From Transition To Transformation: Building The Sustainable Healthcare Sector We Want

The good, the bad and the ugly of South Africa’s healthcare sector were hotly debated on day two of the 23rd annual conference of the Board of Healthcare Funders (BHF).

Kicking off proceedings for the day, Professor Nomafrench Mbombo, Provincial Minister of Health for the Western Cape, disclosed the province’s plans to ensure healthcare for all. 

Following this, Timothy O. Olweny from the Social Health Authority, Kenya, provided insights into ongoing Universal Health Coverage (UHC) initiatives in the country, along with the challenges encountered in achieving success. Additionally, Dr. Michael Gone, an expert in health financing and private sector engagement, shared lessons learnt from Rwanda’s community-based health insurance (CBHI) system.

Subsequently, Dr. Siri Wiig, Centre Director of SHARE – Centre for Resilience in Healthcare at the University of Stavanger (UiS) in Norway, presented findings on the significance of high-quality health systems in fostering a sustainable future.

Notably, Dr Katlego Mothudi, Managing Director at BHF, delved into the organisation’s vision for a successful healthcare future, suggesting that healthcare organisations across southern Africa are negotiating a multifaceted landscape, fraught with escalating challenges and promising opportunities. 

“The rapid surge in non-communicable diseases has placed a substantial burden on healthcare systems worldwide. Concurrently, economic volatility continues to escalate healthcare costs, rendering essential care less accessible to many. Furthermore, the pervasive presence of fraud, waste, and abuse within the system exacerbates these financial strains. Compounding these issues is the limited expansion of private health insurance or medical scheme coverage, further hindering efforts to ensure comprehensive healthcare access for all,” he said. 

Despite these obstacles, several encouraging developments have surfaced, offering avenues for progress. These include a steadfast commitment to achieving health equity, an intensified emphasis on primary healthcare, care coordination, preventative measures and wellness initiatives. Additionally, the rapid advancement of digital health technologies has opened up new possibilities, alongside notable growth in the health insurance sector. 

Although progress towards value-based care has been gradual, strides are being made in this direction. Moreover, collaborations with both local and global tech innovators, coupled with a strategic internal focus on tech integration, are shaping promising pathways forward.

Mothudi alluded to several critical and interconnected barriers that are impeding progress towards sustainable healthcare.

“Regulatory hurdles, exacerbated by inefficiency and politicisation, are stalling critical healthcare reforms, including the implementation of the NHI bill and revisions to Prescribed Minimum Benefits (PMBs),” adds Mothudi. “The healthcare sector faces a conundrum of workforce and technological strains, including inadequate training, limited job opportunities, high emigration rates and workforce burnout. This, together with challenges in formalising a developmental pipeline for human resources, management capacity and enterprise development; and a lack of integration of digital health technologies, are just a few examples of the complexity of the issue at hand.”

Furthermore, economic instability is straining healthcare affordability and the viability of public services, compounded by workforce shortages, infrastructure decay, and rising costs for traditional medical schemes. In South Africa, additional challenges include the absence of low-cost benefit options and restrictions on provider tariffs and collective bargaining.

Lastly, the growing corporatisation of healthcare threatens smaller, independent practices, potentially reducing patient care diversity. The shift towards larger entities and hospital-centered care may concentrate the market, diminishing patient choice and weakening the traditional community-based healthcare model.

In response, healthcare organisations are taking strategic actions to mitigate these challenges. This includes collaboration with government and business; encouraging private sector participation; promoting the harmonisation of regulations; encouraging the strengthening of governing agencies; shifting towards integrated healthcare models; and adopting advanced technologies and digitalisation.

While these responses may attend to current challenges, Mothudi suggests that a more comprehensive set of longer-term solutions are required at a systems level to be sustainable. 

“To achieve Universal Health Coverage (UHC), a multi-payer system must ensure quality care for all without financial strain. Implementing UHC principles involves aligning benefits to promote preventative care and managing chronic diseases. Public-Private Partnerships (PPPs) can enhance access and improve care quality, with proactive private sector engagement complementing government responsibilities in policy implementation,” said Mothudi. 

“Furthermore, policy and regulation should aim to strengthen oversight by enhancing regulatory institutions and promoting inclusivity and knowledge sharing across the SADC region to learn from each other’s experiences,”he added.

To enhance healthcare infrastructure and workforce development, it is imperative to invest in facilities and technology in underserved areas, strengthen training, improve workforce planning, and leverage digital health initiatives such as telemedicine and electronic records. Lastly, the adoption of environmental, social and governance standards are required to promote resilience and position Southern African healthcare systems as leaders in sustainable practice.

“As we steer beyond the transitional state of the liminal into a future ripe with potential, it becomes clear that a resilient and inclusive healthcare system is within our reach. Through these collaborative efforts, we are not just meeting the current needs, but laying the groundwork for future demands,” concludes Mothudi. 

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