South Africa's health system has to make a 180 degree turn, away from the dominant curative health system, which is unsustainable and unaffordable, to a health system in which prevention is the cornerstone. So says Health Minister Aaron Motsoaledi.

If this happens, the much-debated National Health Insurance (NHI) will become an affordable option and will see all South Africans having equitable access to excellent health services, where primary healthcare is the foundation. But to achieve this, prevention programmes need to be bumped up.

Motsoaledi was speaking in an interview with Health-e.

"What we are doing is not sustainable. For example the issue of antiretrovirals. We have to issue them, it's normal in every health system to do that. It's also an issue of human rights. But at this rate it's not sustainable if we are going to increase the number of people who need ARVs.

"Common sense should tell us that we need to prevent and stop this disease from spreading" says Motsoaledi.

He is adamant that more resources will be going to immunisation campaigns, school health programmes, HIV prevention, TB case finding, infection control and primary healthcare.

He agrees that NHI is not affordable if based on the current public health system, which leans heavily towards curative services and an expensive private healthcare service. He says that South Africa took its eye off the ball after the first democratically-elected Health Minister Nkosazana Dlamini-Zuma established a primary healthcare system as a central part of the bigger system.

"Now it's gone and South Africa is running an extremely expensive curative healthcare system

"We know that the public health system is not working very well. I've been open about it.

"But the bottom line is that we have world famous hospitals like Chris Hani-Baragwanath hospital and world-class institutions like Charlotte Maxeke being skeletons of their former selves.

At the back of that people are looking at NHI and they believe it is a reflection of what will happen in the NHI.

"When last did you see a nurse in any school checking kids' teeth, eyesight, ears, tonsils, whether they have been immunised, nutritional status?" he asks.

"They must get sick first and go to hospital and then we calculate what it will cost the NHI. That's what everybody is focusing on.

"I want to change that mentality dramatically. Not only the mentality, but the practice, it has to change dramatically," the minister says.

He says not a week passes without his signing an approval for a SADC patient to access the healthcare system for a kidney transplant, cardiac surgery, ophthalmic surgery or cleft palate surgery.

"We are regarded as a superpower in health on the continent. Yet most of the countries that turn to us for hi-tech healthcare have low infant and maternal mortality rates. South Africa is one of ten countries in the world, that over the past decade dismally failed to bring down infant mortality.

"The others are Bangladesh, Pakistan, countries at war. Which war are we fighting?" asks Motsoaledi

"How do we successfully do all this high powered medical procedures for the rest of the sub-continent, but fail to bring down the rate of death of mothers and children?

"These things can be changed. It's clear that there is something wrong somewhere and when you check budgets there is no country in the whole of Africa, none which has got a budget that we have in health.

""These are very poor countries which depend on us for high powered medical procedures, but they are able to save their mothers and children. So there is something we are doing wrong, , grossly wrong, that South Africans don't want to face.

Motsoaledi is adamant that it can no longer continue and he is set on overhauling the whole system and redirecting it to primary healthcare.

"South Africa knows that promotion and prevention is always better that cure - we can only go to cure as the last resort, not the other way round as the whole South Africa seems to be thinking."

The minister will later this year undertake a study tour to Brazil where he is interested in learning how the country has implemented an NHI which in turn brought down infant mortality rate.

"They established 30000 primary healthcare teams and that have brought infant mortality down. Our infant mortality is between 60 and 70 per thousand live births. In Brazil it is 19. They didn't bring the infant mortality down by instituting NHI.

They also put emphasis on primary healthcare in terms of prevention, promotion of nutrition, immunisation, school health programmes and all that."

He is also set on overhauling the management of the health system. He believes the health system is underfunded and mismanaged.

"We are not just going to say, today it's NHI. It's going to be a process that will take a long time." - Health-e News