BASIC POINTS OF DEPARTURE

 

The NP’s basic point of departure is that individuals are primarily responsible for their own health, and that the State must create the right environment for this to take place.  The State should however accept responsibility for an individual’s health if such a person is not able to do it himself.

 

The NP is not in favour of the State having full control over health services, and is also against excessive and counterproductive regulation of the private sector’s involvement in health care.  Encouraging partnerships between the public and private sector with an empowering policy framework is a point of departure which stands more chance to succeed.

 

PRIMARY HEALTH AND HOSPITALS

 

The NP believes that a primary health system should form the basis of the state sector’s service delivery model.  However, the NP does not want a primary health system to be developed at the expense of secondary and tertiary systems.  As before, the secondary, and especially the tertiary hospitals, should be centres for excellent quality of service delivery and research.  The NP therefore supports a comprehensive programme for hospital maintenance and renovation.  The NP believes that quality facilities and service in the state health sector can never be compromised.

 

The situations in clinics and some state hospitals remain in great concern, and members of the public are often hesitant to use these facilities.  The NP wants Provincial Ministers for Health, who have the line function responsibility, to give the highest priority to the quality of health care that is provided at these state institutions.

 

The NP also pushes for the strengthening of complaint mechanisms with regard to such institutions, and demands that people who visit state institutions must be entitled to the complete and effective handling of their complaints about unacceptable treatment.

 

Acceptable service is a prerequisite for healthy health care and can be rightfully claimed.

 

HEALTH WORKERS

 

The effect of large-scale transformation and legislation n the health sector since 1994 is that working conditions of health workers, especially in the state sector, have deteriorated significantly.  This has caused large numbers of well-trained staff to resign or to leave the country.  The NP accepts that the working conditions of health workers must be significantly improved to retain staff.  Simultaneously an incentive system must be used to lure back and/or retain some of these people.

 

The training of enough well-equipped health workers in all the relevant professions remains an important social responsibility of the State, with the public health services as the primary platform for these activities.  Problems with sustainable funding for health worker training, inter alia due to two funding streams by the Department of Education and Health, should be addressed urgently.

 

NATIONAL HEALTH ACT

 

The NP accepts the principle that the regulation of health services through licensing or accreditation might become necessary.  We can however not support the principle of the so-called Certificate of Need as contained in the recently adopted National Health Act.  The Certificate of Need is based on badly defined principles, and could eventually lead to subjective / political decisions, which do not sufficiently respect the rights of the individual.

 

Government’s motivation for the Certificate of Need is the rectification of the unbalanced distribution of health services, especially with regard to the rural areas.  The NP is however of the opinion that it will not have the desired result, and would rather support an incentive system (as already announced).

 

We are currently at a critical point in South Africa’s health history.  The process must be managed compently in order to prevent the deterioration of the system.

 

PRIVATE MEDICAL PRACTITIONERS

 

The NP says that South Africa has the unique advantage of well-trained, competent and motivated doctors, a national asset that must be globally recognised, mobilised and appreciated.  Especially general practitioners, who have for many years formed the backbone of primary health care across the country, should always be seen and mobilised as part of the primary solution to South Africa’s health system.  Specific mechanisms and systems can be put in place to form a partnership between a countrywide network of doctors, and the State.  Thereby the State gets access to facilities and staff for which it does not have to incur a single expense, except for services rendered at a specific tariff.

 

The future of the private general practitioners of South Africa is uncertain, especially due to extremely limiting and one-sided legislation and regulation that are laid down by Government and medical aid funds – an increasing number of doctors must go overseas to survive.  This should not be happening in a country where 70% of our population is in urgent need of medical care.  Limiting doctors’ rights and ignoring free market principles will definitely not keep them here.  The State on the other hand does not have the facilities to handle the millions of patients on their own – therefore everyone will benefit from such a partnership.

 

The most important requirement is for Government to enter into talks with the right people, i.e. the general practitioners, and must treat them as equals.  Doctors will contribute more than their share and are, despite everything, still positive about he country, the ir patients and their calling.

 

MEDICAL INFLATION

 

It is a global phenomenon that “medical inflation” tends to be a few points higher than normal inflation.  The reasons are the rapid scientific and technological progress in health, and that it is human nature to demand the best possible treatment at all times.  In South Africa this “medical inflation” is further increased by uncertainty in the health sector caused by large-scale transformation, and far-reaching and often unnecessary controversial legislation and regulation.  The irony is that most of this legislation in fact aims at cost reduction and the fair distribution of services, but that it often does not have this effect.  A factor that can also not be ignored in the inflation process is HIV/AIDS.

 

HIV/AIDS

 

The issue of HIV/AIDS and the provision of first class health care is most probably one of the greatest challenges South Africa is facing.

 

A survey done by the Independent Bureau of Economic Research and the South African business Coalition in October and November 2003, found that HIV/AIDS now starts to impact negatively on the business world.  Out of the 1006 businesses that were investigated, 9% said that they are being badly affected, while 43% indicated that they will start to experience it in 2008.  South Africa has the highest number of people in the world who live with HIV/AIDS.  One out of every ten of approximately 48 million South Africans are HIV positive.

 

But the AIDS pandemic can be stopped.  We must inform and education our communities about the disease, and counseling must be freely available.  The provision of antiretroviral treatment to all HIV positive persons is critical.

 

The NP’s approach goes further than just the HIV/AIDS pandemic; it relates to the whole health system.  In a country where many children still die form cholera, and where TB is still often diagnosed, the issue of health and the provision of health services must be approached holistically.

 

Every South African deserves a fair share of world-class health care.

 

EUTHANASIA

 

The NP can under no circumstances support active euthanasia (i.e. where euthanasia is actively administered). Simultaneously, the concept of passive euthanasia (i.e. withholding treatment) can be supported in the following circumstances. Health workers must be protected in the process by legislation / regulation. Health workers prefer to refer to the process as the provision of palliative care (pain-reducing without removing the cause) and the regulation of artificial maintenance of life.

 

Legislation is needed to provide for the so-called living will. The NP endorses recommendations by the Law Commission on this subject that briefly entail the following. A health worker may prescribe enough medication to relieve a patient’s pain, even though it might shorten his / her life. A terminally ill patient may refuse treatment even though it might shorten his / her life. If the patient is unable to express him/herself, but there is a living will expressing such a wish, treatment could be ceased, even though it might shorten his / her life.

 

In the absence of a living will, a patient’s family may give permission to cease treatment even though it might shorten the patient’s life. Treatment may also be ceased if so ordered by a court.

 

SUMMARY

 

A healthy health care system for our country and its people is our right, and is something towards which the NP will continue to strive, in conjunction with the relevant professions and the community.

 

   

 

 

 
 

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