South Africa needs a more equitable, resilient and sustainable healthcare system

There is a need to build a more equitable, resilient and sustainable healthcare system for South Africa. This is according to discussions at the 17th Health Quality Assessment (HQA) Industry Results Presentation and Clinical Quality Conference that was held on 5 August 2021.

Held annually, the conference brings together a panel of experts to discuss the future of the healthcare sector. Among the keynote speakers at this year’s gathering, was Professor Glenda Gray, President and CEO of the SAMRC. Speaking on the state of the South African Healthcare System in times of a pandemic and economic distress, Prof Gray presented a roadmap of what is needed to deliver quality healthcare services to all, consistently. She reiterated that during the COVID-19 pandemic, managing the healthcare system is essentially a balancing act between saving lives and saving livelihoods; and that if the excess mortality from natural deaths was considered, then the actual number of deaths occurring since the beginning of COVID-19 are likely to be three times higher than the officially reported number of COVID-19 related deaths.

“This points to a data-gap and it is not clear whether the excess deaths are COVID-19 related or a result of a compromised healthcare system,” said Gray, also adding that the number of TB and HIV diagnoses dropped significantly since the beginning of COVID-19, something she ascribed to hesitancy from pregnant mothers to access antenatal care. “These reduced levels of essential care and early identification of disease being of major concern.”

Key findings from the 2021 HQA Industry Report

Presenting the Report, Dr Johann van Zyl said the analysis included data on almost 80% of the insured lives of the South African health care industry across 18 medical schemes, representing 91 benefit options and 78.7% of all insured beneficiaries (about 7 million individuals). 174 health quality indicators were assessed, with clinical quality measured against national and international standards.

Overall, there was a lower patient/doctor engagement in 2020 than in previous years, with a reduction in hospital admissions albeit with an increased length of stay. Admissions for beneficiaries with no chronic conditions or with better managed chronic conditions were lower than those with poorly managed chronic conditions. The downward trend of admissions can be ascribed to the reduction of scheduled procedures due to COVID-19 related reasons, with individuals reluctant to seek hospital care, which may lead to a sharp upward trend once the pandemic has ended. However, it is noteworthy that the admissions for beneficiaries with a chronic condition remained relatively high, compared to admissions for beneficiaries without chronic illnesses.

Additionally, the lower scores in prevention, screening and chronic disease management than in previous years could have a negative impact on the burden of disease and the development of co-morbidities and complications. Furthermore, the HQA analysis revealed a pattern of health seeking behaviour that could be economically motivated, with a constant trend of medical scheme members opting for more affordable benefit options, resulting in reduced access to healthcare. A continuation of this trend may have a negative impact on the quality of healthcare.

In her presentation, Prof Gray emphasized that game changing action is required to build a more resilient and innovative healthcare system and that only through transformative changes will the country’s healthcare system become more equitable, resilient and sustainable. “Governance strategies are required to focus on the maintenance of essential healthcare services and systems to be supported during and following the pandemic by prioritizing services, shifting service delivery, and actively managing the healthcare workforce, supplies and data.”

In conclusion, Prof Gray highlighted that financial barriers to essential services should be reduced and access to emerging technologies such as diagnostics, vaccines and treatments should be accelerated. “Furthermore, digital health solutions and novel technologies are needed to bridge the gap in care, with a special focus on ensuring the continuity of services to the most vulnerable in fragile settings and supporting efforts to reach marginalised communities, thereby building public trust for collective action towards protecting health and a One Health Approach.”