The next three years will, without a
doubt, be among the most challenging for all the major players across the South
African healthcare landscape. Newly-elected SA Medical Association (SAMA)
chairperson, Dr Angelique Coetzee – Pretoria GP, long-serving executive of the
association’s North Gauteng branch, and board member since 2012 – is under no
illusions about this. But now after only two months in the chair she is already
clear about her priorities, as she told Med Brief Africa co-editor Roy Watson…
RW: The last weekend in October was quite
momentous for you, being elected to head up what is still by far and away the
country’s biggest and arguably most significant healthcare body. How did it all
AC: Still not quite sure…destiny perhaps!
When I heard that my name was nominated for the position of Chairperson of this
august organization, I got cold feet. I
then told everyone that I am not the person for that job for a number of
reasons which need explaining! That didn’t help and here I am, honoured to be
the latest SAMA Chair.
RW: Stock question: what is your vision
for SAMA under your watch?
AC: As I have heard and actually
remember, there was a time not that long ago that SAMA – and of course MASA
before it – was more powerful than even the Department of Health when it came
to the daily well-being and interests of the country’s doctors. We’re going to
go back to that TIME. We are going to try very, very hard to regain the power
that has been lost. SAMA has got to become the main player once again. That’s
my vision. There is no reason why this vision cannot be achieved.
RW: Many independent doctor groups have
sprung up over that past two decades, mainly in the private sector, which in a
sense could be deemed to have de-unified the profession. Would you not say that
SAMA, particularly in the light of a looming NHI and its unique almost 50/50
private/public representation, is best placed to remedy this?
AC: Yes. We would like to unite doctors
with SAMA being the flagship and regain that force again. And I agree SAMA
should have a pivotal role representing both our public and private doctors in
an NHI environment. No other body has that benefit ability. It won’t be an easy
one, marrying the two (public and private), but SAMA can and must do it on the
important understanding that each sector has to have its own space under NHI.
But we can marshal it…
RW: What used to be your Committee for Public
Sector Doctors (CPSD) is now the SAMA trade union, an aim being to give it a
more clearly defined role medico-politically. Is this happening?
AC: It is, but I feel we must brand the
SAMA advocacy for our public sector doctors. We are dealing with two different
environments, the public sector being largely governed by the Department of
Health and its many regulations. In the private sector, however, it’s all about
schemes and fees. In both sectors it’s not difficult to know where the problems
are. The challenge is how to get it right in each case.
RW: Wanting SAMA advocacy to become a
public sector brand. What about the private sector? Something similar?
AC: Sort of, but definitely working with
other groups by taking the initiatives on dealing with certain issues and
administering related projects under the SAMA banner when and where possible. Working
through our Private Practice Department under the leadership of Dr Vusumuzi
Nhlapho, we have concluded a Memorandum
of Agreement with a number of IPAs representing a significant number of General
Practitioners and a national footprint. The GP Unity Forum (GPUF) will jointly
address common issues facing general practice in a unified fashion. The GPUF
will be launched later this month when a major announcement will be made with
regard to collaborative initiatives that address GP issues.
RW: Can you at least give some idea of
the motivation behind this? Obviously to do with schemes and fees as you have
AC: Right. At issue has always been the
schemes drawing up contracts with the doctors. We, for example, want to change
this. As medical professionals, we must actually draft the contracts ourselves.
We need to say to the schemes: “We will do the managed care for you but we will
draw up the contract. This is our negotiation. No other way around – take it or
RW: Can’t close without some comment on
the Presidential Summit, on NHI and the way the proposed legislation is being
AC: As we speak we now have to wait to
see what was changed in the NHI after the reported interventions in the last
couple of weeks. There will however still be time for us to give input again. All
the Presidential Summit did was raise points everybody knew were the problems. So,
the way I see it is we first have to fix the system before we can start
thinking of NHI. Some people confuse the two as being parallel systems but
can’t go to B if A is not fixed. At the Summit SAMA and the health professional
sector in general was asked for input. What we can’t do is fix their problems. “Cannot
do this if that is not fixed in hospitals” is not our beef. Ours is to say “yes
we can do this” and give it to a task team. But this can only be achieved if
they bring their side to the party, i.e. fix the system.
RW: Care to volunteer any specific examples at
AC: A good one would be private doctors
being made available to work in the public sector to assist with, for example, surgical
backlogs. SAMA is currently working on a
plan that will allow GPs and Specialists to be insured while working in the
public sector. This would, in practical terms, enhance
private-public-partnership and contribute to addressing the current surgical
backlogs. If government can facilitate and allow doctors to work there all well
and good, but it can’t be “onus is on
you to get it right!”