. According to Stats SA deaths due to non-communicable diseases such as cardiovascular disease, cancer, diabetes and chronic lower respiratory disease increased by 58.7% over 20 years.
In the same breath, South Africa still hasn’t a handle on infectious diseases like TB. The disease is a leading cause of death claiming 54,000 lives in 2022.
“Despite the huge burden of TB infections we don’t do well with notifications, these are always far lower than the number of people diagnosed with TB. As it can be noted, still driven by the HIV epidemic, there is a high rate of mortality from TB in this country,” he says.
Ntusi says substantial advances have been made in treatment of HIV and TB which saw improved clinical services and robust programmatic care. But the treatment cascade for HIV and TB remain suboptimal.
“The ideal situation would be to have 100% of people with HIV and TB diagnosed; 100% of those on treatment; and 100% of those treated to either achieve a durable cure for TB or sustained virological suppression for HIV,” he says.
In the global efforts to end HIV as a public health threat, the UNAIDS set the 95-95-95 target that by 2025: 95% of people living with HIV know their status; 95% of people with HIV are on treatment; and that 95% of those on treatment have viral load suppression. Currently South Africa’s numbers are: 94.2-78-89.
“Also the intersection of infections and non-communicable diseases warrants serious attention,” says Ntusi.
Studies suggest that several infections might influence the development of many non-communicable diseases. According to research the presence of infectious diseases such as HIV and TB coexist with elevated blood glucose and blood pressure.
Recommendations
Ntusi says there is a desperate need for multisectoral collaboration and innovation.
Poverty and socio-economic disparity are among the greatest obstacles facing South Africans impacting heavily on healthcare. This leads to a hostile environment characterised by worsening social disparities and social determinants of health. To address these issues, Ntusi highlights the need for strong, ethical leadership.
He adds that there is a need to measure, monitor and evaluate health services to ensure a high quality of care in the health system. While bodies such as the Office of Health Standards Compliance exist, Ntusi says to make it more impactful there is a need to strengthen the health system ensuring that there is sufficient staffing, functional equipment and infrastructure, no corruption and appropriate funding of healthcare. – Health-e News
Source:
health-e.org.za
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