The South African Committee of Medical Deans (SACoMD) has called on the government to take drastic steps to address the ongoing health crisis in the country.

In a statement‚ the committee said that despite multiple interventions on the part of the minister of health and the Department of Health‚ it was of the view that the health system in South Africa remained in crisis.

“The Cabinet’s recent decision to place the North West health department under administration of the national government in the wake of the health worker protests and the appointment of the Intervention Task Team in the Gauteng health department to advise on a turn-around strategy are indicative of a limping and indeed failing health system‚” the committee said. “The Deans are calling on government to take drastic steps to address the systemic failures in the provincial health departments as a matter of priority‚” it added.

The committee stated that an optimal health system in South Africa was a prerequisite for a well-functioning academic health complex to train and graduate quality health professionals at undergraduate and postgraduate level (including at specialist and sub-specialist levels).

The recent health workers strike in the North West province had brought into sharp focus the challenges facing the health system in South Africa‚ it said.

“The Deans are deeply concerned that industrial action by organised labour actively prevented the access to health care for the most vulnerable members of society and patients have died. These events follow several significant events in the national health system including the Life Esidimeni tragedy‚ the ongoing oncology service crisis and the ever increasing burden of diseases‚ which all demand some introspection amongst those managing health services. These do not support an environment for the eventual realisation of a health system based on the concept of Universal Health Coverage.”

The deans also expressed grave concerns about the future of academic medicine because of the chronic underfunding of health professional education and training‚ saying the absence of a national integrated and comprehensive health system plan‚ poor human resource planning‚ and poor governance and management of the health system continued to destabilise academic health services.

“The constant failure to adequately fund internship and community service placements for graduating health professional represents a serious human resources challenge as well as ethical disquiet. The Deans believe that the National Government has a duty to ensure that all South African students and those with permanent residence status should be placed in fully funded posts as this is a legal requirement for practice in the country.”

The committee was also deeply concerned that the additional training sites required to complete the training of the medical students from the Mandela-Castro Medical Collaboration Programme were still not fully prepared with only 60 days left before the first group of 720 students arrived back in South Africa from Cuba. The committee called on the national minister of health‚ in consultation with the national minister of higher education and training and the National Treasury‚ to urgently:

1. Ensure that all the training sites have been assessed and are ready to host the medical students returning from Cuba by 30 June 2018 (Mandela-Castro Medical Collaboration Programme);

2. Engage with organised labour to ensure that industrial action does not limit access to healthcare for patients (North West Province Strike);

3. Initiate a policy development process in conjunction with the universities that will result in the publication of the regulations governing Academic Health Complexes as provided for in the National Health Act of 2003‚ Chapter 7‚ section 51(a) and (b). The Deans believe that this process must resolve the issues related to policy‚ governance‚ organisation and management‚ and the financing of Academic Health Complexes;

4. Establish the National Tertiary Health Services Committee and National Governing Body for Human Resources for Health (incorporating Training and Development) by the end of July 2018. These National Health Insurance Implementation Structures will enable the health and higher education and training sector to jointly plan the short-‚ medium- and long-term future of health services and health professions education and training. The establishment of a joint workforce planning process will also ensure that funding can be made available for guaranteed allocation in Internship and Community Service posts.

5. Facilitate engagements with the Parliamentary Portfolio Committee on Health to host open and public hearings during June and July 2018 on the crises in provincial health departments. The outcome of these hearings should be addressed by Government and where necessary and appropriate‚ to use the constitutional provisions in Section 100 of the Constitution to address the systemic failures in service delivery in these departments.