In 2015, the Sustainable Development Goals (SDGs) set a target to “ensure healthy lives and promote well being for all at all ages.” The goal contains a list of set targets relating to maternal health, child health, HIV/AIDS, substance abuse, and improving the uptake of preventative medicine. Will South Africa be able to meet these?

The first part of this blog series looked at the challenges South Africa faces in ensuring that there are enough doctors for the public health sector. But it is not simply the doctors and nurses that help to make a system work. It is also the infrastructure, management and the environment. Doctors and nurses can go to work, but when the conditions are poor, this can influence both their ability and willingness to work well. This will impact on the patient most significantly.

Over the past few years there have been reports of corruption in health facilities in several provinces including KwaZulu Natal, the Free State, and Limpopo. Unfortunately, according to research conducted by WITS University this is not a new trend. The WITS research found that R24 billion of provincial health department expenditure between 2009 and 2013 was irregular, either from corruption or spending that was not in line with the planned budget.

Inefficient financing and expenditure makes it less likely that facilities will be adequately and appropriately resourced. This directly impacts on the ability of the public health care system to meet the needs of patients creating shortages of medicines, beds, and impacting on the cleanliness and hygiene of facilities, impacting on worker morale.

When already limited beds are full, some patients are referred to private hospitals. These referrals cost the Government money, adding to the expense of health care services, putting an already strained budget under further stress. Inefficient spending thus impacts morale, working conditions, and the ability of the health systems to meet the needs of the patients.

South Africa already has legislation and policy in place to regulate health systems, and thus the answer is not necessarily stricter policy but rather effective execution of such. Political and bureaucratic will is thus needed to implement and monitor the policies that are already in place.

Obviously addressing effective financial management of the health system requires a multidirectional approach including:

• The private sector reporting collusive or otherwise corrupt practices such as improper tender awards;
• Members of the public reporting poor conditions or service at hospitals to the Department of Health so that these can be investigated;
• Where officials are found to be involved in corrupt activities they must be sanctioned;
• Capacity building in Leadership and governance for all senior management

In order to promote the health of South Africans, we need the system to be healthy too.