Sunday Times STLive By Chris Barron, 2012-03-25

So Many Questions 25 March


Health Minister Aaron Motsoaledi has announced the launch of a pilot project for South Africa's National Health Insurance scheme.

When can we throw away our private medical aid cards? That's still far off, a long way away. We are still in the preparation phase.

How long will it last? Five years. This is the phase where we improve infrastructure, the quality of healthcare, send specialist teams into the districts.

Five years for the pilot project? No, no, we're not going to spend five years just in the pilot areas, obviously. In the pilot areas, we would like to spend a year and then see. If it works well, we will extend it to other districts so that, over the next five years, we cover all the districts in the country.

And if it doesn't work so well? Then it will show there is a particular problem with a particular plan. Then it will be foolhardy to rush it to other districts. When we realise that we have a plan that is working well, then we can start extending it.

So how are you going to get things up to standard? We have done an audit of all health facilities in South Africa. There are 4200 health facilities. We have covered 3900. An audit of infrastructure, financial management, general management, cleanliness, attitude of staff, drug stock going out, infection control, long queues, safety and security of patients. And we know, for each of the institutions audited, what the state is in terms of these things. So the director-general will lead a team of about 20 experts to make a plan in each of these institutions to correct them. This will happen in every institution in SA, but we are starting in the pilot areas.

What has the audit told you? That things are not good at all in at least two main areas. The issues of staff cleanliness and attitude emerged as two of the biggest problems our healthcare institutions are facing.

How are you going to correct that? We have trained 40 teams already who are well skilled in helping hospitals to get these things right.

The same people tasked with getting these things right up to now? What do you mean?

Who are these experts? They're experts from various institutions of health, from NGOs, from the national Health Department, from our development partners.

Are you going to put new management teams in these selected hospitals and clinics? Do you mean are we going to put new managers in and expel those who are there?

How can you improve things using the same people? Each team will have experts in the areas that we have found to be weak. If it is a problem of cleanliness, they will make a plan that will guide them at that institution on how to make it clean. If the problem is a long queue, they will help the hospital to come up with a plan and say, if you follow this plan, you'll no longer have long queues. If the problem is running out of drugs, the management will be taught how to take their stock, how to run their dispensary, how to know beforehand that this stock is going to run out.

What about the nurses? We are refurbishing and improving nursing colleges. We are not very happy that the primary training platform for nurses was universities since 1994.

Where will the doctors come from? We have asked the medical schools to accept more students, and we're also going to increase the number of students who train in Cuba.

Do your cabinet colleagues share your confidence in the improvement of state hospitals? I'm sure they do.

So why is a private hospital for them and their families being built in Pretoria? There is no such thing. I read about it in newspapers, but there is no such thing. It was some officials in public works, and we have stopped them. We won't accept that. I won't allow it. That is madness, and we won't allow it.