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22 June 2020
Universities Critical to Changing Unequal Healthcare System

(Published - 22 June 2020)

As the country battles the impact of the coronavirus pandemic, discussions on healthcare systems are often intriguing, enlightening and thought-provoking. An address by Health Minister Dr Zweli Mkhize during a webinar, hosted by UWC’s School of Government in the Faculty of Economic and Management Sciences, was no different. 

Entitled, ‘Social Solidarity and Equitable Healthcare for All in a Time of COVID-19 and Beyond’, Acting Rector and Vice-Chancellor, Professor Vivienne Lawack, Dean of the Faculty of Economic and Management Sciences, Prof Michelle Esau, and Acting Director of the School of Government, Prof Gregory Davids, were among the panelists. 

In her welcoming address, Prof Lawack said it was an opportune time for UWC to be part of social solidarity, “thinking through what contribution our University can make in re-thinking our healthcare systems and the lessons we are learning during COVID-19 and thinking beyond COVID-19”. 

Dr Mkize said he was aware that the University had a special interest in reconfiguring a fragmented, unequal healthcare landscape into a single system that provided equal access and quality of care to all in the context of an uneven socio-economic environment. 

“COVID-19 must be our chance to invest in the things that matter as a country, and build a lasting legacy of true emancipation, empowerment and equality to access, access to quality health care and access to opportunities,” said Dr Mkhize. 

He said there were links between the ability to contain the virus and the socio-economic impacts of successes or failures. 

“If the capacity is low it is either you lose a lot of lives, or you stop everyone from interacting, thus severely compromising the economy,” he said. 

Dr Mkhize noted that the realisation of the National Health Insurance has been a road hampered by opposition, and is a fundamentally flawed system that is being protected by those who benefit from it. Although the annual budgets of the private and public sectors are similar, the private sector only serves16% while the public sector serves 84% of the population.

“With such inequality, the public healthcare system has suffered in the sheer weight of the burden while the private sector was characterised by over-servicing in the face of rising and escalating healthcare costs,” he said. 

According to Dr Mkhize, the Health Market Inquiry published by the Competition Commission in November highlighted the gross inequity in healthcare. He said it was driven by fundamentally anti-competitive activity in the private sector and the flaws in legislation that allowed for the environment to thrive. There were certain regulations that were fought in court, like the Certificate of Need and the pricing regulations. These regulations sought to address deficiencies highlighted by the Health Market Inquiry.

Dr Mkhize reminded panelists and attendees that it was everyone’s fear that, after the virus was imported by generally affluent members of society, a spillover into vulnerable sectors of society was inevitable and there would be no telling what would happen to the poor, the malnourished, the elderly and those living with comorbidities - including the world’s largest population of people living with HIV. 

“That has indeed been the progress of things and we have a virus raging like a bushfire in our townships and densely populated, impoverished areas,” he said.

He said the government had little choice but to open the economy despite the rising numbers as “it will not help us to save people from COVID 19 only for them to succumb to hunger. We recognised that it is possible to beat COVID-19 with extreme social distancing, so behaviour influences what happens to your curve to a lesser or greater extent”.

The role of the University

Dr Mkhize said UWC has a big role to play in the healthcare system of South Africa. 

“This University has fought and won for the past 60 years. You have been preparing for the role of the era: to be the incubator that shapes Policy and Governance and equips staff in the Department of Health, indeed across the departments and spheres of government, with competencies and attributes that will change the healthcare environment,” he said.

“Now, this University finds itself at the belly of it all - the Western Cape. You have about 60% of the national burden right at your doorstep. For this Faculty, this is an opportunity to produce tangible results and set up the gold standard of governance to the world, particularly crisis management.”

One of the biggest concerns, Dr Mkhize revealed, was the reluctance to quarantine in a facility by people who did not have the means to isolate safely. The government was engaging civil society, religious organisations, past patients and NGOs to encourage social change.

“This is one of the challenges that the University can rise up to so we can get adequate compliance to do the things that break the cycle of transmission. This is our weakest point that we are seeing as we engage communities,” he said.

Another pertinent area Dr Mkhize mentioned was a digital race for the ultimate geo-spatial tracking and tracing service. 

“This means all centres of learning need to relook into their systems of learning and adapt. We need graduates that are outcomes-orientated and results-driven. In the future, the history of mankind may very well be defined by our pre- and post-COVID-19 terms. This is the institution that is up for the challenge,” he said.