Public health system ‘resilient’ despite challenges: Minister Phaahla

Even with limited resources, Health Minister Dr Joe Phaahla, believes that many public health facilities could perform better if it were not for inefficiency, poor management, neglect of duty due to poor supervision and outright corruption.

The Minister acknowledged that the public health system faces several challenges, including a high burden of disease leading to huge service demands while resources are continuously reducing because of poor economic performance.

However, despite these serious weaknesses the system has proven to be “resilient” even under the most testing pressure of the COVID-19 pandemic.

“While there were days especially at the peak of [COVID-19] wave when both the public and private hospitals ran out of high care and ICU beds, the system did not collapse,” Phaahla said.

The Minister was speaking at the second Presidential Health Summit at the Birchwood Hotel in Boksburg – a platform to review the implementation of the interventions agreed to during the 2018 summit and assess the performance of the health system against the Health Compact.

The summit aims to assess the readiness of the health system to implement National Health Insurance (NHI).

Phaahla told delegates that millions of South Africans still receive “acceptable” service at many public health facilities despite the public sector having to contend with many hurdles.

He highlighted pockets of excellence at many facilities from primary health up to specialised services.

For instance, he said, the Prince Mshiyeni Memorial Hospital in Durban delivers about 1 000 babies a month, while a private hospital in the same area delivers about 60 to 80 babies a month with a 70% caesarean section.

The Chris Hani Baragwanath Hospital in Johannesburg records between 1 500 and 1 800 births monthly.

“This just goes on to show the difference in pressure of service between public and private hospitals.”

He cited the Council for Medical Schemes annual report that shows that expenditure on private health excluding out-of-pocket expenditure is slightly higher than the total expenditure of the public health budget, but only services about 15% of the population.

In addition, he said, as unemployment grows more people are being pushed to depend exclusively on the public health system.

“Even those employed and on medical aids are suffocating under ever-increasing contributions.

“Anybody who denies the fact that the current path of our two-tier health system is not sustainable is a denialist… The need for reform of the current trajectory should not be a matter of debate even where we may differ on details but to those who say leave the private sector alone and just fix the public health, we say this is disingenuous.”

The Minister said he was looking forward to interrogating progress reports and proposals on how to accelerate the further implementation of all pillars which will contribute positively to the implementation of Universal Health Coverage through the NHI.

The nine pillars include human resources; access to medicine, vaccines and health products; infrastructure; private sector engagement; quality healthcare; public sector financial management improvements; governance and leadership; community engagements; information systems and pandemic preparedness.

While the COVID-19 pandemic may have derailed the focus on the systematic implementation of the pillars, Phaahla said some gains have been made in the implementation of some of the priorities.

For instance, the issue of training nurses has been resolved with the South African Nursing Council (SANC) and training of medical specialists, although this is more complex.

Meanwhile, he said a number of cases were investigated by the Special Investigating Unit (SIU) leading to disciplinary processes after the management of personal protective equipment exposed serious weaknesses leading to reputational damage.

He also noted that the overall audit outcomes of the health sector showed a slight improvement in 2022/23 even though a lot still needs to be done to improve the quality of management, especially on health facilities.

“The nine focal topics of the summit which subsequently became the compact pillars were not thumb sucked by the organisers but rather are well researched key performance areas which are critical if we are to turn our health system around for the better.”

Phaahla also praised President Cyril Ramaphosa, who is expected to deliver a keynote address on the second day of the summit on Friday, for holding health as a high priority since he assumed office in 2018.

“The first Presidential Health Summit laid the foundation for the areas which the country needed to focus on if we were to get any closer to our dream of providing good quality health services to our people.” –

Source: South African Government News Agency