Major shake-up for SA’s health system

26 July 2013

Health Minister Aaron Motsoaledi has announced a raft of major changes to South Africa’s health care system, starting in Gauteng province with the decentralisation of a number of functions from provincial health offices to the level of hospital CEOs and managers.

“A decision has been taken to implement a direct delivery system to certain categories of hospitals,” Motsoaledi said in Johannesburg on Thursday.

“It will start with central, tertiary, regional and specialised hospitals. This will ensure more efficient supply to these hospitals and free up the depot to deliver more effectively to district hospitals and primary health facilities.”

Hospitals in South Africa’s most populous province will, from Friday, be allowed to order medical products directly from pharmaceutical companies, in order to end the delays in hospitals and clinics getting their medical supplies.

A “rapid response team”, made up of clinical engineers, has also been set up to attend to the maintenance of hospital equipment on an urgent basis in “any province that experiences malfunction of equipment”, Motsoaledi said.

The team, which will be based at the Department of Health’s office in Pretoria, will be appointed on 1 August.

“It has become very common in our country that whenever NHI [National Health Insurance] is mentioned, critics will immediately point to the serious weaknesses in the public health care system,” Motsoaledi said. “They will point to the ineffectiveness of the health care system, the deteriorating quality of care, as well as constant stock-outs of essential drugs and other essential supplies.

“Quite often stories will emerge about non-functioning equipment, whereby patients are forced to wait for long times to the detriment of their health.”

He said the time for change in South Africa’s health system had come.

“The time has arrived that we should part with such a scenario and usher in a totally new era of development. We believe that this is an area where things must be done so well that the rest of the country must learn from.”

As part of the major shake-up, Motsoaledi announced that:

  • Hospital CEOs have been given a “contingency budget” for emergency procurement of non-negotiables on an urgent basis to do away with delays and “stock-outs” of essential items. They will also be given the power to buy equipment worth less than R500 000 on a quotation basis.
  • A health care “war room”, called the Cost Centre Management System, is being set up at the Department of Health’s office in Pretoria to monitor the availability of medicines and other essentials via other cost centres that will be based at regional and district hospitals.
  • Clinicians will be given decision-making powers on matters relating to their services, including monitoring the availability of non-negotiables, availability of equipment and consumables.
  • A committee made up of clinicians will meet monthly to assess the maintenance of essential equipment, compile a list of equipment that will be forwarded directly to suppliers to eliminate the middle man.

“A team of eight clinical engineers is being put together with a view to dispatching them to hospitals to do a rapid assessment of medical equipment and to establish which equipment should be repaired or replaced.”

Motsoaledi said that while these changes only affected Gauteng province, he would soon present the plan to the other provinces, and was confident that they would embrace and implement it.

He said, meanwhile, that a partnership with retail and community pharmacies and chain stores was being considered to allow stable patients with chronic illnesses, who did not need to see a doctor but had to collect their monthly medicine, could get their medicines at alternative points.

This, he said, would ease the pressure on an overstretched health system that already supplies millions of chronic medicines every month.