Wednesday, 17 July 2024

The COVID-19 pandemic period marked a dark period in the global health sphere claiming millions of lives. In the South African context, the pandemic also exposed our country’s poor healthcare infrastructure and how this impairs the ability of our health systems to efficiently address health crises. The country’s underdeveloped and strained infrastructure was evident through measures which had to be undertaken to respond to the pandemic such as tents being set up to create more physical spaces to attend to patients. Furthermore, our health system had to expand its human resources and repurpose existing spaces to make temporary testing stations and different facilities being outsourced as quarantine sites.

Although the COVID-19 pandemic exacerbated existing fractures in our health infrastructure, prior to the pandemic, numerous interventions had already been undertaken to improve the quality of our health infrastructure. For instance, the ideal clinic’s framework was introduced in 2015 as a quality assessment initiative to measure the quality of health facilities. According to this framework, at the end of 2023, about 59% (2046 of 3471) of primary healthcare facilities had attained Ideal clinic status. Despite hurdles on the path to getting primary health care facilities to obtain ideal clinic status since inception, there has been an overall improvement from 2015 from 9% to 59% by March 2023. Gauteng province is reported to have improved from 24% of ideal clinics in 2015 to 97% of Ideal Clinics in 2023, KwaZulu-Natal province is also reported to have improved from 23% to 92% and Western Cape province improved from 16% to 82%. Ideal Clinic status strides are also being undertaken in other provinces where the Eastern Cape province for instance is reported to be at (25%), Limpopo province (23%) and Northern Cape province (17%).

In addition, the Ideal Hospital Framework was developed and commenced implementation in 2020, and is allocated at about, 11%, translating to about 25 district hospitals having been designated as ideal. Furthermore, the Department has rolled out the National Quality Improvement Plan to 70% of public health facilities; making 344 Quality Learning Centres, 2579 primary health care facilities 259 public hospitals, 118 private hospitals and 75 emergency medical services.

Therefore, the significant role of improving our health infrastructure for the successful implementation of the National Health Insurance and delivering effective health interventions to our people cannot be overemphasized. Through the continued phased implementation of the NHI, the budget vote will allow for the department to continue to invest in improving and expanding our systems infrastructure. Through the establishment of a robust and resilient healthcare system, our country will be better position to deal with health threats such as the COVID-19 pandemic. 

The COVID-19 pandemic in South Africa unfolded against the backdrop of longstanding epidemics such as HIV. This intersection was burdensome not only on the infrastructure and human capacity of our healthcare system but also for people with HIV who were 30–50% more likely to die from COVID-19 before the rollout of vaccines. Due to the escalated rate of COVID-19 infections and deaths, critical resources and structures established for HIV management had to be redirected to manage the pandemic such as testing services centres. The reallocation of resources resulted in difficulties for patients to obtain their medicines, and constrained access to testing facilities, access to condoms, contraceptives, Pre-Exposure Prophylaxis (PrEP), and Post-Exposure Prophylaxis (PEP), as well as people participating and benefiting from awareness programs and other preventative measures

The unintended consequences of the COVID-19 interventions on HIV include interrupted treatment which increases risks of drug resistance and transmission and heightened chances of HIV positive people contracting COVID-19 due to weakened immune systems and underlying medical issues. In addition, the effects of these disturbances also increased the likelihood of people dying from both HIV and COVID-19. Therefore, the convergence of these two health crises has demonstrated the need to reinforce the resourcing and capacitation of the health sector in order to develop an agile and robust system which can provide adequate health care, particularly for the poor and vulnerable.

Prior to the outbreak of the pandemic, South Africa was facing systematic and structural challenges, such as poor economic performance which deepened inequalities and threatened nation-building. The emergence of COVID-19 increased existing vulnerabilities and inequalities by exacerbating these fractures. The pandemic highlighted how having a strong infrastructure is instrumental in health preventative measures, in the testing and screening of people, thus leading to early diagnosis and treatments.

In addition, improving our systems infrastructure is instrumental for data collection. This enables us to better understand the health patterns, timeously intercepting outbreaks and minimizing the spread and impact. Furthermore, accurate and updated health information better informs the allocation of human and financial resources to effectively respond to crises, such as tracking for HIV and TB patients who need to be on treatment and those who may have fallen off. Thus, this encourages better monitoring capabilities.

In line with the priorities of the department, we support commitments aimed at improving the quality and standard of our health system. Specially, we are encouraged by commitments to

• Expanding the achievement of the ideal status of about 2650 public health care facilities and 25 District Hospitals. 
• Visiting 14 million households for health screening services, linking communities to facilities for appropriate care as well as tracing patients that are lost to care significantly contributing to gains in both TB and HIV treatment. 

Therefore, we are encouraged by commitments to make strides in improving the compliance, quality and efficiency of our healthcare system. Such interventions go a long way in boosting public confidence in our healthcare system and lay a solid foundation for the successful implementation of the National Health Insurance. We are also encouraged by the technological advancements which seek to make our system seamless and more patient centred. These collective efforts are at the core of ensuring that the South African health system is responsive, innovative and results driven.

We seek to build from the lessons of our health challenges and leverage on the extensive investments and progress made over the past 30 years to build a better system which embodies the principles enshrined in our Constitution and better aligns with the global community as declared by the World Health Organisation for all nations to strive towards the realisation of Universal Health Coverage.

Thank you.