Opinion: PHC re-engineering health care in South Africa is essential

Our current health care system is not appropriately addressing the death and disability in our country – we need a major shift to education and prevention.

Since the first democratic election in South Africa in 1994 the country has been plagued by a quadruple burden of disease.  Both the developing country infectious diseases like HIV and TB, as well as maternal  disorders, together with the developed country diseases like hypertension, diabetes and cardiac disease are wreaking havoc under the population.  Furthermore, the high level of violence and injuries contributes largely to our country’s morbidity and mortality.  Compared to other middle-income countries, South Africa unfortunately stands head and shoulders above its counterparts when comparing the burden of disease.

The situation can be ascribed to many factors:  our unequal and turbulent past; our inability to recognize the devastating rise of the infectious diseases (e.g.  HIV); uneducated, impoverished and unempowered citizens unable to make the right decisions; politically appointed government officials focussing on affirmative action while real life health indicators were forgotten; and, of course, the way our health system is functioning.

From a health system perspective it is easy to blame the Department of Social Development for the poor housing, water, sanitation and other infrastructure for its contribution to health.  Similarly, fingers could be pointed to Education, Road Safety, Police, Legislation and numerous government departments for their contribution to our poor health.  Unfortunately, in the end, the Department of Health is to blame for the high mortality rate.  For that reason it is also the responsibility of the Department of Health to actively contribute to mitigating the problem.

Our new Minister of Health, Dr. Aaron Moatsaledi, and his team formulated a ‘10-Point Plan’ – among others appointing qualified managers and emphasizing accountability – to fix the management and misspent budgets of the health care system.  But with these measures alone, our health care system stays a curative system and it is not capable of making a significant impact on the burden of disease in South Africa.  Access to free and effective health care is a human right and to really turn things around for good we need to build a health system on health promotion and disease prevention.  Missing early stages of disease and not treating and preventing problems causes patients to present late with advanced disease needing very specialized and expensive treatment in hospitals – most of which could have been prevented with very simple, but early interventions. 

That is the reason for the now famous ‘Primary Health Care re-engineering’ (PHCR) plan.  Currently we have a health care system that is missing the essential foundation for a healthy population.  Health care workers in clinics passively wait for ill patients to arrive.  Patients on the other hand are waiting longer than they should before seeking medical care.  This causes neglect of the earliest signs and symptoms of disease that, if treated early, could have prevented progression.  Apart from this many of our clinics are understaffed and health care workers can only attend to the sickest of sick; other patients fall through the metaphorical cracks. 

There are other reasons for the unhealthy gap between the population and the health care system.  These include language barriers, differences in belief, transport, access or financial problems, education and many others.  PHCR aims to bridge this gap. 

The crux of PHCR is the employment of qualified Community Health Workers (CHWs).  CHWs will be responsible for the health of a certain number of households (approx. 250) in a designated area called a ward.  CHWs will be sensitive to the context of the area and with their deeper understanding they will effectively focus on issues like health promotion and disease prevention, adherence to chronic medicine, identification of households with domestic problems, linking with other community organizations to improve health by e.g. improving sanitation and refuse removal.  They will have strong ties and share goals with the clinics to which they will report and also refer patients if needed at an early stage.  This will improve the understanding and co-operation between the community and the health care system and will eventually lead to a healthier society – all done in a relatively cost-effective socially acceptable way.

This is the chance for all South Africans to embrace change and by supporting PHCR contribute to a South Africa whose citizens can live their human right of free access to effective health care and by doing so create a healthier, happier, more productive and internationally competitive South Africa.

Note that the views expressed in this article are those of the author(s) and do not necessarily represent the views of PHASA.

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