FROM THE EDITOR

Where to now?

On 22 May 2022, paediatric gastroenterologist Tim De Maayer wrote an open letter to the administrators of Rahima Moosa Mother and Child Hospital, published in Daily Maverick,^[1] detailing the appalling conditions under which he and the rest of the hospital's staff have to work. The conditions he outlines make for harrowing reading and are not unique to this institution. The letter was written from the heart. A conscientious and committed clinician, De Maayer had gone through all official channels - in vain.

On the evening of 9 June 2022, news broke that he had been suspended by the Gauteng Department of Health. As the news went viral, calls for De Maayer's reinstatement came from many quarters and Gauteng Premier David Makhura intervened, saying he was waiting for a report from the MEC. By the morning of 10 June 2022 the decision had been rescinded.

But now comes the news that De Maayer and some of his colleagues are subject to disciplinary action and that De Maayer may yet be suspended. This has understandably led to an outcry. In an open letter to health minister Joe Phaahla and Gauteng premier David Makhura, signed by 137 leading figures in the health sector, De Maayer's treatment is condemned.^[2,3]

The actions against De Maayer and the refusal of our health authorities to recognise the appalling state of our health services are a tipping point. That our health services have deteriorated to a point where they are no longer fit for purpose is irrefutable. Those at the frontline in our public health facilities across most of the country daily face conditions at least as bad as those outlined by De Maayer in his letter. The COVID-19 pandemic merely served to expose the huge inadequacies of the health system in South Africa (SA), both public and private. On Monday 20 June 2022, the Concentric Alliance and SECTION27 released a report based on a year of research.^[4] This report is pivotal and must be widely disseminated. It is not a report on the nuts and bolts of why our health services are failing. These are plain to see. The most important message is that health system reform efforts have stagnated, after a decade of discussion and debate. People are tired and distrustful. Motives are suspect. But, there is no doubt about the fact that the foundation of a health system should be right of access to healthcare services.

The open letter in Business Day^[3] points out that access to healthcare is a constitutional right and that the current state of our health services constitutes a 'gross violation of the rights of all who live in South Africa'. This is backed up by lawyer and ethicist David McQuoid-Mason,^[5] who points out that the officials who sought to discipline De Maayer were themselves guilty of violating the Constitution, the National Health Act and the Children's Act and should themselves be disciplined.

My reading of the current parliamentary debates around the introduction of the much-vaunted National Health Insurance Bill is that most discussion is around ideological issues, and that the ANC are essentially accusing those who are against the current framing of the Bill as being against universal access to healthcare. Nothing could be further from the truth. I doubt that there is a single healthcare professional in SA who is opposed to the principle of universal health coverage and access. What is urgently needed is a full and exhaustive independent and transparent investigation into the true state of our public health services. And this should be done before any attempt to introduce NHI. We cannot allow our health authorities to rest on their laurels and point to theoretical universal access to a failing health system as the answer to these issues.

Bridget Farham

Editor

ugqirha@iafrica.com

References

1. De Maayer T. A wake up call for Health Department heads: Children are dying because of horrendous state of our public hospitals. Daily Maverick, 22 May 2022. https://www.dailymaverick.co.za/article/2022-05-22-a-wake-up-call-for-health-department-heads-children-are-dying-because-of-horrendous-state-of-our-public-hospitals/ (accessed 22 June 2022).         [ Links ]

2. Kahn T. Top health figures want probe into targeting of whistle-blower doctor. Business Day, 22 June 2022. https://www.businesslive.co.za/bd/national/health/2022-06-22-top-health-figures-want-probe-into-targeting-of-whistle-blower-doctor/ (accessed 22 June 2022).         [ Links ]

3. Mathivha LR, Dasoo A, Lasersohn L, et al. Open letter: Halt victimisation of public healthcare whistle-blowers. Business Day, 22 June 2022. https://www.businesslive.co.za/bd/opinion/letters/2022-06-22-open-letter-halt-victimisation-of-public-healthcare-whistle-blowers/ (accessed 22 June 2022).         [ Links ]

4. Concentric Alliance and SECTION27. Health reform: Perspectives and proposals. November 2021. https://section27.org.za/wp-content/uploads/2021/11/S27-CA-healthsystemsreform2021-21.pdf (accessed 22 June 2022).         [ Links ]

5. McQuoid-Mason DJ. Is there a legal and ethical duty on public sector doctors whose complaints to hospital administrators have been ignored to inform the public about harm to child patients due to intentional maladministration, negligence or indifference at the local and provincial level? S Afr Med J 2022 (epub 21 July 2022). https://doi.org/10.7196/SAMJ.2022.v112i8.16707        [ Links ]