The sharing of hospital resources during the height of COVID and the collective effort on the planning and implementation of the entire vaccination programme are clear examples of people in South Africa beginning to realise that “your health is my health”.

“If every one of us isn’t healthy and our negative health is impacting on the person next to us, the whole of society loses and nobody scores,” Dr Nicholas Crisp, Acting D-G for Health, told SAMED conference delegates this week.

Participating in the “Unpacking the sustainability of National Health Insurance” session, Crisp reminded his audience that in South Africa procedures such as heart transplants and intrauterine implants on foetuses were taking place, but not 400km away there were people who had no access to basic healthcare needs such as immunisation and anti-natal care.

“Fact of the matter,” he continued, “we have a large part of population who, for example, will never get ARV treatment from anywhere if we don’t reorganise the way we deliver health care and the system itself.

“One might ask: why not fix one system at a time? If you want to fix the public health system you would have to triple the expenditure if you want to match the private sector. If you want to benchmark on the private sector you would have to spend a huge amount of money – 72% of birth deliveries are by caesarean section; remove tonsils from every single child that gets tonsillitis. You must in fact do a whole lot of things the private sector themselves acknowledge is bad medicine. So neither one has a solution.

“At the moment what we do is argue and fight with one another instead of sitting around the table and saying what the common ground is. Where’s the patient?”

Returning to the COVID experience, Crisp noted: “We have built amazing partnerships. There have been some banging of heads, but we have learned, for example, that we can share hospital resources – might not all be happy with the arrangement, but we can do it.

“We have had one information system that runs the entire vaccine programme for the whole country, with service delivery by private pharmacies, hospitals, and public sector mobiles where we cooperate and work together. I’m not saying it’s easy or that we did it all right, but we can do it!

“If we can do all these things together,” Crisp ventured, “imagine how powerful it would be if we could share hospital resources where public and private patients who really need healthcare can get it where they need to get it. But to do it we have to change the way we buy and pay for it and that’s what NHI is striving towards.

“It is not about ‘I want to compete with you”, it’s about what can we do as South African citizens to get better health care with the money we pour into this big hole at the moment and don’t get the desired outcomes.

“And this,” he concluded, “is why it is important for stakeholders to talk to each other, as we are doing in this forum, and to work together.”