27th July 2009

My fellow citizens of KwaZulu Natal

Health care available in South Africa mirrors our country’s position as a mix of the First and Third Worlds: some public health care facilities in rural areas are very basic and deteriorating while some private facilities and medical research are cutting-edge, placing South Africa firmly at the forefront of global medical advances.  

In general, public facilities tend to be underfunded, bureaucratic, inefficient and hopelessly over-subscribed, whereas many private facilities are excellent – as good as any found in Europe or the USA.  

Although the state contributes about 40% of all expenditure on health, the public health sector is under pressure to deliver services to about 80% of the population. Most resources are however concentrated in the private health sector, which sees to the health needs of the remaining 20% of the population. This sector, run largely on commercial lines, caters to middle- and high-income earners who tend to be members of medical schemes (18% of the population, 5.6 % in KwaZulu Natal).  

Drug expenditure per person varies widely between the sectors. In 2000 about R8.25-billion was spent on drugs in South Africa, with the state spending only 24% of this figure. Thus, R59.36 was spent on drugs per person in the state sector as opposed to R800.29 on drugs per person in the private sector. 

The number of private hospitals and clinics continues to grow. Four years ago there were 161 private hospitals, with 142 of these in urban areas. Now there are 200. The mining industry also provides its own hospitals, and has 60 hospitals and clinics around the country.  

Most medical professionals, except nurses, work in private hospitals. With the public sector's shift in emphasis from acute to primary health care in recent years, private hospitals have begun to take over many tertiary and specialist health services.  

Public health consumes around 11% of the government's total budget, which is allocated and spent by the nine provinces. How these resources are allocated, and the standard of health care delivered, varies from province to province. With less resources and more poor people, overburdened provinces like KwaZulu Natal face greater health challenges than wealthier provinces like Gauteng and the Western Cape.  

Added to KwaZulu Natal’s inherent challenges is our poorly run provincial Department of Health. This department is responsible for the bulk of the province’s current overdraft and the signs are there that far from being on the path to fiscal recovery, the department may be incurring further over-expenditure in the day-to-day running of its operations.  

The worst part of this is, of course, the fact that this overspending has not led to demonstrably improved standard of health care delivered to the province’s public. The recent doctors’ strike as well as the crisis linked to the distribution of ARVs at Edendale hospital – KwaZulu Natal’s largest facility serving HIV patients – attest to this.  

This week, as we debate the provincial Health budget for the 2009/2010 financial year, we expect from the department a cogent plan aimed not only at repaying the previous over-expenditure but also arresting the trends that may be leading to current budget overspending. So far we have seen little of this commitment from both the political leadership or the managerial structure of the department. 

We in the IFP expect the provincial government to demonstrate that it can begin to run the KwaZulu Natal Department of Health effectively and efficiently before it delves into the debate on a much larger ambition of establishing universal public health care by way of the National Health Insurance (NHI) scheme. This is the ultimate objective we all share. 

We expect the provincial Department to demonstrate that all previously runaway operating expenditure is firmly under control, that its core functions are prioritized whitivities become the subject of budget cuts and that the most urgent challenges such as HIV/Aids, TB, and malaria are addressed urgently and adequately.

Sincerely,

Dr Bonginkosi Buthelezi MPL

Leader of the Official Opposition

Contact: Dr Bonginkosi Buthelezi, 082 516 0156