SAMA's new Chair, Dr Mvuyisi Mzukwa

A month after the resignation of Dr Angelique Coetzee as Chairperson of the South African Medical Association, her subsequent suspension as a member of the Board and the decision to bar her from speaking to the media, SAMA says it continuing with its main functions of delivering on the interests of doctors and patients. SAMA’s interim Chair, Dr Mvuyisi Mzukwa (pictured above), agreed to this interview with MedBrief Africa’s co-editor, Marietjie van den Berg, on condition that issues around the former chair would not be discussed – subject to SAMA discontinuing all media engagements on her resignation and the understanding that the Board’s view on the matter is already public knowledge. Before assuming the role as interim Chair, Dr Mzukwa was the Vice-chair of the Association. He is an experienced GP, practicing in Isipingo in KwaZulu-Natal.

 Q: You have taken over the helm at SAMA at a very turbulent time with the resignation of Dr Coetzee due to apparent internal issues in the leadership putting further stress on the Association. However, this is not new in SAMA. We saw it with the resignation of Dr Kgosi Letlape as chair in 2009 and the subsequent breakaway of the SAMA specialists to form the South African Private Practitioners Forum (SAPPF). We have heard from several SAMA members, particularly in private practice, that they are considering their resignation from the Association. How will you be addressing this to try and foster new unity in SAMA and prevent members from leaving?

 Answer: I’m glad you observe that I’m taking over at a very turbulent time, and that SAMA has been going through similar occurrences in the past and you made historic examples. As a new Chairperson, I will capacitate the board of directors by diversifying the skills and human factors such as race, gender, age, etc. This is as I believe that a diverse board will be able to lead a diverse society of doctors. So, all board resignations will be replaced by the appropriate expertise.

Q: In short what is your vision for SAMA as the representative body for doctors in the country?

Answer: I’d like to see a credible association that embraces science with authority and an association that is enabled and emboldened to deliver on the interests of doctors and patients.

Q: Doctors are dealing with many challenges. In private practice, doctors are trying to rebuild their practices after the financial ruin many of them experienced due to the pandemic. In the public sector, doctors are faced with numerous challenges including lack of equipment, staff shortages, lack of maintenance in state hospitals, corruption and for medical interns, lack of supervision and posts and non-payment…the list goes on and on. How will SAMA deal with these in the short term.

Answer: SAMA is seized with engagements with both the National Department of Health and Provincial departments on the issues you are raising. SAMA is also talking to funders on the need to have a viable private sector, where practitioners enjoy a conducive working environment, and are not unnecessarily harassed by funders which make it difficult to survive in private practice.

Q: The dysfunctional HPCSA is a huge problem and the possibility of creating an independent Medical and Dental Council has been discussed for many years. How does SAMA intend addressing the problems with the HPCSA, and is the creation of an independent council still a discussion point?

Answer: The unbundling of HPCSA is very imminent. There is much mobilisation of various associations and trade unions which are deliberating on the issue. We are no longer talking ‘if,’ but talking when this will take effect. The strength of this unity has been tested when these various formations spoke with a unified voice against HPCSA fees and the outcomes thereof.

Q: The HPCSA’s fee hike has caused a huge outcry. SAMA in collaboration with various other medical associations and societies are now approaching the Minister of Health to discuss this. Have you had any feedback from the minister yet and what will be SAMA’s next step should the minister fail to intervene?

A: Reliable sources have informed us that the Minister of Health has intervened and gave instructions to the HPCSA to abide by the instruction. We are going to allow that process to take its course and intervene appropriately. We are very resolute that we are not going to be bullied by the Council, but we are going to use our force and power to make sure that healthcare professionals including doctors are not victims of this inefficiency.

Q: Judgment has been reserved in Solidarity’s case to have the Certificate of Need (CoN) declared invalid and the relevant sections removed from the Health Act. SAMA has made a comprehensive submission on the CoN. Please elaborate what you would like to see as far as that is concerned, particularly in the light of South Africa’s unequal distribution of health resources. What could be another solution rather than introducing a mandatory CoN?

A: On the issue of the certificate of need, SAMA is very clear in its submissions. It cannot be that doctors and healthcare workers must take the blame for the failure of government to develop rural areas where there are poor schools, management, poor sanitation, no running water, no basic amenities that would make a healthcare worker survive in that environment. We stand resolute that we cannot allow healthcare workers to be mopping up after the government’s failures.

Q: Twelve years after the court declared the 2007 RPL illegal, the fight is ongoing as many medical schemes still revert to the 2006 RPL to determine tariffs and codes (of which most are outdated). What is and will SAMA do to address this impasse?

A: This was brought to the attention of the previous minister and all we need to do now is to revive this matter making sure that health care workers are not at the back foot. SAMA will make sure that a new platform comes into existence.

Q: An obvious concern for doctors remains the implementation of the NHI. SAMA has taken a strong stand against the way government intends doing it. However, it doesn’t seem as if government is actually listening to healthcare providers’ opinions about NHI. As far as you are concerned, what could be done other than the NHI to create a Universal Healthcare System in South Africa given the inequalities.

A: The NHI is simply a funding mechanism. It does not address other issues which have emerged from the 2018 Presidential Summit on Health, hence, as SAMA, we say the way it is presented makes it hard for SAMA to support it. We need to make sure that the powers of the minister are curtailed and there is no room for corruption. This is a huge fund that is going to be given to bureaucrats who have shown that they are incapable of handling such funds as we have seen with the Covid-19 corruption. If the government does not listen, SAMA reserves the right to weigh in on its options.

Q: Escalating medico-legal claims against healthcare providers in both the public and private sector are having huge implications on the way doctors practice medicine and the specialties they choose. On top of that we are now dealing with the increasing criminalisation of cases against doctors. SAMA has been very outspoken about this but what is it actually doing to address the issue in a way that will be beneficial to both doctors and patients?

 Answer: SAMA Is very concerned about the skyrocketing medico-legal claims. There are ongoing engagements with the Law Reform Society of South Africa and other doctor groupings to make sure that we come up with sustainable solutions that are going to benefit the patients, doctors, society and government. So, all stakeholders assist with this discourse making sure that a viable solution is found.

Q: Interns are our future doctors and if they are not looked after properly, we are going to lose them. The battle to get them posts and paid and ensuring that they are properly supervised and trained when they are working has been raging for years. What is SAMA’s plan to ensure that it doesn’t happen again next year?

A: SAMA Is looking at many options. First being that we need to bring it to the attention of the Department of Health and, secondly, if the Department of Health is not taking the matter seriously, obviously, we may need to weigh in on our legal options. What has happened this year where interns were not paid appropriately and on time should never happen in a democratic country that purports to respect human rights. Interns have been humiliated by government and it should be ashamed of that inefficiency.