As the threat of Covid-19 dissipates, South Africans have remained focused on their constitutional right to access healthcare. The past few years have shone a spotlight on the stark inequalities embedded in our healthcare system as too many people find themselves unable to access the very healthcare services that have been constitutionally promised.
Section 27 of the Constitution guarantees the progressive realisation of healthcare access to everyone, yet in the more impoverished and remote areas, healthcare is either unavailable or too far away, leaving a sizeable portion of South Africans without the resources to travel to existing facilities.
A study by BMC Health Services Research found that 15% of poor rural households in South Africa live more than an hour away from the closest clinic and 20% live more than an hour away from the closest hospital. Transport is expensive and unreliable, and roads are in a poor condition so that the costs of accessing health services can be prohibitive.
In addition to transport challenges, issues around the quality of care at facilities also persist. According to Stats SA, rural communities make up over a third (32.9%) of the South African population, yet health service delivery in those areas remains poor.
Reports of varying levels of healthcare outcomes in the public health system, particularly in predominantly rural areas such as the Eastern Cape, have highlighted the urgency with which we all need to respond to this challenge. It is important to highlight that with the National Health Insurance in the works, it will be crucial to ensure that we address the infrastructural challenges to ensure that there are sufficient hospitals and clinics to support the country if we are to achieve universal healthcare coverage.
The private sector plays a crucial role in this regard. At this year’s inaugural SA Healthcare Summit, Gift of the Givers founder and president Dr Imtiaz Suliman iterated that the public sector cannot do it alone, noting that we as the private sector need to come on board to support the public sector through partnerships to strengthen the public health system using private sector resources.
At the GIBS/PPS Healthcare Industry Insights 2022 Conference at which I was a speaker, the private sector was once again challenged on how they can make a meaningful contribution to equitable healthcare. This is a national and economic imperative.
Greater focus needs to be placed on primary healthcare services in rural areas, especially those with historically low health coverage. In this way, the government can make significant progress toward meeting its universal health coverage objectives within a short period of time.
Bringing care closer to the patient is the key to bridging the gap in healthcare accessibility. Nurse-run community clinics, mobile clinics and clinic-in-a-bag services are just some of the possibilities. However, these need to be coupled with the promotion of cheap, affordable and reliable transport for communities, particularly those in rural areas; the repair and maintenance of hospitals that will ensure that there are enough beds and other resources to support the communities; and the recruitment, training and retention of staff to address the staff shortage currently facing hospitals.
The AfroCentric Group already partners with more than 700 nurse-run community pharmacy clinics that include clinics within DisChem, Clicks, Alphapharm, and more than 100 independent clinics. These provide primary healthcare services to areas where healthcare services would otherwise be inaccessible to communities.
The group also partners with a wide range of private providers of primary, acute and sub-acute health care services. These partnerships provide an extensive and reliable national footprint of healthcare facilities from which healthcare services can be provided.
Through mobile health facilities and healthcare vehicles, healthcare services can be delivered to the people, especially in remote locations.
Most private sector mobile facilities are already fully equipped with the required private healthcare equipment and can be solar-powered, powered through electrical mains or via generators. These mobile units and vehicles have internet connectivity, which can further enable electronic health record creation and telemedicine implementation.
Community healthcare workers should also be empowered to travel on-site with a bag containing clinic equipment and medication. The mobile healthcare worker can operate from an enclosed space or room in an environment that is clean, reasonably accessible by road transport, safe to work from and with enough privacy for patient-employee consultations.
In addition to supporting the government with the provision of private healthcare service delivery models, the private sector can also provide the staff and equipment required for implementing the service. These models can also support the provision and distribution of medication to individuals which highlight the opportunity for integration into the CCMDD programme.
As the AfroCentric Group, we can attest to the advantage that public-private partnerships offer in addressing shortages. The group has been a contract holder of the CCMDD programme since inception and has seen first-hand the tremendous success it’s achieved in bringing chronic medication to state patients with greater convenience and alleviating pressure at district health clinics, dramatically improving queues.
CCMDD is the abbreviated term for the national department of health’s Centralised Chronic Medicine Dispensing and Distribution programme, which distributes and dispenses medicine from a central point for patients with chronic conditions.
By integrating private sector services into public systems like the CCMDD, the private sector can finally bridge the gap and forge an accessible healthcare system that is both equitable and reliable. Much like the electricity situation, it is about time that the government extended a hand and let the private sector in for the good of the country.
It is solutions such as those proposed through the CCMDD programme that provide the blueprint for successful public-private partnerships for NHI, which will be key for the sustainability of this noble initiative. The private sector’s proven management and implementation capability will allow the use of best practices through experience, while also guaranteeing skills transfer to the public sector.
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