Challenges in the South African healthcare system: A call for action

The South African healthcare system is facing intense challenges due to inadequate funding, which is exacerbated by a “culture of wastage and mismanagement” at VARIOUS facilities, is the assertion made by KwaZulu-Natal businessman and activist Narendh Ganesh.

Ganesh voiced his concerns about the decaying state of healthcare in the country in a series of letters to Minister of Health, Aaron Motsoaledi.

He highlighted a variety of ongoing issues affecting all tiers of the country's public healthcare system, from major state hospitals to community health centres (CHCs) and peripheral clinics, which hindered the work of healthcare practitioners and ultimately impacted the level of care patients received.

Ganesh said he became well versed with the misuse, wastage, and mismanagement due to extensive consultation with various health practitioners in the province.

Apart from consulting, he penned his observations to the minister via several letters until he was taken by surprise when he eventually received a response on Friday.

“As budgets rapidly deplete long before the financial year concludes, essential services and life-saving drugs become scarce,” Ganesh explained, indicating that pressure on an already beleaguered system was mounting.

Some of the other alarming issues that came to the fore for him were the wastage of drugs and improper disposal practices, which not only led to environmental pollution but also fostered the development of antibiotic resistance.

He also noted the financial losses that occurred when medication expired or were deemed obsolete, which were usually the result of poor management of resources.

“How often have health administrators conducted oversight visits to facilities? Such visits might reveal both the operational issues and the desperate need for intervention,” he suggested.

His claims indicated that oversight was lacking, potentially leaving health administrators oblivious to the serious challenges on the ground. The challenges also extended to prescription practices, Ganesh said.

The Essential Drugs List (EDL), which is used as a reliable guide for medication distribution, has devolved into a “mere formality.” According to Ganesh, many essential medications were unavailable due to unpaid suppliers withdrawing.

"This lack of access to necessary drugs adds yet another layer to the systemic crisis," Ganesh said.

In response, Motsoaledi acknowledged the legitimacy of Ganesh's concerns, particularly the risks surrounding medicine wastage, including expired stock, overstocking, and theft.

He pointed out that stringent protocols under Good Pharmacy Practice (GPP) were being enforced in public health facilities to enhance pharmaceutical management. Those included regular stock reviews and adherence to the First Expiry, First Out (FEFO) principle to combat wastage.

Motsoaledi elaborated on the governance of essential medications and stated: “The National Essential Medicines List Committee (NEMLC) oversees a non-statutory advisory committee responsible for developing and managing the national Standard Treatment Guidelines (STGs) and Essential Medicines List (EML).”

"These guidelines aim to steer clinical practice and inform the procurement of vital medicines in the public sector."

To improve prescribing practices, the minister mentioned that several interventions had been instituted across various levels. These include medicine use evaluations and clinical audits to ensure that all health workers were adhering to best practices.

Educational sessions and workshops were also part of the strategy, promoting the rational use of medicines by prescribers and users alike.

In addressing the urgent need for more human resources in the healthcare system, Motsoaledi stated that the National Department of Health was actively engaging with the National Treasury to secure additional funding for the hiring of more healthcare workers.

"This is a key element of the Human Resources for Health Strategy 2030."

However, he noted that recruitment is hampered by provincial budget ceilings and broader fiscal constraints, despite the apparent need for increased personnel.

Chairperson of the KwaZulu-Natal Legislature Health Portfolio Committee Dr Imran Keeka echoed Ganesh's sentiments and said there was no strict monitoring of several of the matters the minister outlined, which needed oversight.

Keeka said the issues raised were valid, particularly that of doctors prescribing medicine solely at the behest of patients.

"While it's true that the majority of doctors don't succumb to this pressure, it's a two-way street. Patients must also be educated not to force doctors to act against their professional judgment.

"We’ve even heard of instances where people demand medicines on their prescriptions for spouses, family, and friends—believe it or not."

When doctors are identified as succumbing to patient pressure, there must be consequences. "I couldn't agree more with Mr. Ganesh on this point," said Keeka.

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